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PubMed1993

Characterization of spinal somatosensory neurons having receptive fields in lumbar tissues of cats.

In pentobarbital anesthetized cats, extracellular unitary recordings were made from neurons in the extreme lateral dorsal horn of spinal segments L4-5. All 118 units reported had receptive fields in deep somatic tissues and/or skin of the lumbar region, hip and/or proximal leg. Neurons were functionally characterized according to their responses to non-noxious and noxious mechanical stimuli and to injections of algogens. Most neurons (92%) were either wide-dynamic range (WDR) or nociceptive specific (NS), and most of these had very large nociceptive receptive fields in the back/hip/leg that included both skin and deep somatic tissues innervated through both the dorsal (back/hip) and ventral (leg/ventral spine) rami. Most (72%) were 'hyperconvergent' in that they were responsive to stimulation of many different somatic tissues including skin, muscles, facet joint capsules, ligaments, and periosteum. Some units were tested and found also to be activated by noxious stimulation of spinal dura and ventral annulus fibrosis and ventral longitudinal ligament. Twelve of 22 neurons tested were found to have ascending axons extending beyond Th10. The nocireceptive neurons (NS and WDR) in the population tested are suitable for processing information about tissue damage in deep somatic tissues in the back, hip and proximal leg. The apparent relative paucity of such neurons and their very large hyperconvergent receptive fields suggest that sensations served by these neurons, such as low back and referred leg pain, would be neither well localized nor attributable to pathology in a specific tissue. These deductions, based on physiological characteristics in cats, are consistent with clinical reports from humans who experience pain as a consequence of spinal or paraspinal injuries.

Animals↗
PubMed1993

Children of chronic pain patients: risk factors for maladjustment.

Recent research has documented negative effects of chronic pain problems on patients' spouses and children. This study examined the adjustment of children of 35 chronic pain patients, compared with children of 29 healthy controls, and the relationship of specific parental characteristics to child adjustment. Pain group children had significantly more teacher-rated behavior problems and significantly lower teacher-rated social competence than did control group children. Children of male patients were rated by parents as significantly less socially competent than children of female patients. Compared with controls, pain patients and their spouses reported significantly more depression, and pain patients were significantly more disabled. Patient functional disability was significantly associated with parent-rated child behavior problems, but group membership, patient gender, patient depression, and patient marital satisfaction were not. Child social competence was predicted by patient gender, but was not predicted by patient depression or disability, group membership, or by patient marital satisfaction. The results suggest that children of chronic pain patients may be at risk for adjustment problems.

Adaptation, Psychological↗
PubMed1995

Cutaneous injection of the capsaicin analogue, NE-21610, produces analgesia to heat but not to mechanical stimuli in man.

Intradermal injection of the capsaicin analogue, NE-21610 (Procter and Gamble), inactivates nociceptors but not low-threshold mechanoreceptors in monkey. The present study examined the effects of cutaneous NE-21610 on heat and mechanical sensation in normal human volunteers. In the first series of experiments, subjects received intradermal (i.d.) injections (30 microliters) of the vehicle alone or with the drug (0.3, 3.0, 10 micrograms) into different sites on the volar forearm. Subjects were randomly assigned to 1 of 3 protocols to examine drug-evoked pain (n = 8), or alterations in pain to heat (n = 8) or mechanical (n = 8) stimuli induced by the drug. An additional 7 subjects rated pain to mechanical and heat stimuli before and after subcutaneous (s.c.) injections (300 microliters) of the vehicle or drug (100 micrograms). The peak pain occurred at the time of injection, was of short duration, and was similar for vehicle and drug injections. A mild, dose-related pain followed that lasted up to 2 h. Von Frey thresholds for detection, sharpness, and pain at the injection site (measured 24 h after injection) were not significantly altered by either i.d. or s.c. drug administration. However, pain to stepped heat stimuli was reduced in a dose-dependent fashion for both types of injection. At the highest drug doses, analgesia to heat stimuli was still present 1 week after injection. Recovery of heat sensitivity occurred several weeks after injection. This dissociated loss of heat but not mechanical pain sensibility may be due to: (1) a selective action of the drug on heat transducers in nociceptors responsive to both heat and mechanical stimuli, or (2) a selective action on that subset of nociceptors responsible for signaling heat-evoked pain.

Analgesia↗
PubMed2005

Quality of life following lower third molar removal.

The objective of this study was to evaluate the quality of life (QoL) and degree of satisfaction among adult outpatients after surgical extraction of a lower third molar under local anaesthesia, and to assess the impact of thorough explanation of the anticipated postoperative course on their pain and daily activities. Ninety-two patients filled a questionnaire assessing social isolation, working isolation, eating ability, speaking ability, sleep impairment, physical appearance, discomfort at suture removal and overall satisfaction on days 4 and 7 after surgery. A 100-mm visual analogue scale (VAS) of pain was scored by the patients every day after extraction until day 7. Before extraction, patients were randomly allocated to one of two groups: the test group received detailed verbal instructions from a surgeon about the postoperative course after extraction of the third molars, together with a written text containing postoperative instructions. One day after extraction, they were asked by telephone about their status. The control group only received the written text with postoperative instructions, with a few basic oral explanations. Ninety-one patients (53 of them female) completed the questionnaires. The decrease in pain was linear over time. Men referred significantly less pain than women, but there were no statistically significant differences between the test and control groups. The test group was characterized by a significantly greater inability to work. Lower third molar surgery significantly affects patient quality of life and environment, particularly during the first 3 days after extraction.

Adult↗
PubMed2004

Nattrassia mangiferae keratitis after laser in situ keratomileusis.

A 32-year-old man had photophobia and blurred vision 2 weeks after uneventful laser in situ keratomileusis to correct myopia. He was treated with steroids for suspected diffuse lamellar keratitis, antiherpetics, and antibiotic eyedrops, but the condition worsened and the patient developed further blurred vision, an inflamed eye, and pain. When referred to us, the patient had an extensive corneal ulcer with hypopyon and mycelia were reported in scrapings of the ulcer bed. Nattrassia mangiferae (Hendersonula toruloidea) was cultured from the specimen. The patient was treated with antifungal agents and 2 penetrating keratoplasties. At the last examination, the uncorrected visual acuity was 20/200.

Adult↗
PubMed2006

Chiropractic treatment of lower extremity conditions: a literature review.

OBJECTIVE: The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions. METHODS: A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non-peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale. RESULTS: There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale. CONCLUSIONS: Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.

Ankle↗
PubMed2004

Knee scores in a 'normal' elderly population.

Many scoring instruments are now available for assessment of outcome after knee replacement. We performed a community study to record the three most frequently used knee scores in the UK in a 'normal' elderly population with no history of knee, hip, spine or lower limb disorder. The Oxford Knee Score (OKS), Bristol Knee Score (BKS), and American Knee Society Score (AKSS) were recorded in 100 volunteers whose mean age was 72 years. Normalised median scores in this population were 97% (42-100), 96% (69-100) and 98% (46-100), respectively. Significant negative correlations were found to exist between knee score and increasing age (P<0.001) and presence of coexistent 'major' medical conditions (P<0.001). The 'function' component of each score was the aspect of the score most influenced by these demographic variables. Comparison of outcomes after knee replacement on the basis of knee scores should take account of demographic variables.

Aged↗
PubMed2006

The use of surface electromyography as a tool in differentiating temporomandibular disorders from neck disorders.

The aim of this study was to assess the electromyographic characteristics of the masticatory muscles (masseter and temporalis) of patients with either "temporomandibular joint disorder" or "neck pain". Surface electromyography of the right and left masseter and temporalis muscles was performed during maximum teeth clenching in 38 patients aged 21-67 years who had either (a) temporomandibular joint disorder (24 patients); (b) "neck pain" (13 patients). Ninety-five control, healthy subjects were also examined. During clenching, standardized total muscle activities (electromyographic potentials over time) were significantly different in the three groups: 75 microV/microVs% in the temporomandibular joint disorder patients, 124 microV/microVs% in the neck pain patients, and 95 microV/microVs% in the control subjects (analysis of variance, P<0.001). The temporomandibular joint disorder patients also had significantly (P<0.001) more asymmetric muscle potentials (78%) than either neck pain patients (87%) or control subjects (92%). A linear discriminant function analysis allowed a significant separation between the two patient groups, with a single patient error of 18.2%. Surface electromyographic analysis during clenching allowed to differentiate between patients with a temporomandibular joint disorder and patients with a neck pain problem.

Adult↗
PubMed2006

Somatosensory cortical plasticity in carpal tunnel syndrome--a cross-sectional fMRI evaluation.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve characterized by paresthesias and pain in the first, second, and third digits. We hypothesize that aberrant afferent input in CTS will lead to cortical plasticity. Functional MRI (fMRI) and neurophysiological testing were performed on CTS patients and healthy adults. Median nerve innervated digit 2 (D2), and digit 3 (D3) and ulnar nerve innervated digit 5 (D5) were stimulated during fMRI. Surface-based and ROI-based analyses consistently demonstrated more extensive and stronger contralateral sensorimotor cortical representations of D2 and D3 for CTS patients as compared to healthy adults (P < 0.05). Differences were less profound for D5. Moreover, D3 fMRI activation in both the contralateral SI and motor cortex correlated positively with the D3 sensory conduction latency. Analysis of somatotopy suggested that contralateral SI representations for D2 and D3 were less separated for CTS patients (3.8 +/- 1.0 mm) than for healthy adults (7.5 +/- 1.2 mm). Furthermore, the D3/D2 separation distance correlated negatively with D2 sensory conduction latency-the greater the latency, the closer the D2/D3 cortical representations (r = -0.79, P < 0.05). Coupled with a greater extent of SI representation for these CTS affected digits, the closer cortical representations can be interpreted as a blurred somatotopic arrangement for CTS affected digits. These findings provide further evidence that CTS is not manifest in the periphery alone. Our results are consistent with Hebbian plasticity mechanisms, as our cohort of CTS patients had predominant paresthesias, which produce more temporally coherent afferent signaling from affected digits.

Adult↗
PubMedDate not supplied

Flow-mediated vasodilation predicts the presence and extent of coronary artery disease assessed by stress thallium imaging.

BACKGROUND: Endothelial function can be measured by flow-mediated vasodilation (FMD) of the brachial artery and has been associated with cardiac risk factors (RF) and angiographically defined coronary artery disease (CAD). Stress single photon emission computed tomography (SPECT) imaging is commonly used to study patients with CAD. We sought to study the relationship between endothelial dysfunction by FMD and stress thallium SPECT to detect CAD. METHODS AND RESULTS: Fifty-five consecutive patients with chest pain syndrome referred for stress SPECT and eleven healthy control subjects had FMD measured on the brachial artery by standard techniques. The main outcome was the percent of brachial artery diameter dilation from baseline and the number of perfusion defects by SPECT. In subjects with no RF, those with RF but no defects, and those with defects, the mean FMD was 18.88% +/- 2.31%, 7.85% +/- 1.66%, and 5.91% +/- 1.07%, respectively (P < .05). A significant correlation was found between the number of thallium defects and degree of FMD impairment (r = -0.40, P < .01). An FMD cutoff value of less than 7.5% had a 72.5% sensitivity and 73.1% specificity in predicting the presence of any thallium defects. After RF adjustment, FMD remained as the strongest predictor of scintigraphic CAD (odds ratio, 10.96; 95% confidence interval, 2.82-57.31). CONCLUSION: FMD independently predicts the presence and extent of scintigraphic CAD.

Adult↗
PubMed2005

Social context and acceptance of chronic pain: the role of solicitous and punishing responses.

Much of the behavior of chronic pain sufferers happens in social contexts where social influences can play a role in their suffering and disability. Researchers have investigated relations of social responses with verbal and overt pain behavior and, more recently, with patient thinking, such as catastrophizing. There has not yet been a study of social influences on patient acceptance of chronic pain. The purpose of the present study was to investigate the relations between solicitous, punishing, and distracting responses, from significant others in the patient's life, with components of patient acceptance of pain. 228 consecutive patients referred to a multidisciplinary pain center provided data for this study including their responses to the Chronic Pain Acceptance Questionnaire and the Multidimensional Pain Inventory. Primary results showed that, as predicted, both solicitous and punishing responses from significant others were negatively associated with acceptance of pain. These relations remained, independent of patient age, education, pain level, and level of general support from the significant other. These results suggest that social influences can play a role in patients' engagement in activity with pain present and their willingness to have pain without trying to avoid or control it.

Adaptation, Psychological↗
PubMed2006

Influence of lower third molar position on the incidence of preoperative complications.

OBJECTIVE: The present study sought to relate the clinical outcome of mandibular third molar impaction surgery to the orthopanoramic radiographically determined position of the affected teeth based on the classifications of Pell and Gregory, and Winter. STUDY DESIGN: A retrospective study was made of 165 patients undergoing the surgical extraction of lower third molars at School of Dentistry of the University of Barcelona, Barcelona, Spain. The positions of the 259 extracted third molars were documented according to the classifications of Pell and Gregory, and Winter, together with the type of mucosal and bony coverage involved. These tooth position parameters were radiologically assessed using Radio Memory software and were retrospectively correlated to the observed infectious, noninfectious, and neurological postsurgical outcomes. RESULTS: A statistically significant relationship (P < .05) was recorded between the appearance of infectious complications and the position parameters "Pell and Gregory classification," "mucosal coverage," and "bony coverage." A statistically significant relationship (P < .05) was observed between the appearance of noninfectious problems and the parameter "Winter classification." Finally, a significant association (P < .05) was recorded between the position variables and the existence of unwanted neurological changes. CONCLUSIONS: The mandibular position of the impacted third molar may be able to be correlated to the development of complications resulting from impaction removal. Vertical third molars in positions IIA and IIB of the Pell and Gregory classification, with partial mucosal and bony coverage, are the most susceptible to undesired outcomes.

Adolescent↗
PubMed2002

A rapidly growing choroidal melanoma.

PURPOSE: We describe a rapidly growing choroidal melanoma that failed to respond to consecutive globe-sparing treatments in an individual with ocular melanocytosis. DESIGN: Interventional case report. METHODS: A 53-year-old man with right ocular melanocytosis, decreased vision in the right eye, and right eye pain was referred for suspected choroidal melanoma. The lesion, which measured 2.4 mm x 6.6 mm x 6.0 mm, was treated with transpupillary thermotherapy on two occasions and with iodine-125 (I-125) plaque brachytherapy, both of which failed. Enucleation allowed histologic analysis. RESULTS: At enucleation, the choroidal melanoma in the right eye measured 13.6 mm x 16.5 mm x 16.9 mm, which demonstrated the most rapid growth and doubling time reported in a tumor of this type thus far. Pathologic analysis classified the tumor as a mixed-cell type. CONCLUSION: This case reiterates the association between ocular melanocytosis and choroidal melanoma, provides additional evidence that rapid growth and doubling time may be associated with transpupillary thermotherapy and I-125 plaque failure, and highlights the need to follow those tumors closely.

Choroid Neoplasms↗
PubMed1998

Dose-related effects of oral acetaminophen on cold-induced pain: a double-blind, randomized, placebo-controlled trial.

The cold-pressor test is a widely used pain-induction model in humans. This method has been shown to be a sensitive measure for detecting opioid analgesia. However, nonsteroidal anti-inflammatory drugs have not produced consistent analgesic effects with use of this model. The analgesic effect of acetaminophen (INN, paracetamol) on cold pressor-induced pain has not been reported by other investigators. In this study, a double-blind, randomized, placebo-controlled design was used to evaluate the dose-related effects of oral acetaminophen on cold pressor-induced pain in 18 normal healthy human subjects. We observed dose-related analgesic activity of oral acetaminophen using the cold pressor-induced pain model in these subjects. There were statistically significant main effects of both dose and time (pain and bothersomeness ratings decreased with increasing drug dose and increased over time). In pairwise comparisons only the contrast between the highest dose of acetaminophen (1000 mg) and placebo reached statistical significance. Results from our study suggest that the cold-pressor method may have clinical value in evaluating nonopioid analgesic agents.

Acetaminophen↗
PubMed2003

Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial.

OBJECTIVE: We sought to determine whether a continuous regional infusion of a local anesthetic delivered to the operative site would result in decreased levels of postoperative pain and narcotic requirements for patients who undergo a standard median sternotomy for cardiac surgery. METHODS: A double-blind, randomized, controlled trial was conducted at a single center. Patients who were undergoing elective coronary artery bypass graft surgery alone or combined with laser transmyocardial revascularization received bilateral intercostal nerve blocks with either ropivacaine or saline. At wound closure, 2 catheters with multiple side openings were inserted percutaneously and placed directly over the sternum. The same agent (ropivacaine vs saline) was then administered as a continuous regional infusion for 48 hours through an elastomeric pump. Requirements for postoperative systemic narcotic analgesics and pain assessment scores were recorded for 72 hours after the operation. Secondary outcome measures were hospital length of stay and pulmonary function test results. Pain scores and narcotic use on the second postoperative day were also compared to avoid the confounding influence of anesthesia administered at the time of the operation. RESULTS: The total amount of narcotic analgesia required by the ropivacaine group was significantly less than that of the control group (47.3 vs 78.7 mg, respectively; P =.038). The ropivacaine group required less narcotics on postoperative day 2 as well (15.5 vs 29.4 mg, P =.025). The mean overall pain scores for the ropivacaine group were significantly less than the mean overall scores for the normal saline group (1.6 vs 2.6, respectively; P =.005). Patients receiving ropivacaine had a mean length of stay of 5.2 days compared with 8.2 days for patients in the normal saline group (P =.001). Excluding the data from outliers (length of stay = 39 days), the normal saline group mean length of stay was 6.3 days (P <.01). There was no difference in assessment of pulmonary function. CONCLUSION: Continuous delivery of local anesthetics significantly improved postoperative pain control while decreasing the amount of narcotic analgesia required in patients who underwent standard median sternotomy. There was also a significant decrease in hospital length of stay, which is likely to result in significant cost reductions.

Aged↗