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This case demonstrates that shoulder pain can be the sole manifestation of a benign gastric ulcer. Thus benign gastric ulcer should be considered in the differential diagnosis of a referred shoulder pain.
After images are based on physiological processes, they can also be treated as subjective phenomena with a psychological meaning. This statement also applies to pain. The basic working hypothesis of this study concerned the relationship between the two phenomena. Forty-one respondents (23 females, 18 males, age range 20-45 years) were given the Cold Pressor Test and the Serial After Image Technique. The data analysis was done by means of cross-tables and an exploratory optimal scaling program (OVERALS). Three pain tolerance groups (low, medium, high) could be differentiated fairly well on the basis of the after image characteristics of the respondents. Pain intolerant respondents more frequently had small and "immature" after images, whereas highly pain tolerant respondents had more large and "mature" after images. The implications of these results for a bio-psycho-social theoretical frame of reference for pain are discussed.
BACKGROUND: Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. METHODS: The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. RESULTS: Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was pre-ponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain. CONCLUSIONS: Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain. CLINICAL IMPLICATIONS: Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.
Chronic regional pain syndrome refers to a class of disorders thought to involve common neuropathic and clinical features. These disorders usually are caused by injury, and they manifest in pain and sensory changes that are disproportionate in intensity, distribution, and duration to the underlying pathology. The result of these injuries is significant impairment of motor function over time. This article is divided into two parts. Part I discusses background information such as pain, pathophysiology, diagnosis, clinical stages, and the most common treatment modality, sympathetic nerve blocks. Part II, discusses alternate treatment modalities, such as sympathectomy, physical therapy, stimulators, trigger point injections, acupuncture, tourniquet effects, placebo effects, and amputation.
As a student nurse in the middle '70s, I recall being struck by the unsophisticated and somewhat haphazard way pain relief following surgery was managed. I had been expecting to receive tuition in the clinical environment, as my classroom studies had not included any reference to pain or pain management. I was, like other staff on the ward, largely ignorant of pain physiology and pain psychology, and accustomed to making subjective judgement of other people's pain, based largely on my own misconceptions and inappropriate inherited attitudes. This, in turn, led to analgesia being offered in much the same way as a 'nice cup of tea', 'Something for your pain, dear?' Standard doses of analgesia were prescribed for the majority of patients via intramuscular or oral routes, and the actual dose administered was randomly selected by nursing staff and delivered at varying intervals. Thankfully, over the last few years, things have started to change.
Endometriosis remains a mystery because it has not yet been shown why these cells are viable in the abdominal cavity, although it has been thought that the immune system plays a role in implantation outside the intrauterine cavity by abasement in the regulatory capacity of natural killer cells, as well as peripheral and peritoneal immunologic cells. Among methods used to recognize this illness are laparoscopy, laparotomy, ultrasound, antibodies, and the histologic study. It has been observed that surgical scars can present cyclical inflammation and pain when affected with this pathology. We present the case of a patient with a second delivery who arrived at the Gynecology Service due to referring intense pain in the episiorrhaphy scar as well as superficial dyspareunia. One year after performance of the surgical procedure, pain did not allow the patient was unable to sit normally; in addition, during the last 3 months the area of the cicatrix augmented in volume during menstruation. Under peridural block and with surgical spindle excision, the abnormal tissue was dissected without complications; the surgery showed brittle tissue and with abundant new vascularity. The histologic diagnosis reported vulvar-tissue endometriosis. Was initiate complementary treatment was initiated with gestrinon once a week for 4 weeks, as well as danazol daily for 2 months to avoid possible persistence of endometrial tissue. The scar at present is minimal and is observed along the borders of the surgical union line, without an increase in size nor discomfort on digital pressure. We consider it necessary to assure cleaning of the episiotomy before initiating surgical suturing to diminish presence of endometriosis, despite the fact that incidence of this disturbance is low (0.03%). Advancement in knowledge of the physiopathology process will permit elimination of the remaining endometrial tissue with new therapeutic strategies, as well as clearing up the mechanism of ectopic implantation of endometrial cells.
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Results of total knee arthroplasty are uniformly good. There is, however, a certain subset of patients who, despite an excellent radiographic result, do not do well. From 1992 through 1994, 20 patients were referred for pain and disability after total knee arthroplasty with normal appearing office radiographs. Fluoroscopic radiographs were obtained after other causes of disability were excluded. In 14 of the 20 patients, the diagnosis of aseptic loosening was made with fluoroscopically guided radiographs. Each patient thought to have a loose component at fluoroscopy did, in fact, have a loose component at revision. Each patient improved after revision with an average increase in the Hospital for Special Surgery score of 26 points. Fluoroscopically guided radiographs can be helpful in evaluating the patient with a painful total knee arthroplasty and normal appearing office radiographs.
Hydatid cyst has been reported in various unusual anatomical sites. Primary limb and muscular hydatid cyst remains extremely rare. We report a case of hydatid cyst in the thigh presenting with referred hip pain 40 years after leaving an endemic region, and review the literature.
This article describes the diagnosis and treatment of a patient exhibiting nonodontogenic tooth pain. A 25-yr-old female patient presented to postgraduate endodontics, SUNY at Stony Brook, for evaluation and treatment of pain associated with the upper and lower left quadrants. After thorough intraoral and extraoral examinations, it was determined that the pain was referred to the dentition from a trigger point in the masseter muscle. An extraoral injection of 3% Carbocaine was administered into the trigger point, and the pain abated within 5 min. The patient has experienced no recurrence of this pain for 12 months. Consideration of nonodontogenic dental pain should be included in a differential diagnosis.
Osteoid osteoma, a benign osteoblastic tumour comprised of osteoid and atypical bone, is a well-known entity. However, clinical diagnosis may be delayed, especially when the pain is referred to a nearby joint. This paper reports a series of 11 cases occurring in physically active patients in whom the diagnosis was delayed because of pain referral to the knee. The mean duration from the onset of symptoms to diagnosis of osteoid osteoma was 20 months (range 3 to 48 months). Review of these 11 lesions indicates that they can be classified on the basis of their anatomical location: (a) distant to the knee; (b) periarticular; or (c) subarticular (intraarticular). It should be noted that initially only 5 of the 11 cases displayed characteristic x-ray findings; in the remaining 6 cases, diagnosis was dependent on positive 99mTc radionuclide bone scans, tomograms, and computerised tomography scans. Of the 9 patients who underwent surgical resection of their lesions, all had complete relief of symptoms and all continued to be asymptomatic at follow-up evaluations.
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The Authors refer about the pain syndrome of the hand. They describe a recent surgical technique, by the enervation. This surgical treatment gives in all patients a quickly recovery with remission of pain and with no compromise of superficial sensibility. We are sure in an increment of our positive casistic.
OBJECTIVE: The aims of this study were to (a) study the persistence of panic disorder (PD); (b) investigate the association between PD at baseline and outcome [chest pain, psychiatric morbidity, health care utilization, suicidal thoughts, work impairment and health-related quality of life (HRQOL)]; (c) study the course of pain, distress, symptom attribution and HRQOL; and (d) describe treatment and perceived treatment needs of patients with PD. METHOD: A 1-year follow-up study of 199 chest-pain patients referred to cardiac outpatient investigation was completed. Assessments included Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), Short-Form McGill Pain Questionnaire, Symptom Checklist-90-Revised, the Illness Attitude Scales, the 36-item Short-Form Health Survey and a chest-pain questionnaire. RESULTS: At follow-up, 57 of the 153 patients reassessed with the SCID suffered from PD. Forty-three of the 55 patients (78%) who were diagnosed with PD at baseline still suffered from PD at follow-up. PD at baseline was associated with pain persistence, psychiatric morbidity (current major depression, pain disorder and simple phobia), significantly higher scores on psychological distress, hypochondriasis, negative outcome expectation, lower scores on seven of the eight dimensions of HRQOL and more general practitioner consultations. Only 6% of the patients with PD used effective treatment, and 3% reported a treatment need at follow-up. CONCLUSION: Despite chronic distress and impairment, we found significant undertreatment of PD, which needs to be addressed in future studies.
Pain in osteoarthritis (OA) remains an intractable problem in a majority of patients, with many of the commonly prescribed analgesics providing insufficient relief and considerable side effects. However, the structural or mechanistic cause of OA pain is still unknown. Animal models to address this issue have only recently been established, with much of the research to date focused on tissue pathology rather than pain. We have previously compared the surgically induced partial medial meniscectomy and chemically induced intra-articular iodoacetate injection rat models of OA in the rat, with reference to pain behaviour. This demonstrated relevant tissue pathology in both models, but greater evidence of pain related behaviour in the iodoacetate induced model. Here we further investigate the iodoacetate model using Fast Blue backlabelling from the articular joint space to identify the cell bodies of primary sensory afferents from the knee at the L4 dorsal root ganglion. Expression of calcitonin gene-related peptide (CGRP) and the vanilloid receptor TRPV1 was quantified in these backlabelled cells and was enriched in the knee afferents in all animals studied, compared to the expression in neurons across the whole dorsal root ganglia (DRG). Analysis of the backlabelled population in the osteoarthritis model and controls showed an increase in both CGRP and TRPV1 expression in the iodoacetate model compared with control animals. Therefore, there is a potential role for CGRP and TRPV1 in the manifestation of pain behaviour accompanied by OA changes in the knee in the iodoacetate induced model.
Medial shin pain, often referred to as shin splints, is a common but difficult to diagnose entity in many athletes. Chronic deep posterior compartment syndrome as a cause of medial leg pain is still controversial. The problems of deep posterior compartment pressure measurement contribute to this controversy. These problems include safety of catheter insertion and the possibility that the patient has more than one deep posterior compartment. In this paper, we present a new technique for catheter placement in which continuous ultrasound guidance is used. This technique allows for the safe placement of the catheter into the deep posterior compartment and for documentation of catheter tip location.
Chest pain is a common complaint of athletes in all age groups. In athletes, chest pain is often attributed to "chest tightness," and treatment for bronchospasm is considered. However, the causes of the pain are wide and varied, and the pain is referable to the many organ systems that localize to the thorax. Therefore, when treatment with bronchodilators fails, it becomes important to consider other nonasthmatic causes of the pain. These causes can be organized by system and are explained in this article. Cardiac causes are the most feared and, fortunately, are very rare in the adolescent setting. With a thorough knowledge of etiologies of chest pain, the physician can often make a diagnosis with only a history and a physical exam.
Author points to principles upon which not only the control of pain but also of all other symptoms depends: an appreciation of symptoms as a psychosomatic phenomenon, an accurate diagnosis of the cause of the symptom and in reference to pain application of the World Health Organisation's Analgesic Ladder for Cancer Pain. He takes these principles for granted and elaborates on the use of drugs and to lesser extent, other techniques which are used in hospice practise. Morphine is metabolised into M6G i M3G, the first being significantly more potent an analgesic as morphine. Its late and prolonged presence is probably basic for continuous morphine application instead of "as required" way. Author is giving very precise recommendations for per os and parenteral dose titration, discussing the side-effects and data about the related drugs, the analgesia in neuropathic pain and the special techniques like radiation, nerve blocks and epidural analgesia. Speaking about the palliative home care problems the author explains the most important factors enabling a family to continue their care at home. The author keeps discussing the poor appetite, vomiting, dysphagia, constipation. Respiratory problems are elaborated with more details especially those in "death rattle", with the optimal drug option recommendation, and many technical details.