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At least 1,135 records · Page 63Linked to original sources
PubMed2005

Low back pain comorbidity among male farmers and rural referents: a population-based study.

Farmers report more low back pain (LBP) than rural referents. We have previously demonstrated that the difference in reporting rate cannot be fully explained by known risk factors such as physical work exposures, psychosocial factors and lifestyle. Other etiological factors must be involved. In this cross-sectional population-based study, we investigate LBP comorbidity in terms of coexistent symptoms. A total of 1,013 male farmers, 40-60 years old, and 769 matched rural referents participated in an extensive health survey. Information on causes of primary health care and hospital admissions, symptoms, lifestyle factors, physical work exposures and psychosocial factors were gathered through standardized interviews and questionnaires. In the combined farmer-referent group, the prevalence of LBP was associated with musculoskeletal symptoms other than LBP, chest discomfort, dyspepsia, symptoms from eyes, nose and throat mucous membranes, skin problems, work-related fever attacks, and primary care appointments due to digestive disorders. The associations were independent of age, educational level, smoking habits, body mass index, physical work exposures and psychosocial factors. Presence of both respiratory and digestive disorders doubled the LBP prevalence. Significant associations between LBP and digestive and respiratory disorders were revealed, indicating that LBP and these disease entities may have etiological factors in common.

Agricultural Workers' Diseases↗
PubMed1998

Exercise testing in patients with chest pain to sumatriptan.

OBJECTIVES: In order to assess whether chest pain attributed to sumatriptan is associated with abnormalities on cardiac exercise testing, we performed a case-control study. SUBJECTS: Cases were selected as consumers of sumatriptan who reported sumatriptan associated chest pain. A reference group was selected randomly from consumers of sumatriptan with the same GP as the case, who reported no chest pain after use of sumatriptan. If possible, controls were matched for age (within 5-year groups) and gender. OUTCOMES: In a total of 74 cases and 55 controls symptom-limited exercise tests were performed. Besides a small difference in age, there were no differences in basic characteristics between cases and controls. Three cases had ST-depression on ECG during exercise. However, none of the variables measured during exercise testing differed significantly between cases and controls. CONCLUSIONS: The prevalence of abnormal exercise tests in patients with sumatriptan-induced chest pain is low, and not statistically different from patients without chest pain after intake of sumatriptan. Routine performance of exercise testing in patients with sumatriptan-associated chest pain is not recommended.

Adult↗
PubMed1998

Referral patterns of hip pain in patients undergoing total hip replacement.

This study was undertaken to determine the most common referral patterns of hip pain in patients scheduled to undergo primary and revision total hip replacement. The exact location of pain from the hip was recorded prospectively for 323 patients (358 hips) who had primary total hip replacement and for 94 patients who had revision of a loose total hip. Seventy-three percent of patients with primary hip disease had pain in the groin, and 27% had groin pain that referred to the knee. Eighty-nine percent of 57 patients who had femoral component loosening had thigh or knee pain, and all of the 34 patients who had a loose acetabular component with a well-fixed femoral implant had pain in the hip region without distal radiation of pain. These results indicate that in patients who have a painful total hip, thigh pain is highly suggestive of femoral component loosening and pain located around the hip region that does not radiate distally is associated with isolated acetabular component loosening.

Adult↗
PubMedDate not supplied

[Peptic disease: comparative study between children and adolescents]

OBJECTIVES: To make a comparative analysis of clinical and endoscopic data in peptic disease in a group of children (CR) and adolescents (AD).MATERIAL AND METHODS: 30 children and 76 adolescents with peptic disease were studied between August 1992 and November 1994. In all cases the diagnosis was confirmed by endoscopic and histologic examination. Clinical data referring abdominal pain (localization, degree of intensity, chronicity and related symptons) were compared in both groups. Statistical analysis was done by the Fisher Test (significance value p< 0.05).RESULTS: Findings referring to predominance in the female sex (66% in group CR versus 70% in group AD), duration of pain between 2 and 6 months (40% CR versus 38% AD), intensive degree of pain (70% CR versus 83% AD) and presence of vomiting and nausea (42% CR versus 55% AD) were similar in both groups. Epigastric pain was predominant in AD (87%) versus CR (63%) with significant difference p=0.012. The endoscopic findings were normal in 30% of CR and 14% AD (p=0.052). Light to moderate gastritis was significantly more common in AD (72%) than CR (37%) (p=0.01). In the CR group, there was mainly antral nodular gastritis while in AD the diffuse form was more frequent. Bulbar duodenitis was present in 10% CR and 12% AD, but it was more erosive and serious in children. Peptic ulceration was found in 16% of CR (2 gastritis and 3 duodenal) and 7% AD (1 gastric and 4 duodenal) (p=0.067). H. pylori colonization was more frequent in AD (52%) than in CR (36%) (p=0.195).CONCLUSIONS: 1) epigastric pain is the main symptom in both groups; 2) endoscopic findings may be normal especially in the childreńs group; 3) antral nodular gastritis is the predominant type in children while in adolescents it is diffuse gastritis; 4) H. pylori colonization is present in 1/3 of children and 1/2 of adolescents with peptic disease; 5) in both groups ulcers are more frequent in the duodenum.

Journal Article↗
PubMed2006

Pain attacks in non-complicated and complicated gallstone disease have a characteristic pattern and are accompanied by dyspepsia in most patients: the results of a prospective study.

OBJECTIVE: The cardinal indication for surgical treatment of gallstones is pain attacks. However, following cholecystectomy, 20% of patients remain symptomatic. It is unclear to what extent post-cholecystectomy symptoms can be ascribed to persistence of preoperative symptoms or to new pathology. The pain and digestive pattern in gallstone patients has not been defined in a recent setting with ultrasonography as the diagnostic method. The aim of this study was to characterize a pain pattern that is typical for gallstone disease and to describe the extent of associated dyspepsia. MATERIAL AND METHODS: A total of 220 patients with symptomatic gallstone disease including complicated disease (acute cholecystitis and common bile duct stones) were interviewed using detailed questionnaires to disclose pain patterns and symptoms of indigestion. RESULTS: All patients had pain in the right upper quadrant (RUQ) including the upper midline epigastrium. The pain was localized to the right subcostal area in 20% and to the upper epigastrium in 14%, and in the rest (66%) it was more evenly distributed. An area of maximal pain could be defined in 90%. Maximal pain was located under the costal arch in 51% of patients and in the epigastrium in 41%, but in 3% behind the sternum and in 5% in the back. The pain was referred to the back in 63% of the patients. The mean visual analogue scale (VAS) score was very high: 90 mm on a 0-100 scale. A pattern of incipient or low-grade warning pain with a subsequent relatively steady state until subsiding in the same fashion was present in 90% of the patients. An urge to walk around was experienced by 71%. Pain attacks usually occurred in the late evening or at night (77%), with 85% of the attacks lasting for more than one hour and almost never less than half an hour. Sixty-six percent of the patients were intolerant to at least one kind of food, but only 48% to fatty foods. Symptoms of functional indigestion (gastroesophageal reflux, dyspepsia or irritable bowel symptoms) were seen in the vast majority in association with attacks. CONCLUSIONS: Gallstone-associated pain follows a certain pattern in the majority of patients. The pain is located in a defined area with a point of maximum intensity, is usually referred, and occurs mainly at night with duration of more than one hour. The majority of patients experience functional indigestion, mainly of the reflux type or dyspepsia.

Acute Disease↗
PubMedDate not supplied

[Evaluation of the frequency of depression in patients with endometriosis and pelvic pain].

OBJECTIVE: Evaluate the frequency of depression in women with endometriosis and actual symptom of pelvic pain to determine the necessity of psychological support. METHODS: A total of 50 women aged 24 to 48 with endometriosis and referring pelvic pain. The prevalence of depression was evaluated by Beck's Depression Inventory adapted to the Brazilian population. RESULTS: It was found that 92% of the subjects presented depressive symptoms, being 56% from moderate to high levels. Although 66% of the women were using hormonal medication to treat endometriosis, there was no significant correlation between the presence of depression and the use of these medications. CONCLUSION: The results showed a high prevalence of depression symptoms in these patients confirming the necessity of psychological support.

Adult↗
PubMed2003

Children and adolescents with low back pain: a descriptive study of physical examination and outcome measurement.

STUDY DESIGN: A retrospective, cohort study of children and adolescents with low back pain (LBP) referred to physical therapy. OBJECTIVES: To describe the clinical presentation, examination findings, and classification of children and adolescent patients with LBP, and to explore the concurrent validity of the Oswestry questionnaire as a disability measure in this group. BACKGROUND: Little information is available regarding the clinical presentation, physical examination findings, and outcome assessment in children and adolescents with LOP. METHODS AND MEASURES: Charts were reviewed for historical, diagnostic, physical examination,and outcome information. Diagnoses given by the referring physicians were recorded. A treatment-based classification was made for each subject. Descriptive statistics were calculated for all variables. The validity of the Oswestry questionnaire was examined. RESULTS: The children and adolescents included in this study represented 5% (n = 25) of all cases of LOP referred to physical therapy. A greater percentage of patients had difficulty with extension than with flexion range of motion (ROM). Initial pain scores were lower if a specific pathology was present (P = .001). Initial pain and Oswestry scores were poorly correlated (r = 0.16). Forty-four percent (n = 11) of patients scored under the floor value of 12% on the Oswestry. CONCLUSION: The referral rate of children and adolescents with LBP seems to be low. Compared to adults, children and adolescents appear more likely to have a specific diagnosis given to them by their physician. The physical examination findings appear to indicate that spinal stabilization approaches may be beneficial for many patients. The Oswestry questionnaire may not be a valid tool for documenting changes in disability in these patients. Further research is needed on the conservative management of children and adolescents with LBP.

Adolescent↗
PubMedDate not supplied

Evaluation of reference sites for scalp potentials evoked by painful and non-painful sural nerve stimulation.

The objective of this study was to evaluate reference sites for recording the middle- and long-latency scalp potentials elicited by painful and non-painful sural nerve stimulation. Somatosensory evoked potentials (SEPs) were recorded from the scalp, the mastoid, the earlobe, the neck, and the wrist. Each site was referenced to the sterno-vertebral (SV) electrode, which is a balanced non-cephalic reference with essentially no ECG contamination. There was little or no activity recorded between the wrist and SV, and the SV was located within a region extending from the rostral neck to the wrist where the potentials were stable over space. Hence, the SV reference is indifferent for the middle- and long-latency potentials evoked by painful and non-painful sural nerve stimulation. There was, however, significant activity recorded from the earlobe and mastoid, sites which are frequently used as references for the SEP. It is important that investigators using these cephalic references to study the middle- and long-latency peaks of the SEP be aware of this activity as it will distort SEPs recorded from single sites and the SEP scalp topography, distortions which could unnecessarily complicate their interpretation.

Adolescent↗
PubMed2006

Unusual cause of painful shoulder in an elderly woman with rheumatoid arthritis.

The painful shoulder is a very common condition encountered in the rheumatology clinic with rotator cuff disorders, glenohumeral disorders, acromioclavicular joint disease and referred neck pain being the most common causes. Other rare causes have to be considered in the presence of "red flag" indicators. We describe a case of a patient with mild rheumatoid arthritis and a past medical history of stage 2C epithelial ovarian carcinoma who presented to the rheumatology clinic with a painful shoulder and who was initially diagnosed with rotator cuff tendinopathy. When seen 3 months later she was found to have a 15 x 10-cm firm, non-tender soft tissue mass over the right scapula and X-rays showed a large lytic mass destroying much of the upper border of the scapula, suggestive of metastasis. Bone metastases in patients with ovarian carcinoma are very rare; they occur in about 2% of cases and are invariably predictors of poor prognosis. To our knowledge, this is the first case of ovarian cancer metastasised to the scapula. We suggest that rheumatologists should be aware of the differential diagnosis of painful shoulder and look for "red flag" indicators in patients with known rheumatic conditions.

Aged, 80 and over↗
PubMed1987

Spontaneous splenic rupture in infectious mononucleosis.

Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis. Patients typically present with acute abdominal pain most marked in the left lower abdomen. Occasionally the pain is referred to the left shoulder and preceded by "flu-like" symptoms. Palor, orthostasis, and tachycardia can also be observed. Because abdominal pain and tachycardia are unusual in uncomplicated cases of infectious mononucleosis, the possibility of spontaneous splenic hematoma or rupture must be considered. The case presented here typifies the clinical manifestations of this entity and illustrates appropriate management.

Adult↗
PubMedDate not supplied

[The role of nursing in percutaneous cervical cordotomy in the control of oncologic pain].

Oncological pain is usually progressive and enabling. One third of the patients under treatment and two thirds of the patients with advanced cancer refer to pain. Generally treatment starts with non-opioids analgesic medicines and other drugs, passing to opioids with a progressive increase of the doses and neurosurgical procedures when recommended. Percutaneous cervical cordotomy is a neurosurgery procedure to treat unilateral cancer pain, especially in extremities, which gives immediate relief and low morbidity. The nursing professional plays an indispensable role in the effectiveness of this treatment. For this reason the author decide to report on this experience.

Cordotomy↗
PubMedDate not supplied

The segmental dorsal ramus neuropathy as a common cause of chronic and recurrent low back pain.

The causes of recurrent and chronic low back pain usually remain unknown. The dorsal ramus lesion was found in 57 of 200 low back pain patients in this study in L5 or L4 segment without any neurophysiologic or neuroradiologic evidence of proximal ventral root compression. The neuropathy of dorsal rami, especially in their medial branches seems to be surprisingly common finding associated with low back pain and referred symptoms.

Adolescent↗
PubMed2002

Psychological management of pain.

PURPOSE: In this article an overview is given on the attempts of understanding and treating chronic pain from the psychodynamic view and the perspective of behavioural medicine. ISSUE: Pain cannot be reliably measured. Assessment of pain depends on verbal description, nonverbal expressions, specific tests and our empathy. From this perspective pain is a matter of subjective experience and communication. Several phenomena (e.g. phantom limb pain, stress analgesia, the pain-relieving effects of relaxation, hypnosis, placebo, etc., pain in spite of a non-existing injury) obviously show that psychological factors like distraction, relaxation, fear, depression, former pain experiences as well as family and cultural influences modulate the way pain is experienced. Different parts of the CNS are involved in the modulation of pain-experience. Referring to cognitive and emotional processes, the importance of the the neocortex and and the limbic system are to be underlined. CONCLUSION: Chronic pain (as a category of ICD-10) presupposes a continuous, torturing pain, which sometimes even cannot be explained sufficiently by an organic damage. Psychosocial problems such as emotional conflicts, misleading thoughts, etc. are recognizable and can be brought into connection with the pain the patient experiences.

Acute Disease↗
PubMedDate not supplied

Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims.

OBJECTIVE: There has been little research examining chronic pain and posttraumatic stress symptoms in persons injured in motor vehicle accidents. The purpose of this study was to evaluate differences in physical injury and impairment, psychological distress, and pain coping strategies in litigating chronic pain patients low and high in motor vehicle accident-related posttraumatic stress symptoms. DESIGN: A total of 160 consecutive chronic pain patients referred for psychological-legal assessment underwent semistructured interview and testing. The testing battery included the Minnesota Multiphasic Personality Inventory-2, the Multidimensional Pain Inventory, the Sickness Impact Profile, and the Coping Strategies Questionnaire. Using the sample-specific median split of 18 posttraumatic stress symptoms on the Minnesota Multiphasic Personality Inventory-2 Posttraumatic Stress Disorder scale, chronic pain patients were categorized as evidencing low or high levels of posttraumatic stress symptoms. RESULTS: The findings indicate that participants evidencing high posttraumatic stress symptoms had more physical impairment, psychological distress, and maladaptive pain coping strategies and were more likely to be treated with antidepressants, other medications, and psychological management than participants evidencing low posttraumatic stress symptoms. A discriminant function analysis was performed using the full combination of physical injury and impairment, psychological distress, and pain coping variables in the prediction of posttraumatic stress symptom-defined group membership. The resulting discriminant function accounted for 61% of the between-group variance and correctly classified 92% of participants who were low in posttraumatic stress symptoms and 88% of participants who were high in posttraumatic stress symptoms. CONCLUSIONS: Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims are associated with increased physical and psychological morbidity.

Accidents, Traffic↗
PubMed2001

Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?

BACKGROUND: Spinal signs found in association with atypical chest and abdominal pain may suggest the pain is referred from the thoracic spine. However, the prevalence of such signs in these conditions has rarely been compared with that in those without pain. In this study, the prevalence of spinal signs and dysfunction in patients with back, chest and abdominal pain is compared with that in pain free controls. The aim of the study is to determine the significance of spinal findings in patients with such pain. METHODS: A general practitioner blinded to the patients' histories performed a cervical and thoracic spinal examination on general practice patients with back, chest and/or abdominal pain and on controls without pain. Thoracic intervertebral dysfunction was diagnosed on the basis of movement and palpation findings. RESULTS: Seventy-three study patients plus 24 controls, were examined. For cervical spinal signs, pain in the back, chest and/or abdomen was associated with pain with active movements and overpressure at end range and with loss of movement range. For thoracic spinal signs, this association held for pain with active movements and overpressure, but not with loss of movement range. The prevalence of thoracic intervertebral dysfunction was 25.0% in controls, 65.5% with chest/abdominal pain, 72.0% with back pain and 79.0% with back pain with chest/abdominal pain. This prevalence was higher with chest pain than with abdominal pain. CONCLUSIONS: The results show an association, but not a causal link between thoracic intervertebral dysfunction and atypical chest/abdominal pain. A spinal examination should be performed routinely assessing these conditions. The minimum examination for the detection of intervertebral dysfunction is testing for pain with spinal movements and palpation for tenderness. The interpretation of positive signs requires knowledge of their prevalence in pain free controls and in patients with visceral disease.

Abdominal Pain↗
PubMed1996

Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies.

The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture. This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.

Adult↗