Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Referred Pain”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed1999

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims.

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.

Adult↗
PubMed2001

Recall bias, pain, depression and cost in back pain patients.

OBJECTIVES: To investigate the relationship between recall bias for pain stimuli in chronic low back pain patients and the cost of managing their back pain in primary care. DESIGN: A retrospective cross-sectional investigation. METHOD: A sample of 63 low back pain patients were interviewed in a primary care setting. Information was gathered on their pain intensity, disability ratings, depression, anxiety, and duration of pain. They were also presented with a surprise recall test for pain descriptors. The cost of each patient's treatment specifically for back pain in the previous 12 months was calculated. The relationship between the cost of back pain treatment and the scores from the interview were calculated first for total cost, and then for the breakdown of individual cost items. RESULTS: Results indicated that recall bias for pain stimuli were significantly related to total cost (R2 = 8%). A detailed analysis revealed that pain intensity was related to the number of appointments with the general practitioners; depression scores related to the number of appointments with the in-house osteopaths; and recall bias for pain stimuli related to referrals to external experts (out-patients). A minority of patients high on recall bias was found to account for a disproportionate amount of the cost. CONCLUSION: Although no causal path can be deduced from the findings, the study provides a novel approach to measuring psychological factors in back pain in reference to health care utilization. It is limited by its retrospective design, and should be followed by prospective studies to understand fully the relationship between cognitive bias and utilization of health services.

Adolescent↗
PubMed2001

Abdominal pain in patients with resectable pancreatic cancer with reference to clinicopathologic findings.

Abdominal and/or back pain is one of the most common symptoms in patients with pancreatic cancer. However, the cause of the pain and the clinicopathologic features of patients with pain have not been fully elucidated. We retrospectively determined the factors related to preoperative abdominal and/or back pain in 95 patients with resectable pancreatic cancer. Pancreatic tumor size, invasion of the intrapancreatic nerves, invasion of the anterior pancreatic capsule, and lymph node metastasis were determined to be variables related to the pain. Pancreatic tumor size, invasion of anterior pancreatic capsule, and lymph node metastasis were also variables significantly correlating to pain intensity. Survival also correlated with pain intensity: the median survival periods were 29 months in patients without pain, 19 months in those with mild pain, and 9 months in those with severe pain who required analgesics. Larger pancreatic tumors, invasion of the intrapancreatic nerves, and invasion of the anterior pancreatic capsule may cause abdominal and/or back pain in patients with resectable pancreatic cancer. This study also suggests clinical implications of the pain intensity as a prognostic factor in patients with resectable pancreatic cancer.

Abdominal Pain↗
PubMed2005

Association of adult celiac disease with surgical abdominal pain: a case-control study in patients referred to secondary care.

BACKGROUND: Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease. AIMS: We aimed to assess the association of celiac disease with surgical abdominal pain. PATIENTS AND METHODS: A case-control study was undertaken involving 300 consecutive new unselected patients presenting with acute abdominal pain (in a university hospital) and healthy controls (age and sex matched) without abdominal pain (n = 300). Initial investigations for celiac disease were immunoglobulins, IgA/IgG anti-gliadin (AGA), and endomysial antibodies (EMA). Any patient with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency was offered a small bowel biopsy to confirm the diagnosis. RESULTS: : There were 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease (6 EMA positive; 3 EMA negative). One antibody positive patient (EMA in isolation) declined duodenal biopsy and the remaining 23 had normal duodenal mucosa. Within the control group, there were 2 cases of celiac disease. Compared with matched controls the association of acute abdominal pain with celiac disease gave an odds ratio 4.6. (P = 0.068, 95% confidence interval, 1.11-19.05). When only considering NSAP the prevalence of celiac disease was highly significant at 10.5% (9 of 86, P = 0.006). Patients' symptoms improved on a gluten-free diet at 12- to 18-month follow-up. CONCLUSION: Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care. Targeting patients who have NSAP or celiac associated symptoms/diseases may improve the diagnostic yield.

Abdomen, Acute↗
PubMed2002

Hemicrania continua.

Unilateral throbbing headaches may present similar signs and symptoms as dental pathology and are a diagnostic challenge for dental practitioners. Cases may be seen with a primary complaint of unilateral pain or referred by medical colleagues for exclusion of dental causes. In the present article the authors add a new case of hemicrania continua (HC), which is one such unilateral headache, and review the previously published cases. HC is relatively easy to treat since it responds completely to treatment with indomethacin. However, as is presented in this case, HC may masquerade as dental pain. Cases secondary to trauma, systemic disease, and nervous system pathology have been described in the literature, and the clinician must exclude these possible causes. A thorough knowledge of this entity is therefore essential.

Adult↗
PubMed1980

Multivariate analysis of the MMPI profiles of patients with multiple pain complaints.

The MMPI profiles of 123 male and 221 female patients with multiple pain complaints referred for psychological evaluation over a three-year period were examined using a multivariate clustering technique. Replicable subgroups were found in the patient cohorts in both the male and female samples. Multiple discriminant analysis and analysis of variance showed that the subgroups differed significantly from one another and within subgroup variation was small relative to between subgroup variation. It is suggested that pain patients are characterized by a variety of personality styles; subgroup membership may be an indication of behavior and personality dynamics which may have implications for treatment selection. Inferences as to possible treatment responses based on subgroup membership are made.

Female↗
PubMed1991

Laser laparoscopic cholecystectomy in the ambulatory setting.

Gallbladder disease, with or without the formation of stones, can be treated in a number of ways. Conservative treatment of a low-fat diet may be difficult for the patient to maintain over a period of time, and may be ineffective in the long run. Chemodissolution of gallstones is a costly pharmacologic treatment that may require repeating within a 5-year period. Other forms of treatment include the still experimental shock wave lithotripsy to break up gallstones before chemodissolution therapy, or surgical removal of the gallbladder by traditional open laparotomy or by laparoscopic intervention. Laser laparoscopic cholecystectomy, a procedure suited to the ambulatory surgery setting, can be used for many individuals requiring cholecystectomy. It is less invasive than traditional surgery and results in a shorter hospital stay, less postoperative pain, and more rapid ambulation and recuperation. Most people can return to work in 3 days and can resume full physical activity after 1 week. Potential intraoperative complications include the puncture or rupture of a blood vessel or viscus with resulting hemorrhage or sepsis. Less serious complications in the postoperative time frame can include nausea and vomiting, minimal to moderate abdominal discomfort, and referred shoulder pain secondary to the pneumoperitoneum. A strong social support system is essential for the patient who is discharged to home within 4 to 23 hours after surgery.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

The long-term effects of spinal fusion on the sacroiliac joints and ilium.

Ninety-six patients who had lumbar disk excision and primary posterior fusion were studied 10 or more years after their operations. Thirty-seven per cent complained of persistent graft donor site pain. A comparison of fused patients with and without donor site pain and 36 patients who underwent simple disk excision, revealed no differences in the flexion-extension mobility of the sacroiliac joints, or degenerative changes in the sacroiliac joints. Ectopic bone formation at graft donor sites, and cluneal nerve neuromata did not influence the result. Patients with graft donor site pain had significantly greater complaints of persistent low back pain, postoperative leg pain, and lost more time from work. If the graft was taken from the same side as that of preoperative leg pain, persistent complaints were more common. It is concluded that the sacroiliac joints are not adversely affected by lumbar spine fusion, and that persistent donor site pain is more likely part of a total pain complex referred from the lumbar spine. The sacroiliac joints appear to be relatively noncontributory to problems following lumbar disk surgery.

Bone Transplantation↗
PubMedDate not supplied

Occult dysraphism in adulthood. A series of 24 cases.

The results of a retrospective study of 24 adult patients with occult dysraphism are described. There were 15 males and 9 females, with an average age of 31.1 years. Specific circumstances precipitated symptomatic onset in 67% of patients. Pain, often referred to the anorectal region, was the most common presenting symptom. Bladder and bowel dysfunction were also common findings. The most common tethering lesions were intradural lipoma and a short thickened filum terminale. Myelography revealed the diagnosis of tethered conus in most cases, but the addition of CT and MRI images provided valuable structural details. The surgical outcome was gratifying in relation to pain and sensory-motor deficits but disappointing in the resolution of sphincter disorders. Our conclusion is that symptoms and/or signs of TCS with onset in adult life are not invariably irreversible.

Adult↗
PubMed2001

Dyspepsia.

Dyspepsia refers to pain or discomfort centered in the upper abdomen. This symptom is remarkably common, with 1-year prevalence rates averaging 25% in the community. Symptoms suggestive of the irritable bowel syndrome and reflux disease frequently overlap but do not form part of the definition of dyspepsia. Electrical and other stimuli can cause similar or different symptoms in various patients, and even the site to which symptoms are referred varies considerably. Dyspeptic symptoms are therefore a relatively poor guide to the origin or nature of any "disturbances" in the gut. Identification of patients who require further investigation to rule out serious structural disease, such as peptic ulcer disease or cancer, is a key issue because unaided clinical diagnosis is unreliable. The use of an age threshold (typically 45 years) and the identification of alarm features, including weight loss, repeated vomiting, and signs of bleeding, seem to be valid on the basis of the limited evidence available. Dyspeptic symptoms fall into distinct subgroups resembling the perceived clinical entities of ulcer-like and dysmotility-like dyspepsia. Unfortunately, because of overlap with reflux symptoms and between the subgroups, the clinical significance of these groups remains highly questionable. A focus on symptom predominance may be more rewarding. Lack of validated outcome measures has hampered clinical studies and has led to the development of complex outcome measures that integrate and weigh different symptoms or other indirect indicators of outcome into a general score. Further testing and validation are in progress.

Dyspepsia↗
PubMedDate not supplied

[Spanish study of quality of life in migraine (I). Profile of the patient with migraine attending neurology clinics].

BACKGROUND: Migraine is the main reason for neurological consultation. OBJECTIVES: To analyse the profile of the patient with migraine attending the Neurological Services of our country. PATIENTS AND METHODS: Neurologists from 7 hospitals in different spanish regions interviewed 305 patients (at least 40 per hospital) who met migraine diagnostic criteria. They used an ad hoc questionnaire in which detailed demographic and migraine clinical data were included. Patients with transformed migraine or tension-type headache more than two days per week were excluded. RESULTS: The majority (82%), were women, with no other diseases, with an average social (88%) and cultural (41%) level. The mean age at consultation was 38 +/- 11 years, while the mean duration of migraine history was 18 +/- 13 years; 78% met criteria of migraine without aura, 15% of migraine with aura and the remaining (8%) both migraine with and without aura criteria. Main subjective precipitating factors were: stress (80%), foods (68%), drugs (34%), alcohol (20%) and menstruation (8%). Migraine pain was referred to as mild by 4% of cases, as moderate by 59% and as severe in the remaining 37%. The usual duration of migraine attacks ranged from 12 to 24 h in 35% of cases, from 24 to 48 h in 25%, from 4 to 12 h in 23% and was longer than 48 h in the remaining 17%. More than half (53%) had more than 3 attacks per month. The pain was unilateral in 70% of cases, and more than half had vomiting (57%) and sono and/or photophobia (97%). CONCLUSIONS: The typical profile of the migraine patient attending the Neurology Services in Spain is that of a woman aged from 20-50, with a long personal history of migraine, otherwise healthy and with an average socioeconomic and cultural level. Our data confirm that migraine attacks are incapacitating in a relevant number of these patients.

Adolescent↗
PubMed1990

[Tietze's syndrome].

The results of treatment of 14 patients (11 males and 3 females) with Tietze's syndrome are discussed. The patient's ages ranged from 22 to 56 years. Most of them were engaged in heavy physical work. The correct diagnosis was established before admission only in 9 patients. The complaints and clinical symptomatology were of the same type almost in all of the patients: pain and swelling in the region of the II-IV costal cartilages at the sternum or along the whole cartilaginous part of the ribs, in some cases pain was referred to the upper part of the shoulder girdle. Clinical and X-ray methods of examination failed to make recognition of the disease easier. The diagnosis was established on basis of scrupulous investigation of the complaints, the history of the disease, and the local clinical manifestations. Most patients were subjected to nonoperative treatment, 2 patients were treated by operation--resection of the hypertrophied cartilage. Local application of hydrocortisone and kenalog produced good results. Pain disappeared completely in 7, was relieved significantly in 5, and was not relieved at all in 2 patients.

Adult↗
PubMed1989

[Pharyngeal pain during lateral suboccipital puncture].

Oropharyngeal pain was referred by five fully conscious and collaborative patients during lateral suboccipital puncture (LSP) of the cisterna magna, performed for myelography and/or cerebrospinal fluid collection. The anastomotic connections between the lower cranial nerves, the sympathetic nerves and the upper cervical spinal nerves are reviewed, with emphasis on the relationship between the first cervical nerve (C1), the superior cervical ganglion of the sympathetic trunk, and the spinal accessory nerve (nerve XI), and their central connections. The authors conclude that pharyngeal pain during LSP is provoked by the stimulation of afferent visceral fibers of C1, or of the gray communicating branches of the superior cervical ganglion to C1.

Adult↗
PubMed2004

Systemic capsaicin for burning mouth syndrome: short-term results of a pilot study.

BACKGROUND: Burning mouth syndrome (BMS) is a major diagnostic and therapeutic problem. Systemic and topical treatments (capsaicin, lidocaine, anti-histamines, sucralfate and benzydiamine) have been tried, but they appear to be inadequate. Topical capsaicin is bitter, may cause burning and has low therapeutic efficacy. We hypothesized that systemic administration of capsaicin could reduce the limitations of topical administration and have better therapeutic efficacy; this hypothesis was tested in a controlled trial. METHODS: Systemic oral capsaicin 0.25% was used for patients with BMS, recruited in our single centre. After the diagnosis of BMS, patients were dentally and medically examined. They were alternatively assigned to treatment with capsaicin or to a shape/smell/taste/color matched placebo. The severity of symptoms was scored at trial entry and 30 days thereafter by investigators who were unaware of the assigned intervention. The visual analogical scale (VAS) measure was used to score the severity of pain, and results for the treated and untreated groups were compared by Fisher's exact test. Analysis was performed by intention-to-treat. Statistical significance was considered for values of P < 0.05. Data are expressed as mean +/- SD. RESULTS: Fifty patients were enrolled (25 assigned to systemic capsaicin and 25 to placebo). The VAS score was significantly lower in treated patients (5.84 +/- 1.17) as compared to the placebo-control group (6.24 +/- 0.96). The use of systemic capsaicin implied significant gastric toxicity (referred gastric pain) with eight cases (32%) documented in the treatment group as compared to zero cases (0%) in the placebo control group. CONCLUSION: Systemic capsaicin is therapeutically effective for the short-term treatment of BMS but major gastrointestinal side-effects may threaten its large-scale, long-term use. This preliminary study suggests that more, adequately powered, randomized controlled trials are necessary and worthy to come to a definitive assessment of this matter.

Administration, Oral↗
PubMed1985

Isotope bone scans in the assessment of children with hip pain or limp.

Bone scans from 43 children referred with hip pain of uncertain cause were reviewed. The bone scan was abnormal in 36 patients: normal in 7. In 12 the findings were diagnostic: osteomyelitis, osteoid osteoma, osteomyelitis with septic arthritis, Perthes' Disease and juvenile chronic arthritis. Twenty-four patients had abnormal scans including diffuse peri-articular increase and of these 18 had transient synovitis. Immobilisation and trauma accounted for the remainder. Isotope bone scans have been found to be a valuable investigation in children presenting with hip pain or limp, where the x-rays may appear normal or nondiagnostic.

Adolescent↗
PubMed1984

Pain relief from peripheral conditioning stimulation in patients with chronic facial pain.

In a prospective study, 50 consecutive patients, referred to a pain treatment unit for surgery to alleviate various forms of facial pain, were all given transcutaneous nerve stimulation (TNS) therapy and followed for 2 years. Of the 44 patients remaining at the 2-year follow-up review, 20 (45%) reported satisfactory analgesia from conventional or acupuncture-like TNS. The latter technique markedly improved the overall results. No serious side effects were seen. Atypical facial pain of known etiology responded best to treatment, but satisfactory relief was often produced with tic douloureux. Duration of the pain condition as well as sex of the patient were predictors of treatment results. It is concluded that TNS therapy represents a valid alternative to surgery when pharmacological therapy fails, especially in the elderly and in patients with atypical facial pain.

Adult↗
PubMed2001

[Solitary fibrous thoracic wall tumor. Progression with percutaneous radiotherapy].

HISTORY AND CLINICAL FINDINGS: A 81-year-old patient free of pain was referred to the university hospital for further evaluation and therapy of tumour masses in the right thorax. Clinical examination revealed dullness to percussion and reduced breathing in the right lower lung. INVESTIGATIONS: Computed tomography showed an enlarged solid tumour mass attached to the thoracic cavity and pleural effusion on the right side. Quantification of pulmonary perfusion presented significant defects in the right upper and middle lobe. DIAGNOSIS, TREATMENT AND COURSE: The pulmonary masses were biopsied under CT-guidance. Biopsy and immunohistochemical findings proved a malignant solitary fibrous tumour of the chest wall, a mesenchymal tumour of its own entity. Because of pain in the right arm and because of missing other reliable therapeutic options a palliative irradiation was performed. The tumour did increase in size due to radiotherapy and a severe right ventricular heart failure occurred. The patient died 5 months after diagnosis has been made. Autopsy revealed a transition of tumour cells to sarcomatic growth. CONCLUSION: In our case we conclude an accelerated progression of the solitary fibrous chest wall tumour in the course of irradiation. Whether the development of sarcomatic growth occurred as a result of radiotherapy remains speculative.

Aged↗
PubMed1975

Expanded role for the physical therapist. Screening musculoskeletal disorders.

The primary purpose of this study conducted at two army hospitals was to evaluate the feasibility of using the physical therapist as the primary 'screener' for patients presenting with a complaint of low back pain. The study was organized into two phases. A base line phase consisted of a data collection period under standard operating conditions. Patient waiting times, treatment times, and total care times were measured for patients presenting to various clinics with a complaint of low back pain. The same data were collected during a screeing phase in which all patients presenting with a complaint of low back pain were referred directly to the physical therapist for primary evaluation. An assessment of physical therapist and patient satisfaction and acceptance was made. The quality of care rendered in the screeing clinic was assessed through patient interviews, physician interviews, and record reviews. This concept and the quality of care rendered were found to be acceptable to the patient, the physician, and the physical therapist.

Back Pain↗