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[Neuralgiform paroxysmal migraine].

A 23-year-old woman presented with episodic, strictly unilateral, left-sided headaches of excruciating severity. Pain was referred to the eye, lasted from seconds to a minute and was accompanied by homolateral ptosis, redness of the eye, increased lacrimation and nasal discharge. The attacks of pain repeated up to seven times over 24 hours and clustered around ovulation for seven days a month. After she became pregnant, the attacks increased in frequency and appeared every five to ten minutes during night and day. Different medical treatments including indomethacin, were without effect. Two months later pregnancy was interrupted and the pain immediately subsided. After carotid angiography the pain reappeared for two months, but it finally disappeared and she has been free of pain without treatment for the last nine months. This syndrome can be related to episodic paroxysmal hemicrania.

Abortion, Induced↗

Masturbatory-orgasmic extracephalic pain.

Two single men, one with compressive spondylitic cervical myelopathy and another with tethered cord and intraspinal lipoma, experienced severe paroxysmal ice pick-like pains, solely referred to the neck in the first and to the groin and genitalia in the second, that were precipitated by masturbation and masturbatory orgasms. Continuous, but less intense, background pain was reported by both patients over the same anatomic areas. Neither had intracranial lesions, epilepsy, or suffered from migraine. Recently, extratrigeminal ice pick status was reported in this journal. These two unusual cases represent examples of extracephalic ice pick-like pain triggered by sexual activity, in the absence of orgasmic cephalgia.

Headache↗

Craniofacial postherpetic neuralgia managed by stereotactic spinal trigeminal nucleotomy.

Postherpetic craniofacial neuralgias are notoriously difficult to deal with. Nevertheless, stereotactic spinal trigeminal nucleotomy seems to be a rational approach, as both experimental and clinical data strongly suggest the relevance of nucleus caudalis for certain facial neurogenic pain phenomena. From a series of 136 consecutive nucleotomies, 80 were performed for deafferentation pain. The long-term results of 25 such cases, who underwent this procedure for postherpetic neuralgia, are reported. Their pain was referred to the Vth, to the VII, IX and Xth, and to the C2-3 dermatomes. Abolition of the allodynia, and disappearance of, or marked reduction in, the deep background pain was achieved in 76% of the cases overall. The follow-up period ranged from 1 to 13 years. There was no untoward side-effects. Technical and electrophysiological data germane to accurate target placement are discussed. Spinal trigeminal nucleotomy is then a specially suitable procedure for postherpetic craniofacial dysaesthesiae.

Follow-Up Studies↗

Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis.

The Brief Pain Inventory short form (BPI-sf) is a validated, widely used, self-administered questionnaire developed to assess the severity of pain and the impact of pain on daily functions. A modified version was used daily in randomised control trials of patients with arthritis undergoing treatment with cyclooxygenase-2 specific inhibitors and non-steroidal anti-inflammatory drugs. Results indicate that the modified BPI-sf, much like the original scale, was internally reliable, consistent over time, and had good construct, as well as convergent and predictive validity in assessment of patients suffering from conditions of chronic pain. Each scale and individual pain intensity item refers to changes in osteoarthritis pain associated with medication use. The modified BPI-sf, like the parent scale, is a valid and reliable tool for situations in which pain is assessed daily and minimises the burden placed on patients to record information necessary for scientific investigations.

Adult↗

Sociodemographic predictors of treatment outcome in chronic non-malignant pain patients. Do patients receiving or applying for disability pension benefit from multidisciplinary pain treatment?

The present study investigated the ability of sociodemographic variables to predict the short-term effect of multidisciplinary pain treatment in 286 chronic non-malignant pain patients consecutively referred to a Danish multidisciplinary pain centre. At inclusion and 3 and 6 months later the patients' pain and health related quality of life (HRQL) was assessed using self-administered questionnaires. Sociodemographic variables measured were: age, gender, educational level, civil status, employment status and disability pension (DP) status. Intensity of pain was measured using a VAS scale. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36) and the Psychological General Well-Being Scale (PGWB). Drop out was 30% after 6 months, leaving 170 patients for the study of treatment effects. Among the sociodemographic variables evaluated only retirement pension (RP) and DP-status seemed to be significant outcome predictors: six months after inclusion, patients on RP (patients >68 years, n = 40) reported larger pain reduction (30 mm on the VAS scale) than patients < or =68 years (8 mm on the VAS scale)(P = 0.001). Patients applying for DP-pension (n = 26) did not improve. Patients on DP (n = 54) and patients not receiving DP (n = 50) obtained moderate improvements, but the improvements were significantly larger than the improvements observed in the ApplyDP-group (P = 0.05). The same pattern was seen for changes in psychological well-being (PGWB) and social functioning (SF36-SFA). No improvements were obtained in SF36-Physical functioning scores. DP-status predicted improvement in pain and social functioning even when controlling for the effect of other demographic variables, pain intensity and HRQL at referral. The present study indicates that the multidimensional problems experienced by patients applying for DP are dominated by socioeconomic factors. Focus on solving these socioeconomic problems is important if chronic pain patients are to benefit from multidisciplinary pain treatment.

Adult↗

Chronic non-malignant pain patients and health economic consequences.

UNLABELLED: A prospective cohort study on chronic non-malignant pain patients was performed to describe health consequences and changes in use of health care resources and social transfers following multidisciplinary pain treatment. Patients, referred to a Danish Multidisciplinary Pain Center (MPC), were evaluated during four periods: six months prior to referral, waiting list period, intervention, nine months follow-up. OUTCOME MEASURES: pain intensity (VAS), The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), The Psychological General Well-Being Index (PGWB), The Hospital Anxiety and Depression Scale (HAD). Use of health care resources and social transfers were retrieved from public registers. Statistically significant improvements were obtained in pain intensity, SF-36 bodily pain, PGWB index and subscores vitality, and general health at discharge and follow-up. Intervention costs amounted to EUR 1102 (SD 721). Health care costs were not significantly reduced, but significant reductions in social transfers were seen.

Adult↗

Effects of artificial calculosis on rat ureter motility: peripheral contribution to the pain of ureteric colic.

The contribution of changes in ureter motility produced by a stone to the pain of ureteric calculosis is unclear. In this study we measured ureter motility as changes in intraureter pressure in anesthetized rats 1, 4, and 8 d ys after implantation of an artificial calculus (n = 33) and compared it with motility in normal (n = 8) and ligated (n = 4) ureters. Partial obstruction of the ureter by the stone produced a 478% increase in the amplitude of contractions, a 70% decrease in the rate of contractions, and a 66% decrease in the baseline pressure. The pressures reached during contractions were equivalent to those evoking nociceptive reactions in animals and humans. These changes persisted in rats that had spontaneously eliminated the stone. Complete obstruction of the ureter by the stone or by ligation abolished contractions. We conclude that the increased motility caused by a stone likely contributes to the development and maintenance of visceral pain and referred hyperalgesia in ureteric colic and to the persistence of referred hyperalgesia after elimination of the stone.

Animals↗

Incidence of myocardial infarction and death in relation to walking-induced calf pain and plasma levels of inflammation-sensitive proteins.

Walking-induced calf pain as well as levels of different inflammation-sensitive plasma proteins (ISPs) are related to cardiovascular disease (CVD). This prospective cohort study explored the relationship between ISPs and walking-related calf pain and the interrelationships between ISPs and calf pain in the prediction of death and incidence of coronary events (CE). In 5,725 apparently healthy men, 46 +/-3.0 years old, plasma concentrations of orosomucoid (alpha(1)-acid glycoprotein), alpha(1)-antitrypsin, haptoglobin, fibrinogen, and ceruloplasmin were measured. Walking-induced calf pain was assessed by questionnaire. Mortality and incidence of CE were monitored over a mean follow-up of 18 years in subjects defined by the presence of calf pain and ISP level (0 to 1 or 2 to 5 ISP(s) in the top quartile). The prevalence of calf pain (7.3%) was significantly related to age, lifestyle, and traditional risk factors of CVD and ISP levels. The risk factor-adjusted relative risks for CE, CVD- and all-cause mortality were 1.89 (CI: 1.27 to 2.82), 2.90 (CI: 1.82 to 4.62), and 2.67 (CI: 1.97 to 3.57), respectively, for men with calf pain and high ISP levels (reference: no calf pain and low ISP levels). The corresponding risk for those with calf pain and low ISP levels were 1.34 (CI: 0.91 to 1.97), 1.47 (CI: 0.90 to 2.41), and 1.31 (CI: 0.95 to 1.81), respectively. These results indicate, on the one hand, that walking-induced calf pain is associated with high ISP levels and, on the other, that the risk of CVD in men with calf pain is substantially higher in those with high ISP levels than in those with low levels.

Adult↗

Orofacial pain.

Orofacial pain is an area of considerable interest in aging. Orofacial nociceptive pain arises mainly from injury or disease afflicting the teeth or the supporting structures of the teeth (periodontium); however it may arise from other intraoral or nonintraoral structures. Because of the rich innervation of the orofacial complex, pain may be referred to remote sites. Neuropathic pains, such as trigeminal neuralgia and postherpetic neuralgia, result from nerve injury and are usually seen only in older adults. Establishment of the source and cause of the pain results in effective pain management.

Aged↗

[Pain in pulmonary neoplasms].

The authors review the cases of 81 patients complaining of pain due to lung cancer referred to a Pain Clinic. The cause and characteristics of pain together with treatments and results were assessed. The time elapsed from beginning of pain complaints to diagnosis, referral to the Pain Clinic and death was calculated. The data collected are discussed keeping in mind the aim of providing these patients a better quality of life.

Adult↗

Relief of non-metastatic shoulder pain with mediastinal radiotherapy in patients with lung cancer.

Three patients with lung cancer and shoulder pain for which no local cause could be found are described. All three benefited from a course of palliative radiotherapy to ipsilateral mediastinal disease remote from the site of the pain. It is suggested that the pain is referred from intrathoracic involvement of the phrenic nerve by cancer, and that palliative irradiation of the mediastinum should be considered if investigations fail to reveal a local cause for ipsilateral shoulder pain.

Adenocarcinoma↗

Scrotal pathology as the cause for hip pain. Diagnostic findings on bone scintigraphy.

Scrotal scintigraphy has become a relatively uncommon examination in many nuclear medicine departments. However, scrotal perfusion is visualized during three-phase bone imaging of the pelvis and hips. The authors present a compilation of three cases of hip pain secondary to unsuspected scrotal pathology documented on routine three-phase bone scintigraphy, discussing this topic for the first time in the literature. A short review of the pathophysiology of referred hip pain, differential diagnosis, and imaging alternatives emphasize the unique contribution of nuclear imaging.

Adolescent↗

Questionnaire for the identification of back pain for epidemiological purposes.

OBJECTIVES: To design a questionnaire for the identification and assessment of severity of back pain for epidemiological purposes, and gain preliminary experience of its use. METHODS: A group of specialists, experienced in the epidemiology and clinical assessment of back pain, designed the questionnaire, and tested it individually. It was also given cross sectionally by interview to a population of male coal mine workers. RESULTS: The questionnaire comprised a maximum of 12 questions on the presence, radiation, frequency, and severity of back pain with reference to difficulty with specific activities, interference with normal work, and absence from work. 471 coal miners answered the questionnaire (66% of those invited). 56% (265 men) of the responders reported pain or ache in the back during the previous 12 months, and the incidence of first ever attacks during the same period was reported to be 34%. 69% reported having had back pain at some time. The responses to the questionnaire were partially validated by comparison with certified sickness absence for two days or more attributed to back pain. In men who were symptomatic in the previous 12 months, for the question relating to absence from work because of back pain, the sensitivity was 82% and specificity was 84%. CONCLUSION: The questionnaire is easy to administer and generates clear cut data that could be useful for epidemiological or screening purposes. Preliminary, limited, studies of its validity are reasonably encouraging, although further validation is required. It is hoped that researchers will find the questionnaire useful, will extend its validation, and continue to develop it.

Adult↗

Late results of synovectomy in juvenile rheumatoid arthritis.

We reviewed the records of 251 patients whose cases were diagnosed between 1958 and 1978 at the Children's Hospital Medical Center Special Treatment Center for Juvenile Arthritis. We used a computerized system that included retrieval of data on range of motion, pain, joint swelling, functional capacity, and radiographic changes at each six-month visit over the years that the patient was followed. For the patients who were operated on, the radiographic information was evaluated preoperatively and at the last radiographic follow-up (average, six years after operation). The data bank contained postoperative radiographic information for thirty-two of the joints that had been operated on. We reviewed the late results of forty-one synovectomies in thirty children. The data included range of motion, swelling, and pain before operation, at one and two years after operation, and at an average of 7.1 years of follow-up. There were few if any benefits from the operation with reference to pain or improvement of range of motion, but it did seem to provide permanent relief of the joint swelling. Furthermore, radiographic deterioration seemed to continue in the joints that had been operated on if they already had radiographic changes at the time of operation (late synovectomy). In the joints without radiographic changes at the time of operation (early synovectomy), there seemed to be a continuation of deterioration in those affected by polyarticular disease, while the changes were less pronounced in those affected by pauciarticular disease. We undertook this study with a positive attitude toward synovectomy in the treatment of juvenile rheumatoid arthritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Influence of endometriosis on pain behaviors and muscle hyperalgesia induced by a ureteral calculosis in female rats.

Endometriosis and urinary calculosis can co-occur. Clinical studies have shown that both painful and non-painful endometriosis in women are associated with enhanced pain and referred muscle hyperalgesia from urinary calculosis, but the mechanisms underlying this phenomenon are still poorly understood. The aim of this study was to develop an animal model adequate to explore this viscero-visceral interaction in standardized conditions. Using a model of endometriosis previously developed to study reduced fertility and vaginal hyperalgesia, endometriosis (endo) or sham-endometriosis (sham-endo) was induced in rats by autotransplantation of small pieces of uterus (or, for sham-endo, fat) on cascade mesenteric arteries, ovary, and abdominal wall. After the endometrial, but not the fat autografts had produced fluid-filled cysts (3 weeks), urinary calculosis was induced by implanting an artificial stone into one ureter. Pain behaviors were monitored by continuous 24-h videotape recordings before and after stone implantation. Referred muscle hyperalgesia was assessed by measuring vocalization thresholds to electrical stimulation of the oblique musculature (L1 dermatome). The data were compared with previously reported data from rats that had received only the stone. Neither endo nor sham-endo alone induced pain behaviors. Following stone implantation, in endo rats compared to sham-endo and stone-only rats, pain behaviors specifically associated with urinary calculosis were significantly increased and new pain behaviors specifically associated with uterine pathology became evident. Muscle hyperalgesia was also significantly increased. To explore the relationship between the amount of endometriosis and that of ureteral pain behavior, two separate groups of endo rats were treated with either a standard non-steroidal anti-inflammatory drugs (ketoprofen) or placebo from the 12th to the 18th day after endometriosis induction. The stone was implanted on the 21st day. Ketoprofen treatment compared to placebo significantly reduced the size of the cysts and both ureteral and uterine pain behaviors post-stone implantation. The size of the cysts showed a significant linear correlation with the post-stone ureteral pain behaviors. In conclusion, endo increased pain crises and muscle hyperalgesia typically induced by a ureteral calculosis, and the ureteral calculosis revealed additional pain behaviors typically induced by uterine pathophysiology; and this enhancement was a function of the degree of endometriosis. This result closely reproduces the condition observed in humans and could be due to a phenomenon of 'viscero-visceral' hyperalgesia, in which increased input from the cyst implantation sites to common spinal cord segments (T10-L1) facilitates the central effect of input from the urinary tract.

Abdominal Muscles↗

The diagnostic dilemma created by osteoid osteoma that presents as knee pain.

PURPOSE: Osteoid osteoma is a rare benign bone lesion with a high incidence in adolescents and young people. The objective of our study was to illustrate the difficulties in diagnosis of osteoid osteoma in patients presenting with atypical knee pain. TYPE OF STUDY: Retrospective case series. METHODS: In 10 patients who presented to our department with atypical knee pain between 1984 and 1999, the diagnosis of an osteoid osteoma was delayed. Retrospective review of these 10 cases was performed using interviews and re-evaluation of medical histories, radiographs, computed tomography (CT) scans, isotope bone scan, and magnetic resonance imaging (MRI). RESULTS: Initial radiographs showed features of osteiod osteoma in only 2 cases. In addition, in 1 case, not only initial but also repeated radiographs of the knee joint were still normal 10 months after the delineation of the nidus using MRI. Four unnecessary arthroscopies were performed on 4 of the 10 patients and the final diagnosis was established using MRI, CT, and isotope bone scan. The mean time interval between arthroscopy and osteiod osteoma diagnosis was 11.5 months. CONCLUSIONS: Osteoid osteoma must be included in the differential diagnosis of persistent unexplained knee pain, especially when objective findings of the knee are vague. The presence of the lesion juxta-articular to the knee joint or in the midshaft or upper end of the femur may be referred as pain to a nearby joint. Plain radiographs have a low diagnostic value in the detection of the lesion whereas isotope bone scan and MRI are reliable imaging techniques. The evaluation of the ipsilateral hip joint should not be overlooked.

Adolescent↗