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Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction
Lee, Kang Hun; Lee, Sang Eun; Jung, Jae Wook
Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD. PMID:25589948
Intractable pain--the present position.
Lipton, S.
The broad changes that have occurred in the treatment of intractable pain are considered. There is a new understanding of the anatomy and physiology of pain pathways and pain appreciation. Thus gate control theory, the spinal laminae, and the descending inhibitory pain pathway through the raphe nuclei are discussed in relation to the recent discovery of the opioid (enkephalin) systems. Out of this arises the stimulation methods of pain relief--transcutaneous neural stimulation, periaqueductal stimulation, and acupuncture. These are valuable in patients with a normal expectation of life. For patients with a shortened expectation of life other methods, especially destructive ones, are valuable (though in all types of chronic pain drug therapy is still the most used method). Basic changes in techniques and the equipment used to bring this about are detailed broadly. In particular, the use of the image intensifier X-ray machine and the stimulation and destruction available from the modern lesion generator when used in combination provide accuracy and safety. Techniques and methods are constantly altering and examples of this are given. All this costs money in time, personnel, and equipment; the costings of the Liverpool Centre for Pain Relief are given. Finally, the Pain Relief Foundation is in being in Liverpool in the grounds of Walton Hospital. This has been made possible by a large 'seed' donation by the Wolfson Foundation. Images Fig. 1 Fig. 2 PMID:6894676
Imaging brain mechanisms in chronic visceral pain.
Mayer, Emeran A; Gupta, Arpana; Kilpatrick, Lisa A; Hong, Jui-Yang
Chronic visceral pain syndromes are important clinical problems with largely unmet medical needs. Based on the common overlap with other chronic disorders of visceral or somatic pain, mood and affect, and their responsiveness to centrally targeted treatments, an important role of central nervous system in their pathophysiology is likely. A growing number of brain imaging studies in irritable bowel syndrome, functional dyspepsia, and bladder pain syndrome/interstitial cystitis has identified abnormalities in evoked brain responses, resting state activity, and connectivity, as well as in gray and white matter properties. Structural and functional alterations in brain regions of the salience, emotional arousal, and sensorimotor networks, as well as in prefrontal regions, are the most consistently reported findings. Some of these changes show moderate correlations with behavioral and clinical measures. Most recently, data-driven machine-learning approaches to larger data sets have been able to classify visceral pain syndromes from healthy control subjects. Future studies need to identify the mechanisms underlying the altered brain signatures of chronic visceral pain and identify targets for therapeutic interventions. PMID:25789437
Drug Management of Visceral Pain: Concepts from Basic Research
Davis, Mellar P.
Visceral pain is experienced by 40% of the population, and 28% of cancer patients suffer from pain arising from intra- abdominal metastasis or from treatment. Neuroanatomy of visceral nociception and neurotransmitters, receptors, and ion channels that modulate visceral pain are qualitatively or quantitatively different from those that modulate somatic and neuropathic pain. Visceral pain should be recognized as distinct pain phenotype. TRPV1, Na 1.8, and ASIC3 ion channels and peripheral kappa opioid receptors are important mediators of visceral pain. Mu agonists, gabapentinoids, and GABAB agonists reduce pain by binding to central receptors and channels. Combinations of analgesics and adjuvants in animal models have supra-additive antinociception and should be considered in clinical trials. This paper will discuss the neuroanatomy, receptors, ion channels, and neurotransmitters important to visceral pain and provide a basic science rationale for analgesic trials and management. PMID:22619712
Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome
Kim, Jong-Hoon; Hong, Joo-Chul; Kim, Min-Su
Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES. PMID:20617098
Peripheral kappa-opioid agonists for visceral pain.
Rivi�re, Pierre J-M
Kappa (kappa)-opioid receptor agonists are particularly effective analgesics in experimental models of visceral pain. Their analgesic effects are mediated in the periphery. The molecular targets involved include peripherally located kappa-receptors and possibly, at least for some nonpeptidic kappa-agonists, additional nonopioid molecular targets such as sodium channels located on primary sensory afferents. Overall, these properties are expected to be of therapeutic interest in various visceral pain conditions, including abdominal surgery associated with postoperative pain and ileus, pancreatitis pain, dysmenorrhea, labor pain and functional disorders such as irritable bowel syndrome or dyspepsia. The first kappa-agonists to be developed were brain-penetrating organic small molecules. Their development was eventually discontinued due to central side effects such as sedation and dysphoria attributed to kappa-receptors located behind the blood-brain barrier. New drug discovery programs are now geared towards the design of peripherally-selective kappa-agonists. So far, most of the organic molecule-based peripheral kappa-agonists have achieved limited peripheral selectivity and a practically insufficient therapeutic window to justify full development. These compounds have been used in a small number of clinical pilot studies involving visceral pain. Although encouraging, the clinical data available so far with this class of compounds are too limited and fragmented to fully validate the therapeutic utility of kappa-agonists in visceral pain. Additional clinical studies with safer kappa-agonists (i.e. with higher peripheral selectivity) are still required. The most suitable tools to address this question in the future appear to be the newly discovered class of tetrapeptide-based kappa-agonists, which have shown unprecedented levels of peripheral selectivity. PMID:15051626
TRPV1 sensitization mediates postinflammatory visceral pain following acute colitis.
Lapointe, Tamia K; Basso, Lilian; Iftinca, Mircea C; Flynn, Robyn; Chapman, Kevin; Dietrich, Gilles; Vergnolle, Nathalie; Altier, Christophe
Quiescent phases of inflammatory bowel disease (IBD) are often accompanied by chronic abdominal pain. Although the transient receptor potential vanilloid 1 (TRPV1) ion channel has been postulated as an important mediator of visceral hypersensitivity, its functional role in postinflammatory pain remains elusive. This study aimed at establishing the role of TRPV1 in the peripheral sensitization underlying chronic visceral pain in the context of colitis. Wild-type and TRPV1-deficient mice were separated into three groups (control, acute colitis, and recovery), and experimental colitis was induced by oral administration of dextran sulfate sodium (DSS). Recovery mice showed increased chemically and mechanically evoked visceral hypersensitivity 5 wk post-DSS discontinuation, at which point inflammation had completely resolved. Significant changes in nonevoked pain-related behaviors could also be observed in these animals, indicative of persistent discomfort. These behavioral changes correlated with elevated colonic levels of substance P (SP) and TRPV1 in recovery mice, thus leading to the hypothesis that SP could sensitize TRPV1 function. In vitro experiments revealed that prolonged exposure to SP could indeed sensitize capsaicin-evoked currents in both cultured neurons and TRPV1-transfected human embryonic kidney (HEK) cells, a mechanism that involved TRPV1 ubiquitination and subsequent accumulation at the plasma membrane. Importantly, although TRPV1-deficient animals experienced similar disease severity and pain as wild-type mice in the acute phase of colitis, TRPV1 deletion prevented the development of postinflammatory visceral hypersensitivity and pain-associated behaviors. Collectively, our results suggest that chronic exposure of colon-innervating primary afferents to SP could sensitize TRPV1 and thus participate in the establishment of persistent abdominal pain following acute inflammation. PMID:26021808
Management of intractable pain in adiposis dolorosa with intravenous administration of lidocaine.
Iwane, T; Maruyama, M; Matsuki, M; Ito, Y; Shimoji, K
Intractable pain in a patient with adiposis dolorosa (Dercum's disease) was treated by IV administration of lidocaine (200 to 400 mg). Relief was maximum 20 minutes after the end of drug infusion and persisted for over 10 hours. Toxicity was minimal. Slow EEG waves which appeared during drug administration disappeared within 20 minutes. PMID:943987
[Indication and usage of opioids except morphine for chronic non-malignant intractable pain].
Saeki, Shigeru
Indication and usage of opioids except morphine for chronic non-malignant intractable pain were reviewed. In Japan, other than morphine, we can use only two opioids, codeine phosphate (codeine), and dihydrocodeine phosphate (dihydrocodeine) for non-malignant pain management according to medical insurance system. But in western countries sustained-release opioids such as MS contine, transdermal fentanyl, oxycontin were used for the management of non-malignant chronic pain. The WHO ladder for cancer management should also be used for the management of non-malignant pain. Initial dose of codeine is 60 mg x day(-1) and the dosage should be increased or decreased according to pain intensity, patients' general condition and age. In most cases pain is controlled at the dose of 80-310 mg x day(-1). If pain intensity does not decrease or change, codeine should be changed to morphine. In our clinic, starting dose of codeine was 40-480 mg x day(-1) (average dose: 107.8 mg x day(-1)), maximum dose was 60-1280 mg x day (average dose: 310 mg x day(-1)). Average period for administration of codeine was 294.4 days. Dihydrocodeine has twice analgesic efficacy compared to codeine. The initial dose is the same as codeine. We hope that sustained release opioids such as transdermal fentanyl, oxycontin, tramadol etc will be used in Japan for management of non-malignant chronic pain in the near future. PMID:19039961
Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care
Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; ?uczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; G?�wka, Franciszek
Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III �pain ladder� drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient�s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25�0.5%, 1�2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05�0.1%, 100 mL every 4.5�11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077�0.154 mg�kg?1) and bupivacaine in enema (1.820 mg�kg?1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng�mL?1 and 235.7 ng�mL?1, respectively. Bupivacaine elimination was slower after rectal than after intrathecal administration (t�= 5.50 versus 2.02 hours, respectively). Limitations This study reports two cases only, and there could be inter-patient variation. Conclusion Bupivacaine in boluses administered intrathecally (0.25%, 2 mL) provided effective, safe analgesia in advanced cancer patients. Bupivacaine enema (100 mg�100 mL?1) was shown to be a valuable option for control of end-of-life tenesmoid cancer pain. PMID:25336967
Visceral pain and public speaking stress: Neuroendocrine and immune cell responses in healthy subjects
A. Lucas; G. Holtmann; G. Gerken; A. Pietsch; U. Braun-Lang; K. Gilani; K. Strassburger; S. Gesing; O. E. Janssen; A. Kavelaars; C. J. Heijnen; M. Schedlowski; S. Elsenbruch
Whereas responses to psychological stressors are well-characterized, little is known regarding responses to painful visceral stimuli. We analyzed the emotional, cardiovascular, neuroendocrine, and cellular immune responses to painful rectal stimulation and psychological stress in healthy individuals. Eleven healthy subjects were studied in three conditions on separate days: painful rectal distension, public speaking stress, and rest. Blood was drawn for endocrinological
Evolving patterns of spinal cord stimulation in patients implanted for intractable low back and leg pain.
Sharan, Ashwini; Cameron, Tracy; Barolat, Giancarlo
The objective of this study was to examine the programming strategies used in patients with intractable low-back pain treated with epidural spinal cord stimulation (SCS) utilizing paddle electrodes and a radio frequency (RF) stimulator. Programming strategies were examined in a group of patients implanted with a 16-contact paddle electrode and a dual channel RF receiver to treat chronic low-back pain. Baseline data included previous surgical history information, leg and low back pain severity and characteristics, and routine demographic information. Outcome measurements included the visual analog scale (VAS) (1), patient pain relief rating scale, and programming parameters. Patients rated their pain relief on a 5-point scale where 4 = excellent, 3 = good, 2 = fair, 1 = poor and 0 = none. Success was determined to be a pain relief score of "fair" or above. Data were collected during patient visits or by mail, at approximately 6, 12, and 24 months, postoperatively. Immediate postop data were available in 16 patients, 6-month data in 21 patients, 1-year data in 20 patients, and 2-year data in 10 patients, and analyzed for the purposes of examining programming strategies. The most common location for the tip of the electrode (lead) was found to be in the middle of the 8th thoracic vertebrae (N = 26). At the immediate postop assessment, the majority of cathodes were activated in the upper half of T9. By the 6-month follow-up, the majority of cathodes had shifted to the bottom of T9 and top of T10. Overall 88% of cathode locations were changed at one or more study visits. At 2 years, 86% of the programs used four or more active contacts. At 6 months, 83% of the patients reported that the therapy was a success, at 1 year, success was 94%, and by 2 years, success was 75%. Both SCS and chronic pain are dynamic processes. Complex pain patterns, such as the ones of patients who have pain in the low back and in one or both lower extremities, require a high degree of flexibility in the implanted SCS system. The system must provide the capability to redirect the current electronically over at least two segments of the spinal canal, to electronically steer the current in a medio-lateral direction, and to activate multiple electrical contacts simultaneously. The willingness and ability to provide extensive reprogramming in the long term follow-up is also of the utmost importance. Pain and its treatment with SCS is a dynamic process. PMID:22150814
Exploring relationships for visceral and somatic pain with autonomic control and personality.
Paine, Peter; Kishor, Jessin; Worthen, Sian F; Gregory, Lloyd J; Aziz, Qasim
The autonomic nervous system (ANS) integrates afferent and motor activity for homeostatic processes including pain. The aim of the study was to compare hitherto poorly characterised relations between brainstem autonomic control and personality in response to visceral and somatic pain. Eighteen healthy subjects (16 females, mean age 34) had recordings during rest and pain of heart rate (HR), cardiac vagal tone (CVT), cardiac sensitivity to baroreflex (CSB), skin conductance level (SC), cardiac sympathetic index (CSI) and mean blood pressure (MBP). Visceral pain was induced by balloon distension in proximal (PB) and distal (DB) oesophagus and somatic pain by nail-bed pressure (NBP). Eight painful stimuli were delivered at each site and unpleasantness and intensity measured. Personality was profiled with the Big Five inventory. (1) Oesophageal intubation evoked "fight-flight" responses: HR and sympathetic (CSI, SC, MBP) elevation with parasympathetic (CVT) withdrawal (p<0.05). (2) Pain at all sites evoked novel parasympathetic/sympathetic co-activation with elevated HR but vasodepression (all p<0.05). (3) Personality traits correlated with slope of distal oesophageal pain-related CVT changes wherein more neurotic-introvert subjects had greater positive pain-related CVT slope change (neuroticism r 0.8, p<0.05; extroversion r -0.5, p<0.05). Pain-evoked heart rate increases were mediated by parasympathetic and sympathetic co-activation - a novel finding in humans but recently described in mammals too. Visceral pain-related parasympathetic change correlated with personality. ANS defence responses are nuanced and may relate to personality type for visceral pain. Clinical relevance of these findings warrants further exploration. PMID:19398272
The Long-Term Safety and Efficacy of Intrathecal Therapy Using Sufentanil in Chronic Intractable Non-Malignant Pain
Monsivais, Diane Burn
This report describes the long term safety and efficacy of intrathecal therapy using Sufentanil for the management of chronic intractable neuropathic pain in 12 chronic pain patients. Standardized psychological screening was used to determine treatment suitability. Evaluation data included the Visual Analog Scale (VAS), Wong-Baker Faces Scale, Brief Pain Inventory (BPI), Disability of Arm, Shoulder, and Hand (DASH), McGill Quality of Life Questionnaire, and complications (granulomas, toxicity, withdrawal, or deaths). SPSS version 18 was used for data analysis. Pre- and post- treatment BPI measures and pain scale scores showed a statistically significant difference. There were no complications directly related to drug toxicity, nor drug withdrawals, granulomas, or deaths. Intrathecal therapy with Sufentanil therapy offers a good treatment alternative for those cases that have failed both surgery and standard pain treatment. Strict patient selection based on psychological screening, control of co-morbidities, a proper pain management may contribute to successful outcome. PMID:25031819
Gender differences in brain activity evoked by visceral pain in healthy subjects
M Kano; S J Coen; A D Farmer; Q Aziz
IntroductionFemales are more likely than males to suffer from many chronic pain conditions, including functional gastrointestinal disorders. However, due to the limited number of studies, information available about gender-differences in normal human central processing of visceral pain is still preliminary. We investigated whether gender differences exist in brain response to visceralpain in a large cohort of healthy volunteers.MethodsSixteen males and
Regional cerebral activity in normal and pathological perception of visceral pain
DH Silverman; JA Munakata; H Ennes; MA Mandelkern; CK Hoh; EA Mayer
BACKGROUND & AIMS: To characterize the cerebral processing of noxious visceral events, changes in regional cerebral blood flow associated with perception of intestinal pain were examined. METHODS: The effects of rectal pressure stimuli on regional cerebral blood flow were assessed with 15O-water positron emission tomography (PET) in 12 subjects, half with irritable bowel syndrome (IBS). PET scans were obtained at
Sex differences in morphine-induced analgesia of visceral pain are supraspinally and peripherally mediated.
Ji, Yaping; Murphy, Anne Z; Traub, Richard J
Increasing evidence suggests there is a sex difference in opioid analgesia of pain arising from somatic tissue. However, the existence of a sex difference in visceral pain and opioid analgesia is unclear. This was examined in the colorectal distention (CRD) model of visceral pain in the current study. The visceromotor response (vmr) to noxious CRD was recorded in gonadally intact male and female rats. Subcutaneous injection of morphine dose-dependently decreased the vmr in both groups without affecting colonic compliance. However, morphine was significantly more potent in male rats than females. Because systemic morphine can act at peripheral tissue and in the central nervous system (CNS), the source of the sex difference in morphine analgesia was determined. The peripherally restricted mu-opioid receptor (MOR) antagonist naloxone methiodide dose-dependently attenuated the effects of systemic morphine. Systemic administration of the peripherally restricted MOR agonist loperamide confirmed peripherally mediated morphine analgesia and revealed greater potency in males compared with females. Spinal administration of morphine dose-dependently attenuated the vmr, but there was no sex difference. Intracerebroventricular administration of morphine also dose-dependently attenuated the vmr with significantly greater potency in male rats. The present study documents a sex difference in morphine analgesia of visceral pain that is both peripherally and supraspinally mediated. PMID:16556902
Targeting voltage-gated sodium channels for treatment for chronic visceral pain
Qi, Fei-Hu; Zhou, You-Lang; Xu, Guang-Yin
Voltage-gated sodium channels (VGSCs) play a fundamental role in controlling cellular excitability, and their abnormal activity is related to several pathological processes, including cardiac arrhythmias, epilepsy, neurodegenerative diseases, spasticity and chronic pain. In particular, chronic visceral pain, the central symptom of functional gastrointestinal disorders such as irritable bowel syndrome, is a serious clinical problem that affects a high percentage of the world population. In spite of intense research efforts and after the dedicated decade of pain control and research, there are not many options to treat chronic pain conditions. However, there is a wealth of evidence emerging to give hope that a more refined approach may be achievable. By using electronic databases, available data on structural and functional properties of VGSCs in chronic pain, particularly functional gastrointestinal hypersensitivity, were reviewed. We summarize the involvement and molecular bases of action of VGSCs in the pathophysiology of several organic and functional gastrointestinal disorders. We also describe the efficacy of VGSC blockers in the treatment of these neurological diseases, and outline future developments that may extend the therapeutic use of compounds that target VGSCs. Overall, clinical and experimental data indicate that isoform-specific blockers of these channels or targeting of their modulators may provide effective and novel approaches for visceral pain therapy. PMID:21633634
ZD 7288, an HCN channel blocker, attenuates chronic visceral pain in irritable bowel syndrome-like rats
Chen, Yu; Lin, Chun; Tang, Ying; Chen, Ai-Qin; Liu, Cui-Ying; Lu, Da-Li
AIM: To investigate the effects of ZD 7288, a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker, on rats with chronic visceral pain. METHODS: Rats with visceral hypersensitivity were generated using neonatal colon irritation during postnatal days 8-15 as described previously. Visceral hypersensitivity was evaluated using electromyographic (EMG) responses of abdominal external oblique muscles to 20-80 mmHg colorectal distentions (CRD). Abdominal withdrawal reflex (AWR) scores and pain thresholds were also detected in adult rats. Different doses of ZD 7288 (25, 50, and 100 nmol/L) were intrathecally administered in rats to study the role of spinal HCN channel in chronic visceral hypersensitivity. RESULTS: EMG responses to 20-80 mmHg CRD and AWR scores under 20-60 mmHg CRD significantly increased in rats with visceral hypersensitivity compared to control rats (P < 0.05). The pain threshold in rats with visceral hypersensitivity significantly decreased compared to control rats (P < 0.05). Treatment with 50-100 nmol/L ZD 7288 significantly inhibited EMG responses (16%-62%, 80-20 mmHg CRD, P < 0.05) and AWR scores (24%-37%, 40-20 mmHg CRD, P < 0.05; 12%-61%, 80-20 mmHg CRD, P < 0.05, respectively), and significantly increased pain thresholds (32%-77%, P < 0.05). CONCLUSION: Spinal HCN channels may play an important role in chronic visceral hypersensitivity. PMID:24587682
Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol
NASA Astrophysics Data System (ADS)
Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.
We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ? 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.
Atlanto-axial subluxation syndrome and management of intractable headache, neck pain and shoulder pain with auricular stimulation: a clinical case report.
Kim, K H
Atlanto-axial subluxation syndrome is a condition that is easily overlooked, misdiagnosed and mismanaged. Anatomy, neurovascular involvement and description of clinical manifestations are reviewed. Bi-Digital O-Ring Test is employed to establish an accurate diagnosis and its value and accuracy described briefly. Bi-Digital O-Ring Test has been an important diagnosis confirmation method (reconfirmed by CT or MRI in over 95% of more than 850 clinical cases) in this author's practice of spinal disorder and intractable pain management. A newly described device, the KIM-STIM, offers auricular stimulation of multiple points, using electrical microcurrent. Each unit is individually custom-molded to the patient's ear, and fitted with multiple electrodes. It was found to be very effective in managing the majority of intractable pain, especially pain requiring multiple daily treatments in order for the patient to live and function normally. The KIM-STIM device allows the patient to self-manage the pain, by day or night, thus allowing for a reduction or elimination of medication intake and diminishing the necessity for frequent doctor visits. PMID:11841111
Chronic pain management--upper visceral malignancies coeliac plexus block with CT scanning--a case report.
Choy, Y C; Puvenesvari, S; Samad, S
Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented. PMID:10968166
Analgesic effect of Minocycline in rat model of inflammation-induced visceral pain
Kannampalli, Pradeep; Pochiraju, Soumya; Bruckert, Mitchell; Shaker, Reza; Banerjee, Banani; Sengupta, Jyoti N.
The present study investigates the analgesic effect of minocycline, a semi-synthetic tetracycline antibiotic, in a rat model of inflammation-induced visceral pain. Inflammation was induced in male rats by intracolonic administration of tri-nitrobenzenesulphonic acid (TNBS). Visceral hyperalgesia was assessed by comparing the viscero-motor response (VMR) to graded colorectal distension (CRD) prior and post 7 days after TNBS treatment. Electrophysiology recordings from CRD-sensitive pelvic nerve afferents (PNA) and lumbo-sacral (LS) spinal neurons were performed in na�ve and inflamed rats. Colonic inflammation produced visceral hyperalgesia characterized by increase in the VMRs to CRD accompanied with simultaneous activation of microglia in the spinal cord and satellite glial cells (SGCs) in the dorsal root ganglions (DRGs). Selectively inhibiting the glial activation following inflammation by araC (Arabinofuranosyl Cytidine) prevented the development of visceral hyperalgesia. Intrathecal minocycline significantly attenuated the VMR to CRD in inflamed rats, whereas systemic minocycline produced a delayed effect. In electrophysiology experiments, minocycline significantly attenuated the mechanotransduction of CRD-sensitive PNAs and the responses of CRD-sensitive LS spinal neurons in TNBS-treated rats. While the spinal effect of minocycline was observed within 5 min of administration, systemic injection of the drug produced a delayed effect (60 min) in inflamed rats. Interestingly, minocycline did not exhibit analgesic effect in na�ve, non-inflamed rats. The results demonstrate that intrathecal injection of minocycline can effectively attenuate inflammation-induced visceral hyperalgesia. Minocycline might as well act on neuronal targets in the spinal cord of inflamed rats, in addition to the widely reported glial inhibitory action to produce analgesia. PMID:24485889
Adenosine for pain relief in a patient with intractable secondary erythromelalgia
U. Lindblom; L.-O. Nordfors; A. Sollevi; O. Sydow
An unusual case is reported with severe erythromelalgia secondary to a sensorimotor polyneuropathy of immunological aetiology. The dominating symptoms were ongoing burning dysesthesia and pain in the legs, sustained thermal hyperalgesia and allodynia to pressure which produced intolerable pain on standing and walking. The primary pain-producing pathophysiology was apparently peripheral neurogenic inflammation with sensitization and excitation of nociceptors. The variable
Intravenous lidocaine for the treatment of intractable pain of adiposis dolorosa.
Atkinson, R L
Adiposis dolorosa (Dercum's disease) is a syndrome of painful adipose tissue which occurs most often in post-menopausal women and is associated with obesity, asthenia, and emotional disturbances. The etiology is uncertain, but is probably multifactorial. Numerous treatments to relieve the pain have generally been unsuccessful. A patient with adiposis dolorosa was treated with intravenous infusions of lidocaine over a two-year period. Relief from pain lasted from two to 12 months after each infusion. A single-blind placebo infusion did not relieve the pain. Lidocaine infusions did not relieve the pain of diabetic neuropathy or of angina in this patient. The mechanism of relief of pain of adiposis dolorosa by lidocaine is uncertain, but previously reported central effects of lidocaine suggest that alterations in the central nervous system may be responsible. PMID:7129748
Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome.
Theodorou, Vassilia; Belgnaoui, Afifa Ait; Agostini, Simona; Eutamene, Helene
The last ten years' wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient's quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation. PMID:25181491
Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome.
Theodorou, Vassilia; Ait Belgnaoui, Afifa; Agostini, Simona; Eutamene, Helene
The last ten years' wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient's quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation. PMID:25184834
Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome
Theodorou, Vassilia; Belgnaoui, Afifa Ait; Agostini, Simona; Eutamene, Helene
The last ten years� wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient�s quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation. PMID:25184834
Treatment of Intractable Pain with Topical Large-Dose Capsaicin: Preliminary Report
Wendye R. Robbins; Peter S. Staats; Jon Levine
Complex regional pain syndromes (CRPS) and neuro- pathic pain are often poorly controlled by conventional pharmacologic interventions. We administered g-methyl- N-vanillyl-6-noneamide (capsaicin) at doses of 5%-10% to individuals with such disorders in this trial. Previous lim- itations to trials with larger-dose, topical concentrations of caps&in included intense burning sensations experi- enced after application. To enable patients to tolerate the high
Epidural spinal cord stimulation with a multiple electrode paddle lead is effective in treating intractable low back pain.
Barolat, G; Oakley, J C; Law, J D; North, R B; Ketcik, B; Sharan, A
The objective of this paper is to examine the outcomes of patients with intractable low-back pain treated with epidural spinal cord stimulation (SCS) utilizing paddle electrodes and a radio frequency (RF) stimulator. A multicenter prospective study was performed to collect data from patients suffering from chronic low-back pain. The study was designed to collect data from 60 patients at four centers and examine their outcomes at, or up to two years post implantation. Patients' participation included written responses to a series of preoperative questionnaires that were designed to collect previous surgical history information, leg and low back pain characteristics, and routine demographic information. Outcome measurements included the visual analog scale (VAS), the Oswestry Disability Questionnaire, the Sickness Impact Profile (SIP), and a patient satisfaction rating scale. Data were collected at each site during patient visits or by mail, at approximately six months, 12 months, and 24 months. A total of 44 patients have been implanted with a SCS system at the time of this writing. Follow-up data were available for 41 patients. Preoperatively, all patients reported more than 50% of their pain in the low back. All patients had pain in both their backs and legs. All patients showed a reported mean decrease in their 10-point VAS scores compared to baseline. The majority of patients reported fair to excellent pain relief in both the low back and legs. At six months 91.6% of the patients reported fair to excellent relief in the legs and 82.7% of the patients reported fair to excellent relief in the low back. At one year 88.2% of the patients reported fair to excellent relief in the legs and 68.8% of the patients reported fair to excellent relief in the low back. Significant improvement in function and quality of life was found at both the six-month and one-year follow-ups using the Oswestry and SIP, respectively. The majority of patients reported that the procedure was worthwhile (92% at six months, 88% at one year). No patient indicated that the procedure was not worthwhile. We conclude that SCS proved beneficial at one year for the treatment of patients with chronic low back and leg pain. PMID:22151612
The prostaglandin E2 receptor-1 (EP1) mediates acid-induced visceral pain hypersensitivity in humans
Sanchoy Sarkar; Anthony R. Hobson; Andrew Hughes; Jim Growcott; Clifford J. Woolf; David G. Thompson; Qasim Aziz
Background & Aims: Central sensitization, an activity-dependent increase in spinal cord neuronal excitability, has been shown to contribute to esophageal pain hypersensitivity. Prostaglandin E2 (PGE2) is a mediator in both peripheral and central sensitization, in part via the prostaglandin E2 receptor-1 (EP-1), and may be a potential target for treating visceral pain. The purpose of this study was to determine
The role of cannabinoids in regulation of nausea and vomiting, and visceral pain.
Malik, Zubair; Baik, Daniel; Schey, Ron
Marijuana derived from the plant Cannabis sativa has been used for the treatment of many gastrointestinal (GI) disorders, including anorexia, emesis, abdominal pain, diarrhea, and others. However, its psychotropic side effects have often limited its use. Several cannabinoid receptors, which include the cannabinoid receptor 1 (CB1), CB2, and possibly GPR55, have been identified throughout the GI tract. These receptors may play a role in the regulation of food intake, nausea and emesis, gastric secretion and gastroprotection, GI motility, ion transport, visceral sensation, intestinal inflammation, and cell proliferation in the gut. However, the regulation of nausea and vomiting by cannabinoids and the endocannabinoid system has shed new knowledge in this field. Thus far, despite evidence of visceral sensitivity inhibition in animal models, data in irritable bowel syndrome (IBS) patients is scarce and not supportive. Furthermore, many compounds that either act directly at the receptor or increase (or reduce) ligand availability have the potential to affect other brain functions and cause side effects. Novel drug targets such as FAAH and monoacylglycerol lipase (MAGL) inhibitors appear to be promising in animal models, but more studies are necessary to prove their efficiency. The promise of emerging drugs that are more selective and peripherally acting suggest that, in the near future, cannabinoids will play a major role in managing an array of GI diseases. PMID:25715910
Vinpocetine and piracetam exert antinociceptive effect in visceral pain model in mice.
Abdel Salam, Omar M E
The effect of vinpocetine or piracetam on thermal and visceral pain was studied in mice. In the hot plate test, vinpocetine (0.9 and 1.8 mg/kg), but not piracetam, produced a reduction in nociceptive response. Vinpocetine (0.45-1.8 mg/kg, ip) or piracetam (75-300 mg/kg, ip) caused dose-dependent inhibition of the abdominal constrictions evoked by ip injection of acetic acid. The effect of vinpocetine or piracetam was markedly potentiated by co-administration of propranolol, guanethidine, atropine, naloxone, yohimbine or prazosin. The marked potentiation of antinociception occurred upon a co-administration of vinpocetine and baclofen (5 or 10 mg/kg). In contrast, piracetam antagonized antinociception caused by the low (5 mg/kg), but not the high (10 mg/kg) dose of baclofen. The antinociception caused by vinpocetine was reduced by sulpiride; while that of piracetam was enhanced by haloperidol or sulpiride. Either vinpocetine or piracetam enhanced antinociception caused by imipramine. The antinociceptive effects of vinpocetine or piracetam were blocked by prior administration of theophylline. Low doses of either vinpocetine or piracetam reduced immobility time in the Porsolt's forced-swimming test. This study indicates that vinpocetine and piracetam possess visceral antinociceptive properties. This effect depends on activation of adenosine receptors. Piracetam in addition inhibits GABA-mediated antinociception. PMID:17085860
Abdominal implantation of testicles in the management of intractable testicular pain in Fournier gangrene.
Chan, Cyrus C; Shahrour, Khaled; Collier, Ronald D; Welch, Marlene; Chang, Shiliang; Williams, Mallory
Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025
Hippocampal NR2B-containing NMDA receptors enhance long-term potentiation in rats with chronic visceral pain.
Chen, Yu; Chen, Ai-qin; Luo, Xiao-qing; Guo, Li-xia; Tang, Ying; Bao, Cheng-jia; Lin, Ling; Lin, Chun
Pain and learning memory have striking similarities in synaptic plasticity. Activation of the N-methyl-D-aspartic acid receptors 2B subunits (NR2B-NMDAs) is responsible for the hippocampal LTP in memory formation. In our previous studies, we found the significant enhancement of CA1 hippocampal long-term potentiation (LTP) induced by high-frequency stimulation (HFS) in rats with chronic visceral pain. However, it is unclear whether the NR2B-NMDAs are required for the LTP in chronic visceral pain. In this study, a rat model with irritable bowel syndrome (IBS) was established by colorectal distention (CRD). The sensitivity of visceral pain and HFS-induced LTP at SC-CA1 synapses were significantly enhanced in IBS-like rats (p<0.05). In addition, hippocampal NR2B protein levels significantly increased in IBS-like rats (p<0.05). To test whether NR2B-NMDAs are responsible for the LTP, effects of Ro 25-6981, a selective antagonist of NR2B-NMDAs, on field potential in CA1 region were investigated in vitro. Our results demonstrated that Ro 25-6981 dose-dependently inhibited the facilitation of CA1 LTP in IBS-like rats. The plausible activation mechanism of hippocampal NR2B-NMDAs in the LTP enhancement was further explored. Western blot data indicated that expression of tyrosine phosphorylated NR2B protein in hippocampus significantly enhanced in IBS-like rats. Accordingly, genistein, a specific inhibitor of tyrosine kinases, dose-dependently blocked the facilitation of hippocampal LTP in IBS-like rats. Furthermore, EMG data revealed that intra-hippocampal injection of Ro 25-6981 dose-dependently attenuated the visceral hypersensitivity. In conclusion, hippocampal NR2B-NMDAs are responsible for the facilitation of CA1 LTP via tyrosine phosphorylation, which leads to visceral hypersensitivity. PMID:24824341
Colon distention induces persistent visceral hypersensitivity by mechanotranscription of pain mediators in colonic smooth muscle cells.
Lin, You-Min; Fu, Yu; Wu, Chester C; Xu, Guang-Yin; Huang, Li-Yen; Shi, Xuan-Zheng
Abdominal pain and distention are major complaints in irritable bowel syndrome. Abdominal distention is mainly attributed to intraluminal retention of gas or solid contents, which may cause mechanical stress to the gut wall. Visceral hypersensitivity (VHS) may account for abdominal pain. We sought to determine whether tonic colon distention causes persistent VHS and if so whether mechanical stress-induced expression (mechanotranscription) of pain mediators in colonic smooth muscle cells (SMCs) plays a role in VHS. Human colonic SMCs were isolated and stretched in vitro to investigate whether mechanical stress upregulates expression of the pain mediator cyclooxygenase-2 (COX-2). Rat colon was distended with a 5-cm-long balloon, and gene expression of COX-2, visceromotor response (VMR), and sensory neuron excitability were determined. Static stretch of colonic SMCs induced marked expression of COX-2 mRNA and protein in a force- and time-dependent manner. Subnoxious tonic distention of the distal colon at ?30-40 mmHg for 20 or 40 min induced COX-2 expression and PGE2 production in colonic smooth muscle, but not in the mucosa layer. Lumen distention also increased VMR in a force- and time-dependent manner. The increase of VMR persisted for at least 3 days. Patch-clamp experiments showed that the excitability of colon projecting sensory neurons in the dorsal root ganglia was markedly augmented, 24 h after lumen distention. Administration of COX-2 inhibitor NS-398 partially but significantly attenuated distention-induced VHS. In conclusion, tonic lumen distention upregulates expression of COX-2 in colonic SMC, and COX-2 contributes to persistent VHS. PMID:25540231
The anti-hyperalgesic actions of the cannabinoid anandamide and the putative CB2 receptor agonist palmitoylethanolamide in visceral and somatic inflammatory pain
Sian I. Jaggar; Fauzia S. Hasnie; Senthy Sellaturay; Andrew S. C. Rice
This study assessed the effects of two N-acylethanolamides in established rat models of visceral and somatic inflammatory pain. (1) The therapeutic effects of the cannabinoid anandamide and the putative CB2 agonist palmitoylethanolamide were tested in a model of persistent visceral pain (turpentine inflammation of the urinary bladder). Both anandamide (at a dose of 25 mg\\/kg) and palmitoylethanolamide (at doses of
Fentanyl-trazodone-paracetamol triple drug combination: multimodal analgesia in a mouse model of visceral pain.
Fern�ndez-Due�as, V�ctor; Poveda, Raquel; Fern�ndez, Alejandro; S�nchez, S�lvia; Planas, Eul�lia; Ciruela, Francisco
Multimodal or balanced analgesia is commonly used in the management of acute and chronic pain in humans, in order to achieve the best analgesic/safety profile. Here, by using a model of visceral acute tonic pain, the acetic acid-induced writhing test of mice, we show a synergistic interaction between fentanyl, trazodone and paracetamol on the inhibition of nociception. First of all, once assessed that all drugs induced dose-related antinociceptive effects, they were mixed in fixed ratio (1:1) combinations and a synergistic drug-drug interaction was obtained in all circumstances. Thereafter, we assayed the effects of the triple combination of fentanyl-trazodone-paracetamol and it was demonstrated that they displayed a potent synergistic interaction on the inhibition of acetic acid-mediated nociception. Interestingly, drug dosage reduction permitted to reduce the incidence of possible adverse effects, namely exploratory activity and motor coordination, thus it was demonstrated that it improved the benefit/risk profile of such treatment. Afterwards, we attempted to elucidate the mechanism of action of such interaction, by means of the non-selective opioid receptor antagonist naloxone. Interestingly, naloxone completely antagonized the antinociceptive effects of fentanyl, and it also partially reversed paracetamol and trazodone mediated analgesia. Furthermore, when naloxone was co-administered with the triple-drug treatment it blocked the previously observed enhanced antinociceptive effects of the combination. Thus, these results indicated that the endogenous opioid system played a main role in the present drug-drug interaction. Overall, the triple combination of fentanyl-trazodone-paracetamol induced a potent synergistic antinociceptive effect, which could be of interest for optimal multimodal clinical analgesia. PMID:21296105
Neural mechanisms mediating positive and negative treatment expectations in visceral pain: a functional magnetic resonance imaging study on placebo and nocebo effects in healthy volunteers.
Schmid, Julia; Theysohn, Nina; Ga�, Florian; Benson, Sven; Gramsch, Carolin; Forsting, Michael; Gizewski, Elke R; Elsenbruch, Sigrid
To elucidate placebo and nocebo effects in visceral pain, we conducted a functional magnetic resonance imaging (fMRI) study to analyze effects of positive and negative treatment expectations in a rectal pain model. In 36 healthy volunteers, painful rectal distensions were delivered after intravenous application of an inert substance combined with either positive instructions of pain relief (placebo group) or negative instructions of pain increase (nocebo group), each compared to neutral instructions. Neural activation during cued-pain anticipation and pain was analyzed along with expected and perceived pain intensity. Expected and perceived pain intensity were significantly increased in the nocebo group and significantly decreased in the placebo group. In the placebo group, positive expectations significantly reduced activation of the somatosensory cortex during anticipation and of the insula, somatosensory cortex, and amygdala during pain delivery when compared to neutral expectations. Within the nocebo group, negative expectations led to significantly increased insula activation during painful stimulation. Direct group contrasts during expectation modulation revealed significantly increased distension-induced activation within the somatosensory cortex in the nocebo group. In conclusion, the experience and neural processing of visceral pain can be increased or decreased by drug-specific expectations. This first brain imaging study on nocebo effects in visceral pain has implications for the pathophysiology and treatment of patients with chronic abdominal complaints such as irritable bowel syndrome. PMID:23867733
An uncommon cause of visceral arterial embolism in patients presenting with acute abdominal pain: a report of 2 cases.
Ulenaers, M; Buchel, O C; Van Olmen, A; Moons, V; D'Haens, G; Christiaens, P
We report on 2 cases of visceral arterial embolism presenting with acute abdominal pain. In neither patient a cause could be established on initial clinical, laboratory, echographic or radiological investigation. Both patients were subsequently found to have a mural thrombus in the thoracic aorta, with visceral arterial embolism. Each underwent a successful operative thrombectomy. Both patients had a normal underlying aortic intima at inspection. The first patient was a young male with no known diseases. He regularly used cannabis and tested positive on admission, an association not yet reported with aortic mural thrombus. He was found to have a slightly reduced protein C. The second patient was a middle aged man with non-insulin dependent diabetes, hyperlipidaemia, arterial hypertension and hyperthyroidism. He was found to have an underlying adenocarcinoma of the lung and received chemotherapy. He died due to his cancer, 4 months after first presentation. PMID:20458852
Role of transient receptor potential channels in intestinal inflammation and visceral pain: novel targets in inflammatory bowel diseases.
Zieli?ska, Marta; Jarmu?, Agata; Wasilewski, Andrzej; Sa?aga, Maciej; Fichna, Jakub
Transient receptor potential (TRP) channels are a large group of ion channels that are prevalent in mammalian tissues. They are widely distributed in the central and peripheral nervous systems, and in nonneuronal cells, where they are implicated in sensing temperature, noxious substances, and pain. TRPs play an important role in immune response and nociception and, therefore, may be involved in the pathogenesis of inflammatory bowel diseases, whose major symptoms include chronic inflammatory state and abdominal pain. In this review, we summarize what is known on TRP channels in inflammatory bowel disease and visceral pain; we focus in particular on TRPV1, TRPV4, TRPA1, and TRPM. We also analyze scientific reports that evidence potential use of TRP regulators in future inflammatory bowel disease treatment. PMID:25437822
Peripheral antinociceptive effects of the cyclic endomorphin-1 analog c[YpwFG] in a mouse visceral pain model
Andrea Bedini; Monica Baiula; Luca Gentilucci; Alessandra Tolomelli; Rossella De Marco; Santi Spampinato
We previously described a novel cyclic endomorphin-1 analog c[Tyr-D-Pro-D-Trp-Phe-Gly] (c[YpwFG]), acting as a mu-opioid receptor (MOR) agonist. This study reports that c[YpwFG] is more lipophilic and resistant to enzymatic hydrolysis than endomorphin-1 and produces preemptive antinociception in a mouse visceral pain model when injected intraperitoneally (i.p.) or subcutaneously (s.c.) before 0.6% acetic acid, employed to evoke abdominal writhing (i.p. ED50=1.24mg\\/kg;
Synergistic effect of 5-hydroxytryptamine 3 and neurokinin 1 receptor antagonism in rodent models of somatic and visceral pain.
Greenwood-Van Meerveld, Beverley; Mohammadi, Ehsan; Tyler, Karl; Pietra, Claudio; Bee, Lucy A; Dickenson, Anthony
Synergistic activity has been observed between serotonergic 5-hydroxytryptamine 3 (5-HT3) and tachykinergic neurokinin 1 (NK1) receptor-mediated responses. This study investigated the efficacy of a 5-HT3 antagonist, palonosetron, and a NK1 antagonist, netupitant, alone or in combination in rodent models of somatic and visceral colonic hypersensitivity. In a rat model of experimental neuropathic pain, somatic hypersensitivity was quantified by the number of ipsilateral paw withdrawals to a von Frey filament (6g). Electrophysiologic responses were recorded in the dorsal horn neurons after mechanical or thermal stimuli. Acute colonic hypersensitivity was induced experimentally in rats by infusing dilute acetic acid (0.6%) directly into the colon. Colonic sensitivity was assessed by a visceromotor behavioral response quantified as the number of abdominal contractions in response to graded isobaric pressures (0-60 mm Hg) of colorectal distension. Palonosetron or netupitant was administered alone or in combination via oral gavage. When dosed alone, both significantly reduced somatic sensitivity, decreased the evoked response of spinal dorsal horn neurons to mechanical or thermal stimulation, and caused significant (P < 0.05) inhibition of colonic hypersensitivity in a dose-dependent manner. The combined administration of palonosetron and netupitant at doses that were ineffective alone significantly reduced both somatic and visceral sensitivity and decreased the evoked response of spinal dorsal horn neurons to mechanical or thermal stimulation. In summary, the combination of palonosetron with a NK1 receptor antagonist showed synergistic analgesic activity in rodent models of somatic and visceral hypersensitivity, and may prove to be a useful therapeutic approach to treat pain associated with irritable bowel syndrome. PMID:25077526
Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome
Tony Lembo; Bruce Naliboff; Julie Munakata; Steve Fullerton; Lynn Saba; Scott Tung; Max Schmulson; Emeran A Mayer
OBJECTIVE:Abdominal pain is thought to be a hallmark of the irritable bowel syndrome (IBS), although currently used symptom criteria do not differentiate between abdominal pain and discomfort. By focusing on viscerosensory symptoms, we sought to determine: 1) which type of symptoms are most commonly reported by IBS patients, and 2) whether patients who report pain as their most bothersome symptom
Antinociceptive effects of systemic tanshinone IIA on visceral and somatic persistent nociception and pain hypersensitivity in rats.
Cao, Fa-Le; Su, Xue-Jia; Wang, Yan; Xu, Min; Shan, Liang
Previous studies showed that tanshinone IIA (TIIA), an important lipophilic component of Danshen, has been well-established to exhibit various neuroprotective actions in the nervous system. Although we previously reported that TIIA had a significant anti-nociceptive effect in complete Freund's adjuvant (CFA)-induced pain, it is surprisingly noted that few pharmacological studies have been carried out to explore the possible analgesic action of TIIA in animals and the appropriate indications for treatment of clinical pain remain unclear. Therefore, in the present study, by using both somatic and visceral pain models, the antinociceptive and antihyperalgesic effects of TIIA were evaluated by intraperitoneal administration in rats. In the bee venom (BV) test, when compared with saline controls, systemic pre- and post-treatment with TIIA resulted in an apparent antinociception against persistent spontaneous nociception (PSN) and primary heat and mechanical hypersensitivity, while for the mirror-image heat hypersensitivity, only pre-treatment was effective. Moreover, in the formalin test, the antinociception of TIIA was significant for both phases 1 and 2 in the pretreatment groups, but only effective for phase 2 in the post-treatment group. In the acetic acid writhing test, the number of writhes was effectively blocked by both pre- and post-treatment of TIIA. Taken together, these results provide a new line of evidence showing that TIIA is also able to produce analgesia against various 'phenotypes' of nociception and hypersensitivity. PMID:24823766
Iontophoretic administration of S(+)-ketamine in patients with intractable central pain: A placebo-controlled trial
J. H. Vranken; M. G. W. Dijkgraaf; M. R. Kruis; N. T. van Dasselaar; M. H. van der Vegt
The efficacy of 50 and 75mg S(+)-ketamine administered daily by an iontophoresis-assisted transdermal drug delivery system was tested against placebo in a randomized, double-blind design in 33 patients with central neuropathic pain. At baseline and 1 week after the start of treatment subjects were evaluated with standard measures of efficacy: pain intensity measured by visual analog scale (VAS), health status
Can intractable discogenic back pain be managed by low-level laser therapy without recourse to operative intervention?
Ip, David; Fu, Nga-Yue
Objective The aim of the study reported here was to investigate the possible clinical role of low-level laser therapy (LLLT) in discogenic back pain patients who failed to respond to a conventional physical therapy program to avoid recourse to operative intervention. Methods The paper reports on the long-term mean 5-year prospective follow-up of a patient cohort of 50 unselected patients visiting our tertiary referral pain center for discogenic back pain who had had a single-level lesion documented by magnetic resonance imaging followed by subsequent discography to confirm the affected disc being the pain generator. All of the patients who entered the study had failed response to a combination of nonsteroidal anti-inflammatory agents and had had not less than 3 months of conventional physical therapy. LLLT, at a wavelength of 810 nm wavelength emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm2, was employed. The treatment regimen consisted of three sessions of treatment per week for 12 consecutive weeks. Results All but one patient had significant improvement in their Oswestry Disability Index score, from a mean of 50% score to a mean of 10% score, at the end of treatment at 12 weeks. In addition, surprisingly, the improvement was found maintained at follow-up assessments 1 year and 5 years later. The one patient among the 50 patients who failed to respond eventually required surgery, while the others did not require surgery. Conclusion We conclude that LLLT is a viable option in the conservative treatment of discogenic back pain, with a positive clinical result of more than 90% efficacy, not only in the short-term but also in the long-term, with lasting benefits. PMID:26064065
Acupuncture at both ST25 and ST37 improves the pain threshold of chronic visceral hypersensitivity rats.
Liu, Hui-Rong; Wang, Xiao-Mei; Zhou, En-Hua; Shi, Yin; Li, Na; Yuan, Ling-Song; Wu, Huan-Gan
Previous studies demonstrated the efficacy of electro-acupuncture (EA) in relieving chronic visceral hypersensitivity (CVH) in IBS rats. However, ST25 which is a key acupoint for patients with IBS has not been reported in these experiments. Eight CVH rats were treated by EA at both ST25 and ST37 for 20 min, once daily for seven consecutive days, model rats (n = 8) and normal rats (n = 8) as controls. After the first EA treatment, the abdominal withdrawal reflex scores were investigated to evaluate the pain threshold. After seven EA treatments, the concentrations of 5-hydroxytryptamine (5-HT), 5-HT3 receptor (5-HT3R) and 5-HT4 receptor (5-HT4R) in colon tissue were assayed quantitatively by enzyme-linked immunosorbent assay. The results showed that EA improved the pain threshold of CVH rats, reduced the 5-HT concentration and increased the 5-HT4R concentration, but had no effect on the 5-HT3R concentration. Further studies are needed to optimize the choice of two-matching points for EA in the treatment of CVH rats. PMID:19387829
Novel Polymeric Bioerodable Microparticles for Prolonged-Release Intrathecal Delivery of Analgesic Agents for Relief of Intractable Cancer-Related Pain.
Han, Felicity Y; Thurecht, Kristofer J; Lam, Ai-Leen; Whittaker, Andrew K; Smith, Maree T
Intractable cancer-related pain complicated by a neuropathic component due to nerve impingement is poorly alleviated even by escalating doses of a strong opioid analgesic. To address this unmet medical need, we developed sustained-release, bioerodable, hydromorphone (potent strong opioid)- and ketamine (analgesic adjuvant)-loaded microparticles for intrathecal (i.t.) coadministration. Drug-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles were prepared using a water-in-oil-in-water method with evaporation. Encapsulation efficiency of hydromorphone and ketamine in PLGA (50:50) microparticles was 26% and 56%, respectively. Microparticles had the desired size range (20-60 ?m) and in vitro release was prolonged at ?28 days. Microparticles were stable for ?6 months when stored refrigerated protected from light in a desiccator. Desirably, i.t. injected fluorescent dye-labeled PLGA microparticles in rats remained in the lumbar region for ?7 days. In a rat model of neuropathic pain, i.t. coinjection of hydromorphone- and ketamine-loaded microparticles (each 1 mg) produced analgesia for 8 h only. Possible explanations include inadequate release of ketamine and/or hydromorphone into the spinal fluid, and/or insufficient ketamine loading to prevent development of analgesic tolerance to the released hydromorphone. As sub-analgesic doses of i.t. ketamine at 24-48 h intervals restored analgesia on each occasion, insufficient ketamine loading appears problematic. We will investigate these issues in future work. � 2015 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 104:2334-2344, 2015. PMID:25990226
Peripheral antinociceptive effects of the cyclic endomorphin-1 analog c[YpwFG] in a mouse visceral pain model.
Bedini, Andrea; Baiula, Monica; Gentilucci, Luca; Tolomelli, Alessandra; De Marco, Rossella; Spampinato, Santi
We previously described a novel cyclic endomorphin-1 analog c[Tyr-D-Pro-D-Trp-Phe-Gly] (c[YpwFG]), acting as a mu-opioid receptor (MOR) agonist. This study reports that c[YpwFG] is more lipophilic and resistant to enzymatic hydrolysis than endomorphin-1 and produces preemptive antinociception in a mouse visceral pain model when injected intraperitoneally (i.p.) or subcutaneously (s.c.) before 0.6% acetic acid, employed to evoke abdominal writhing (i.p. ED(50)=1.24 mg/kg; s.c. ED(50)=2.13 mg/kg). This effect is reversed by the selective MOR antagonist ?-funaltrexamine and by a high dose of the mu(1)-opioid receptor-selective antagonist naloxonazine. Conversely, the kappa-opioid receptor antagonist nor-binaltorphimine and the delta-opioid receptor antagonist naltrindole are ineffective. c[YpwFG] produces antinociception when injected i.p. after acetic acid (ED(50)=4.80 mg/kg), and only at a dose of 20mg/kg did it elicit a moderate antinociceptive response in the mouse, evaluated by the tail flick assay. Administration of a lower dose of c[YpwFG] (10mg/kg i.p.) apparently produces a considerable part of antinociception on acetic acid-induced writhes through peripheral opioid receptors as this action is fully prevented by i.p. naloxone methiodide, which does not readily cross the blood-brain barrier; whereas this opioid antagonist injected intracerebroventricularly (i.c.v.) is not effective. Antinociception produced by a higher dose of c[YpwFG] (20mg/kg i.p.) is partially reversed by naloxone methiodide i.c.v. administered. Thus, only at the dose of 20mg/kg c[YpwFG] can produce antinociception through both peripheral and central opioid receptors. In conclusion, c[YpwFG] displays sufficient metabolic stability to be effective after peripheral administration and demonstrates the therapeutic potential of endomorphin derivatives as novel analgesic agents to control visceral pain. PMID:20713109
Analgesia Induced by Microwave Irradiation of an Acupuncture Point under Conditions of Visceral Pain in Mice: Role of the Serotonergic Cerebral System
E. V. Bagatskaya; E. V. Gura
We studied behavioral manifestations of analgesic effects induced in mice by irradiation of the E36 acupuncture point (AcP) by low-intensity microwaves under conditions of visceral pain evoked by i.p. injections of 0.08 ml of a 2% solution of acetic acid. We also examined changes in these analgesic effects resulting from a drop in the level of serotonin after i.p. injection
Disturbance of the gut microbiota in early-life selectively affects visceral pain in adulthood without impacting cognitive or anxiety-related behaviors in male rats.
O'Mahony, S M; Felice, V D; Nally, K; Savignac, H M; Claesson, M J; Scully, P; Woznicki, J; Hyland, N P; Shanahan, F; Quigley, E M; Marchesi, J R; O'Toole, P W; Dinan, T G; Cryan, J F
Disruption of bacterial colonization during the early postnatal period is increasingly being linked to adverse health outcomes. Indeed, there is a growing appreciation that the gut microbiota plays a role in neurodevelopment. However, there is a paucity of information on the consequences of early-life manipulations of the gut microbiota on behavior. To this end we administered an antibiotic (vancomycin) from postnatal days 4-13 to male rat pups and assessed behavioral and physiological measures across all aspects of the brain-gut axis. In addition, we sought to confirm and expand the effects of early-life antibiotic treatment using a different antibiotic strategy (a cocktail of pimaricin, bacitracin, neomycin; orally) during the same time period in both female and male rat pups. Vancomycin significantly altered the microbiota, which was restored to control levels by 8 weeks of age. Notably, vancomycin-treated animals displayed visceral hypersensitivity in adulthood without any significant effect on anxiety responses as assessed in the elevated plus maze or open field tests. Moreover, cognitive performance in the Morris water maze was not affected by early-life dysbiosis. Immune and stress-related physiological responses were equally unaffected. The early-life antibiotic-induced visceral hypersensitivity was also observed in male rats given the antibiotic cocktail. Both treatments did not alter visceral pain perception in female rats. Changes in visceral pain perception in males were paralleled by distinct decreases in the transient receptor potential cation channel subfamily V member 1, the ?-2A adrenergic receptor and cholecystokinin B receptor. In conclusion, a temporary disruption of the gut microbiota in early-life results in very specific and long-lasting changes in visceral sensitivity in male rats, a hallmark of stress-related functional disorders of the brain-gut axis such as irritable bowel disorder. PMID:25088912
Effects of novel TRPA1 receptor agonist ASP7663 in models of drug-induced constipation and visceral pain.
Kojima, Ryosuke; Nozawa, Katsura; Doihara, Hitoshi; Keto, Yoshihiro; Kaku, Hidetaka; Yokoyama, Toshihide; Itou, Hiroyuki
Constipation is a major gastrointestinal motility disorder with clinical need for effective drugs. We previously reported that transient receptor potential ankyrin 1 (TRPA1) is highly expressed in enterochromaffin (EC) cells, which are 5-hydroxytryptamine (5-HT)-releasing cells, and might therefore be a novel target for constipation. Here, we examined the effects of ASP7663, a novel and selective TRPA1 agonist, in constipation models as well as an abdominal pain model. ASP7663 activated human, rat, and mouse TRPA1 and released 5-HT from QGP-1 cells, and oral but not intravenous administration of ASP7663 significantly improved the loperamide-induced delay in colonic transit in mice. While pretreatment with the TRPA1 antagonist HC-030031 and vagotomy both inhibited the ameliorating effect of oral ASP7663 on the colonic transit, both orally and intravenously administered ASP7663 significantly inhibited colorectal distension (CRD)-induced abdominal pain response in rats. Taken together, these results demonstrate that ASP7663 exerts both anti-constipation and anti-abdominal pain actions, the former is likely triggered from the mucosal side of the gut wall via activation of vagus nerves while the latter is assumed to be provoked through systemic blood flow. We conclude that ASP7663 can be an effective anti-constipation drug with abdominal analgesic effect. PMID:24291101
How to Improve the Efficacy of Endoscopic Ultrasound-guided Celiac Plexus Neurolysis in Pain Management in Patients With Pancreatic Cancer: Analysis in a Single Center
Si-Jie, Hao; Wei-Jia, Xu; Yang, Di; Lie, Yao; Feng, Yang; Yong-Jian, Jiang; Ji, Li; Liang, Zhong; De-Liang, Fu
Visceral pain secondary to pancreatic cancer is often difficult to control and poses a challenge to the physician. We retrospectively analyzed the efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with unresectable pancreatic cancer. Forty-one patients with severe pain despite treatment with opioids underwent EUS-CPN with absolute alcohol. Patients scored their pain on a scale of 0 to 10 and were interviewed after the procedure. Of the 41 patients, 33, 37, and 25 patients reported improvement in their pain within 3 days, at 1 week, and at 3 months, respectively, following the procedure. Of all the patients, 19 patients reported substantial improvement and 4 patients showed complete disappearance of pain. Complication appeared in 2 patients with transient hypotension. In our study, EUS-CPN is a safe and effective form of treatment for intractable pain secondary to advanced pancreatic cancer. PMID:24487155
Human visceral afferent recordings: preliminary report
Madusha Peiris; David C Bulmer; Mark D Baker; George Boundouki; Sidhartha Sinha; Anthony Hobson; Kevin Lee; Qasim Aziz; Charles H Knowles
BackgroundConditions characterised by chronic visceral pain represent a significant healthcare burden with limited treatment options. While animal models have provided insights into potential mechanisms of visceral nociception and identified candidate drug targets, these have not translated into successful treatments in humans.ObjectiveTo develop an in vitro afferent nerve preparation using surgically excised freshly isolated human colon and vermiform appendix-mesentery tissues.MethodsNon-inflamed appendix
... that may be adding to your pain l deep breathing exercises �helps you to relax l guided ... Independence Ave SW, Room 712E Washington, DC 20201 web site: www.womenshealth.gov/faq/ carpal.htm www. ...
Targeting TRP channels for pain relief.
Brederson, Jill-Desiree; Kym, Philip R; Szallasi, Arpad
Preclinical research has recently uncovered new molecular mechanisms underlying the generation and transduction of pain, many of which represent opportunities for pharmacological intervention. Manipulating temperature-sensitive Transient Receptor Potential (TRP) channels (so-called "thermoTRPs") on nociceptive neurons is a particularly attractive strategy in that it targets the beginning of the pain pathway. In the focus of current drug development efforts are the heat-sensitive TRPV1, warm-activated TRPV3, cold-responsive TRPA1, and cool-activated TRPM8 channels. TRPV1 desensitization by topical agonists (e.g. high concentration capsaicin creams and patches) has been in clinical use for decades to alleviate chronic painful conditions like diabetic neuropathy. Currently, site-specific resiniferatoxin (an ultrapotent capsaicin analogue) injections are being evaluated as "molecular scalpels" to achieve permanent analgesia in cancer patients with chronic, intractable pain. In the past few years a number of potent, small molecule TRPV1, TRPV3 and TRPA1 antagonists have been advanced into clinical trials for the treatment of inflammatory, neuropathic and visceral pain. TRPM8 antagonists are following closely behind for cold allodynia. Early TRPV1 antagonists in the clinic, however, showed worrisome adverse effects including hyperthermia and impaired noxious heat sensation. These adverse effects placed the patients at risk for scalding injury and prompted their withdrawal from the clinical trials. Second generation TRPV1 antagonists that do not cause core body temperature elevation have been reported, although the therapeutic utility of this class of compounds is not yet known. This review discusses the promise and challenges of developing TRP channel antagonists as a new generation of pain therapeutics. PMID:23500195
Attenuation of capsaicin-induced acute and visceral nociceptive pain by alpha- and beta-amyrin, a triterpene mixture isolated from Protium heptaphyllum resin in mice.
Oliveira, Francisco A; Costa, Charllynton L S; Chaves, Mariana H; Almeida, Fernanda R C; Cavalcante, Italo J M; Lima, Alana F; Lima, Roberto C P; Silva, Regilane M; Campos, Adriana Rolim; Santos, Flavia A; Rao, Vietla S N
The triterpene mixture, alpha- and beta-amyrin, isolated from Protium heptaphyllum resin was evaluated on capsaicin-evoked nociception in mice. Orally administered alpha- and beta-amyrin (3 to 100 mg/kg) significantly suppressed the nociceptive behaviors--evoked by either subplantar (1.6 microg) or intracolonic (149 microg) application of capsaicin. The antinociception produced by alpha- and beta-amyrin against subplantar capsaicin-induced paw-licking behavior was neither potentiated nor attenuated by ruthenium red (1.5 mg/kg, s.c.), a non-specific antagonist of vanilloid receptor (TRPV1), but was greatly abolished in animals pretreated with naloxone (2 mg/kg, s.c.), suggesting an opioid mechanism. However, participation of alpha2-adrenoceptor involvement was unlikely since yohimbine (2 mg/kg, i.p.) pretreatment failed to block the antinociceptive effect of alpha- and beta-amyrin in the experimental model of visceral nociception evoked by intracolonic capsaicin. The triterpene mixture (3 to 30 mg/kg, p.o.) neither altered significantly the pentobarbital sleeping time, nor impaired the ambulation or motor coordination in open-field and rota-rod tests, respectively, indicating the absence of sedative or motor abnormality that could account for its antinociception. Nevertheless, alpha- and beta-amyrin could significantly block the capsaicin (10 mg/kg, s.c.)-induced hyperthermic response but not the initial hypothermia. These results suggest that the triterpene mixture, alpha- and beta-amyrin has an analgesia inducing effect, possibly involving vanilloid receptor (TRPV1) and an opioid mechanism. PMID:15964027
Involvement of Subtypes ? and ε of Protein Kinase C in Colon Pain Induced by Formalin Injection
Yanbo Zhang; Kerui Gong; Weihua Zhou; Guo Shao; Sijie Li; Qing Lin; Jingjin Li
Protein kinase C (PKC) has been widely reported to participate in somatic pain; however, its role in visceral pain remains largely unclear. Using a colon inflammatory pain model by intracolonic injection of formalin in rats, the present study was to examine the role of PKC in visceral pain and determine which subtypes may be involved. The colon pain behavior induced
Wagner, Mary D
The author presents a poem on the character traits that are necessary for survival in dysfunctional families often create teens who are seen as "trouble." This patient's strong will, sense of responsibility for her own life, and unwillingness to blindly trust authorities helped her come through a difficult adolescence and become a competent, likable adult. (PsycINFO Database Record PMID:26053579
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis.
Eck, Jason C; Sharan, Alok; Ghogawala, Zoher; Resnick, Daniel K; Watters, William C; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Groff, Michael W; Wang, Jeffrey C; Dhall, Sanjay S; Kaiser, Michael G
Establishing an appropriate treatment strategy for patients presenting with low-back pain, in the absence of stenosis or spondylolisthesis, remains a controversial subject. Inherent to this situation is often an inability to adequately identify the source of low-back pain to justify various treatment recommendations, such as lumbar fusion. The current evidence does not identify a single best treatment alternative for these patients. Based on a number of prospective, randomized trials, comparable outcomes, for patients presenting with 1- or 2-level degenerative disc disease, have been demonstrated following either lumbar fusion or a comprehensive rehabilitation program with a cognitive element. Limited access to such comprehensive rehabilitative programs may prove problematic when pursuing this alternative. For patients whose pain is refractory to conservative care, lumbar fusion is recommended. Limitations of these studies preclude the ability to present the most robust recommendation in support of lumbar fusion. A number of lesser-quality studies, primarily case series, also support the use of lumbar fusion in this patient population. PMID:24980584
... been termed �Esophageal or visceral hypersensitivity� (enhanced esophageal perception or sensitivity to balloon distension). Although the cause ... can be used to improve this exaggerated pain perception. Non-esophageal Causes of NCCP NCCP is a ...
Real time network modulation for intractable epilepsy Behnaam Aazhang
Aazhang, Behnaam
Real time network modulation for intractable epilepsy Behnaam Aazhang ! Electrical and Computer;Real time network modulation for intractable epilepsy Behnaam Aazhang ! Electrical and Computer;Real time network modulation for intractable epilepsy Behnaam Aazhang ! Electrical and Computer
Jade S. Hiramoto; Louis M. Messina
Optional statement��Visceral artery aneurysms are an uncommon form of vascular disease, yet are important to the practicing vascular surgeon because\\u000a of the potential for rupture or erosion into an adjacent viscus, resulting in life-threatening hemorrhage. Many visceral artery\\u000a aneurysms still present with rupture, which often results in the death of the patient. An aggressive approach to the diagnosis\\u000a and management
Intractable bone marrow edema syndrome of the hip.
Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Kush, Nepali; Ozaki, Koji
There is a need for an effective and noninvasive treatment for intractable bone marrow edema syndrome of the hip. Forty-six patients with intractable bone marrow edema syndrome of the hip were retrospectively studied to compare the short-term clinical effects of treatment with high-energy extracorporeal shock wave therapy vs femoral head core decompression. The postoperative visual analog scale score decreased significantly more in the extracorporeal shock wave therapy group compared with the femoral head core decompression group (P<.05). For unilateral lesions, postoperative Harris Hip Scores for all hips in the extracorporeal shock wave therapy group were more significantly improved than Harris Hip Scores for all hips in the femoral head core decompression group (P<.05). Patients who underwent extracorporeal shock wave therapy also resumed daily activities significantly earlier. Average overall operative time was similar in both groups. Symptoms disappeared significantly sooner in the extracorporeal shock wave therapy group in patients with both unilateral (P<.01) and bilateral lesions (P<.05). Hospital costs were significantly lower with extracorporeal shock wave therapy compared with femoral head core decompression. The intraoperative fluoroscopy radiation dose was lower in extracorporeal shock wave therapy than in femoral head core decompression for both unilateral (P<.05) and bilateral lesions (P<.01). On magnetic resonance imaging (MRI), bone marrow edema improved in all patients during the follow-up period. After extracorporeal shock wave therapy, all patients remained pain-free and had normal findings on posttreatment radiographs and MRI scans. Extracorporeal shock wave therapy appears to be a valid, reliable, and noninvasive tool for rapidly resolving intractable bone marrow edema syndrome of the hip, and it has a low complication rate and relatively low cost compared with other conservative and surgical treatment approaches. PMID:25901618
R. Chiesa; D. Astore; G. Guzzo; S. Frigerio; Y. Tshomba; R. Castellano; M. R. Liberato de Moura; G. Melissano
Visceral artery aneurysms (VAA) frequently present as life-threatening emergencies. The purpose of this study was to review our experience with VAA treatment. Between 1988 and April 2002, 31 VAA were treated in 28 patients (14 males, 14 females) with average age of 55?�?15 years. The most common locations were the splenic artery (16) and the hepatic artery (7). Three patients
Activation of ERK signaling in rostral ventromedial medulla is dependent on afferent input from dorsal column pathway and contributes to acetic acid-induced visceral nociception.
Kang, Yi; Zhao, Yujie; Guo, Ruijuan; Zhang, Meijuan; Wang, Yue; Mu, Yonggao; Wu, Anshi; Yue, Yun; Wu, Jing; Wang, Yun
Several lines of evidence from both animal and clinical studies have demonstrated that dorsal column (DC) pathway plays a critical role in visceral pain transmission from the spinal cord to supraspinal center. The descending pain modulation pathway from the rostral ventromedial medulla (RVM) area has been implicated in visceral nociceptive neurotransmission. Previous studies have demonstrated that the multiple protein kinase signaling transduction cascades in the RVM area contribute to the descending facilitation of inflammatory pain and neuropathic pain. However, whether these signaling transduction pathways in the RVM area are triggered by the afferent visceral input from the DC pathway during acute visceral pain remains elusive. Here, we have tested the hypothesis that the afferent visceral stimuli from the DC pathway might induce the activation of extracellular signal-regulated protein kinase (ERK) signaling in the RVM area and contribute to the descending facilitation of neurotransmission in a rat model of visceral pain. Our results showed that acetic acid-induced visceral nociception produced a persistent activation of ERK in the RVM area and a microinjection of a mitogen-activated ERK kinase (MEK) inhibitor, U0126, into the RVM area significantly inhibited the visceral noxious stimulation-induced behaviors in rats. A microinjection of lidocaine into the nucleus gracilis (NG) also inhibited the activation of ERK in the RVM area. The current study indicates that activated ERK signaling pathway in the RVM area is dependent on afferent input from dorsal column pathway and may contribute to acetic acid-induced visceral nociception. PMID:23876632
Chronic pain in torture survivors
Annemarie B Thomsen; J�rgen Eriksen; Knud Smidt-Nielsen
According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the
The intractable cigarette �filter problem�
Background When lung cancer fears emerged in the 1950s, cigarette companies initiated a shift in cigarette design from unfiltered to filtered cigarettes. Both the ineffectiveness of cigarette filters and the tobacco industry's misleading marketing of the benefits of filtered cigarettes have been well documented. However, during the 1950s and 1960s, American cigarette companies spent millions of dollars to solve what the industry identified as the �filter problem�. These extensive filter research and development efforts suggest a phase of genuine optimism among cigarette designers that cigarette filters could be engineered to mitigate the health hazards of smoking. Objective This paper explores the early history of cigarette filter research and development in order to elucidate why and when seemingly sincere filter engineering efforts devolved into manipulations in cigarette design to sustain cigarette marketing and mitigate consumers' concerns about the health consequences of smoking. Methods Relevant word and phrase searches were conducted in the Legacy Tobacco Documents Library online database, Google Patents, and media and medical databases including ProQuest, JSTOR, Medline and PubMed. Results 13 tobacco industry documents were identified that track prominent developments involved in what the industry referred to as the �filter problem�. These reveal a period of intense focus on the �filter problem� that persisted from the mid-1950s to the mid-1960s, featuring collaborations between cigarette producers and large American chemical and textile companies to develop effective filters. In addition, the documents reveal how cigarette filter researchers' growing scientific knowledge of smoke chemistry led to increasing recognition that filters were unlikely to offer significant health protection. One of the primary concerns of cigarette producers was to design cigarette filters that could be economically incorporated into the massive scale of cigarette production. The synthetic plastic cellulose acetate became the fundamental cigarette filter material. By the mid-1960s, the meaning of the phrase �filter problem� changed, such that the effort to develop effective filters became a campaign to market cigarette designs that would sustain the myth of cigarette filter efficacy. Conclusions This study indicates that cigarette designers at Philip Morris, British-American Tobacco, Lorillard and other companies believed for a time that they might be able to reduce some of the most dangerous substances in mainstream smoke through advanced engineering of filter tips. In their attempts to accomplish this, they developed the now ubiquitous cellulose acetate cigarette filter. By the mid-1960s cigarette designers realised that the intractability of the �filter problem� derived from a simple fact: that which is harmful in mainstream smoke and that which provides the smoker with �satisfaction� are essentially one and the same. Only in the wake of this realisation did the agenda of cigarette designers appear to transition away from mitigating the health hazards of smoking and towards the perpetuation of the notion that cigarette filters are effective in reducing these hazards. Filters became a marketing tool, designed to keep and recruit smokers as consumers of these hazardous products. PMID:21504917
The Effect of Stellate Ganglion Block on Intractable Lymphedema after Breast Cancer Surgery
Kim, Jin; Cho, Soo Young; Baik, Hee Jung; Kim, Jong Hak
Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema. PMID:25589949
The effect of stellate ganglion block on intractable lymphedema after breast cancer surgery.
Kim, Jin; Park, Hahck Soo; Cho, Soo Young; Baik, Hee Jung; Kim, Jong Hak
Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema. PMID:25589949
Sequencing Intractable DNA to Close Microbial Genomes
Hurt, Jr., Richard Ashley [ORNL; Brown, Steven D [ORNL; Podar, Mircea [ORNL; Palumbo, Anthony Vito [ORNL; Elias, Dwayne A [ORNL
Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled intractable resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such difficult regions in the non-contiguous finished Desulfovibrio desulfuricans ND132 genome (6 intractable gaps) and the Desulfovibrio africanus genome (1 intractable gap). The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. These developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.
Transient receptor potential (TRP) A1 activated currents in TRPV1 and cholecystokinin-sensitive cranial visceral afferent neurons
Myung-Jin Choi; Zhenhua Jin; Yong Seek Park; Young Kyoung Rhee; Young-Ho Jin
Culinary use of the pungent spices has potential health benefits including a reduction in food intake. Pungent spices often contain ingredients that activate members of the transient receptor potential (TRP) family A1 and evoke pain from capsaicin-sensitive somatosensory neurons. TRPA1 channel have also been identified on cranial visceral afferent neurons but their distribution and functional contributions are poorly understood. Visceral
Undecidability and intractability in theoretical physics
Stephen Wolfram
Physical Processes are reviewed as computations, and the difficulty of answering questions about them is characterized in terms of the difficulty of performing the corresponding computations. Cellular automata are used to provide explicit examples of various formally undecidable and computationally intractable problems. It is suggested that such problems are common in physical models, and some other potential examples are discussed.
Neuronal correlates in the modulation of placebo analgesia in experimentally-induced esophageal pain: A 3T-fMRI study
Hsueh-Chieh Lu; Jen-Chuen Hsieh; Ching-Liang Lu; David M. Niddam; Yu-Te Wu; Tzu-Chen Yeh; Chou-Ming Cheng; Full-Young Chang; Shou-Dong Lee
Visceral pain\\/discomfort is the cardinal complaints and treatment targets for functional gastrointestinal disorders (FGID). However, effective treatment for such pain is limited and often associated with high placebo effects. The mechanisms of placebo effects in visceral pain are unclear. We used functional neuroimaging to study the central representations of the placebo effect and its anticipation during esophageal pain in healthy
DREAM Is a Critical Transcriptional Repressor for Pain Modulation
Hai-Ying M. Cheng; Graham M. Pitcher; Steven R. Laviolette; Ian Q. Whishaw; Kit I. Tong; Lisa K. Kockeritz; Teiji Wada; Nicholas A. Joza; Michael Crackower; Jason Goncalves; Ildiko Sarosi; James R. Woodgett; Antonio J. Oliveira-dos-Santos; Mitsuhiko Ikura; Derek van der Kooy; Michael W. Salter; Josef M. Penninger
Control and treatment of chronic pain remain major clinical challenges. Progress may be facilitated by a greater understanding of the mechanisms underlying pain processing. Here we show that the calcium-sensing protein DREAM is a transcriptional repressor involved in modulating pain. dream?\\/? mice displayed markedly reduced responses in models of acute thermal, mechanical, and visceral pain. dream?\\/? mice also exhibited reduced
Hepatic visceral larva migrans
Rohilla, Seema; Jain, Nitin; Yadav, Rohtas; Dhaulakhandi, Dhara Ballabh
Visceral larva migrans (VLM) is a systemic manifestation of migration of second stage larvae of nematodes through the tissue of human viscera. It is not uncommon but is underdiagnosed in developing countries. The liver is the most common organ to be involved due to its portal venous blood supply. The imaging findings are subtle and differentiation from hepatocellular carcinoma (HCC), metastases, cystic mesenchymal hamartoma and granulomatous diseases is difficult. This case report highlights the imaging features of hepatic lesions of VLM along with clinical and laboratory data which help in clinching the diagnosis. PMID:23853189
Bayesian model comparison with intractable likelihoods
Everitt, Richard G; Rowing, Ellen; Evdemon-Hogan, Melina
Markov random field models are used widely in computer science, statistical physics and spatial statistics and network analysis. However, Bayesian analysis of these models using standard Monte Carlo methods is not possible due to their intractable likelihood functions. Several methods have been developed that permit exact, or close to exact, simulation from the posterior distribution. However, estimating the evidence and Bayes' factors (BFs) for these models remains challenging in general. This paper describes new random weight importance sampling and sequential Monte Carlo methods for estimating BFs that use simulation to circumvent the evaluation of the intractable likelihood, and compares them to existing methods. In some cases we observe an advantage in the use of biased weight estimates; an initial investigation into the theoretical and empirical properties of this class of methods is presented.
Noninvasive treatment alternative for intractable startle epilepsy
Klinkenberg, Sylvia; Ubbink, Sander; Vles, Johannes; de Louw, Anton; van Hall, Mariette Debeij; Scheijen, Dyon; Brokx, Jan
We describe a treatment alternative for intractable, startle-provoked, epileptic seizures in four children aged between 8 and 14. Three of the four children had symptomatic localization-related epilepsy. They all suffered from intractable epilepsy precipitated by sudden sounds. The fact that seizures tended to occur with high frequency � more than one seizure a day � had a clear impact on daily life. Clinical seizure pattern demonstrated asymmetric tonic posturing in all four children. Three children experienced several seizure types including focal seizure onset. All children had focal neurological signs or learning disabilities or a combination of both. Our noninvasive treatment method using psychoeducational counseling and sound generators was applied in four children, resulting in a seizure frequency reduction of ?�50% in two of them. PMID:25667869
Narrative spaces between intractability outside the clinic.
Wiederhold, Anna M
In this essay, the author reflects on her experience conducting field research outside an abortion clinic amid volatile protests and counterprotests. She identifies moments of convergence in the oppositional groups' narrative explanations for participating in the weekly protests, and contemplates the possibilities for dialogue in these sorts of intractable conflicts. She concludes with reflections on communication scholars' roles in engaging with polarizing health narratives. PMID:24160468
[Global strategy for rare and intractable diseases].
Kawashima Kodama, Tomoko
The progress has been made in research on rare and intractable diseases, for which new drug development has long been limited due to rarity, by establishing a global network in recent years. In Japan, the countermeasure of rare and intractable diseases has been implemented under national policy outline as an integrated strategy since 1972, including surveys and research, construction of medical facilities, reducing burden of medical expenses for patients, and enhancement of welfare and improving QOL of patients. Along with legislation or regulation of orphan drugs development, treatment and care for rare diseases have been emphasized in each national healthcare system globally. In the US, the Office of Rare Diseases was established under NIH in 1989 and European countries also started collaboration for rare disease projects with their own national plans in 1999. As a platform of rare diseases patients, healthcare professionals, researchers, pharmaceutical industry, and policy makers, Orphanet has a well-designed website which networks them. In Japan, there are urgent needs for global standard patient registration system and strengthening global collaboration for developing treatment and care for the patients of rare and intractable diseases, which needs more cooperative relations with patient organizations and pharmaceutical industry within country. PMID:24291960
Neonatal stress from limited bedding elicits visceral hyperalgesia in adult rats.
Guo, Yumei; Wang, Zhuo; Mayer, Emeran A; Holschneider, Daniel P
Early life stress is a risk factor for developing functional pain disorders. The 'limited bedding' (LB) model elicits psychological stress in the dam and her pups by providing minimal nesting material following delivery. Little is known about the effects of LB on visceral pain. Rats (female, male) were exposed to LB on postnatal days 2-9. Electromyographic visceromotor responses were recorded at the age of 11-12 weeks during titrated colorectal distension. LB exposure resulted in significant visceral hyperalgesia in both sexes. Sex differences were demonstrated only in nonstressed controls, with females showing a greater visceromotor response. Our results prepare the way for use of the LB model in studying the development of visceral pain in adults with functional gastrointestinal disorders. PMID:25426824
Long-term Anterior Thalamus Stimulation for Intractable Epilepsy
Siew-Na Lim; Shih-Tseng Lee; Yu-Tai Tsai; I-An Chen; Po-Hsun Tu; Jean-Lon Chen; Hsiu-Wen Chang; Yu-Chin Su
Background: Deep brain stimulation (DBS) has re-emerged as an alternative therapy for intractable epilepsy. In this study, we investigated the feasibility, efficacy and safety of long-term anterior thalamic nucleus (ATN) stimulation for intractable epilepsy. Methods: In this open-label pilot study of electrical stimulation of the ATN, we investi- gated four cases of intractable epilepsy (one man with generalized seizure, and
Neurobiological Mechanisms of Pelvic Pain
Leone Roberti Maggiore, Umberto; Candiani, Massimo
Pelvic pain is a common condition which significantly deteriorates health-related quality of life. The most commonly identified causes of pain in the pelvic region are gynaecologic, urologic, gastrointestinal, neurological, and musculoskeletal. However, in up to 33% of patients the source of this symptom is not identified, frustrating both patients and health-care professionals. Pelvic pain may involve both the somatic and visceral systems, making the differential diagnosing challenging. This paper aimed to review the mechanisms involved in pelvic pain perception by analyzing the neural plasticity and molecules which are involved in these complex circuits. PMID:25110704
Somatic Pain Sensitivity in Children With Recurrent Abdominal Pain
Katrin Zohsel; Johanna Hohmeister; Herta Flor; Christiane Hermann
OBJECTIVE:Evidence is accumulating that recurrent abdominal pain (RAP) in children is associated with visceral hyperalgesia. However, it is not known whether somatic sensitivity is altered as well. Therefore, the aim of our study was to assess somatic pain sensitivity in children with RAP and healthy controls at the abdomen and a distal site (thenar).METHODS:We examined 20 children with RAP (age
Neuronal correlates in the modulation of placebo analgesia in experimentally-induced esophageal pain: a 3T-fMRI study.
Lu, Hsueh-Chieh; Hsieh, Jen-Chuen; Lu, Ching-Liang; Niddam, David M; Wu, Yu-Te; Yeh, Tzu-Chen; Cheng, Chou-Ming; Chang, Full-Young; Lee, Shou-Dong
Visceral pain/discomfort is the cardinal complaints and treatment targets for functional gastrointestinal disorders (FGID). However, effective treatment for such pain is limited and often associated with high placebo effects. The mechanisms of placebo effects in visceral pain are unclear. We used functional neuroimaging to study the central representations of the placebo effect and its anticipation during esophageal pain in healthy adults. Fourteen subjects were enrolled. Pain extent, psychophysical inventories [Pain Catastrophizing Scale (PAS), visual analogue scale (VAS) and short-form McGill questionnaire], and brain activity upon placebo intervention and upon anticipation were assessed in response to esophageal balloon distension. Large reductions of pain extent, VAS rating, short-form McGill questionnaire scores, and brain activity in the visceral pain matrix [thalamus, somatosensory cortices, insula, prefrontal cortex (PFC), anterior cingulate cortex] were observed upon placebo treatment. The aforementioned brain areas and the bilateral amygdala were significantly correlated with decreased pain extent and VAS in response to placebo. The ventral lateral PFC (VLPFC) was associated with increased activity during anticipation of visceral pain. PAS cannot predict the placebo effect in visceral pain. In conclusion, pronounced placebo analgesia was coupled with prominent changes of brain activity in visceral pain matrix, which are thus likely involved in high placebo efficacy during the treatment of visceral pain in FGID. VLPFC activation during the anticipation of placebo analgesia suggests top-down control in the modulation of pain experience. PMID:19962240
Rethinking Intractable Conflict: The Perspective of Dynamical Systems
ERIC Educational Resources Information Center
Vallacher, Robin R.; Coleman, Peter T.; Nowak, Andrzej; Bui-Wrzosinska, Lan
Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified�
The endogenous hydrogen sulfide producing enzyme cystathionine-? synthase contributes to visceral hypersensitivity in a rat model of irritable bowel syndrome
Guang-Yin Xu; John H Winston; Mohan Shenoy; Shufang Zhou; Jiande DZ Chen; Pankaj J Pasricha
BACKGROUND: The pathogenesis of visceral hypersensitivity, a characteristic pathophysiological feature of irritable bowel syndrome (IBS), remains elusive. Recent studies suggest a role for hydrogen sulfide (H2S) in pain signaling but this has not been well studied in visceral models of hyperalgesia. We therefore determined the role for the endogenous H2S producing enzyme cystathionine-?-synthetase (CBS) in a validated rat model of
Imipramine decreases oesophageal pain perception in human male volunteers
Peghini, P; Katz, P; Castell, D
Background�Visceral hyperalgesia is a hallmark of functional gastrointestinal disorders. Antidepressants improve symptoms in these patients, although their mode of action is unclear. Antidepressant, anticholinergic, and analgesic mechanisms have been proposed. ?Aims�To investigate whether imipramine, which has a visceral analgesic effect, increases pain thresholds to experimental visceral pain. ?Methods�Visceral perception for first sensation and pain was measured with intraoesophageal balloon distension in 15 male volunteers. The effect of imipramine was studied in a double blind, placebo controlled, crossover study. Imipramine was given in ascending doses for 12 days (25 mg days 1-3, 50 mg days 4-6, 75 mg days 7-12), with oesophageal perception studied on day 13. ?Results�Inflation volumes and intraballoon pressures at first sensation were not different between placebo and imipramine. Balloon inflation volume at pain threshold was higher on imipramine (p=0.015). Median intraballoon pressures were not different at pain threshold for placebo and imipramine. Oesophageal wall compliance was not affected by imipramine. ?Conclusion�Increased pain thresholds on imipramine in this group of normal male volunteers in the absence of changes in oesophageal tone imply the presence of a visceral analgesic effect. ?? Keywords: antidepressants; imipramine; visceral hyperalgesia; oesophageal balloon; distension; functional bowel syndromes PMID:9691919
The effect of ketamine as an additive in epidural block on the intractable herpetic neuralgia: a case report
Lee, Jin Young; Kim, Kyung Mi; Oh, Min Seok; Lee, Ji Eun
Ketamine has been shown to have analgesic effect by blocking N-methyl-D-aspartate receptor, thus preventing and reducing central sensitization caused by peripheral nociceptive stimulation. However, due to lack of knowledge about its safety and toxicity in the central nervous system, either epidural or intrathecal injection of ketamine still remains controversial. Here, we describe a case report of satisfactory pain relief after the addition of ketamine in epidural injection in a patient with severe herpes zoster pain that was refractory to conventional medication, intravenous opioids and continuous epidural block. This case indicates the viability of epidural ketamine injection in patients with intractable herpetic neuralgia. PMID:24567816
Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome
Tsukasa Nozu; Miwako Kudaira
BACKGROUND: Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed
Frank, A
The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals. Images FIG 2 PMID:8347190
Vagal nerve stimulation: adjustments to reduce painful side effects.
Liporace, J; Hucko, D; Morrow, R; Barolat, G; Nei, M; Schnur, J; Sperling, M
Vagal nerve stimulation is an approved adjunctive treatment for medically intractable epilepsy. Although it is generally well tolerated, some patients experience pain, coughing, or hoarseness during stimulation. Lowering the pulse width in these patients alleviates pain and reduces voice alteration without loss of efficacy. This allows more optimal programming of stimulation intensities. PMID:11552021
[My way to "Keep Pioneering": integrated neuroscience and immunology research produces a paradigm shift for intractable neurological disease].
Kira, Jun-ichi
The motto of Prof. Yoshigoro Kuroiwa, who established the first independent neurology department in Japan at Kyushu University, is "Keep Pioneering". His students have followed this motto in all fields. I hereby present my efforts to keep pioneering in the following fields: (1) multiple sclerosis (MS); (2) central nervous system (CNS) involvement associated with peripheral atopic inflammation; and (3) care network for patients with intractable neurological disease. In MS, I propose that Th1/Th17 cell-mediated connexin astrocytopathy may play a critical role in producing huge demyelinating lesions in MS, neuromyelitis optica (NMO), and Bal�'s concentric sclerosis. I discovered a peculiar myelitis that occurred in patients with atopic disorders, and designated it atopic myelitis. In this condition, allodynia and neuropathic pain are cardinal features, regardless of the presence or absence of spinal cord MRI lesions. We found that peripheral atopic inflammation in mice produces allodynia as well as activation of microglia and astroglia in the spinal cord. It is important to involve a variety of medical specialists and care coordinators for collaborative work on medical and social care issues for people with intractable disease. The motto of "Keep Pioneering" in neurology covers not only advanced research for the creation of new therapies for intractable neurological disease, but also caring for actual people with intractable disease, which I believe is the corporate social responsibility of our neurological society. I think that "Keep Pioneering" is a challenging process that never ends throughout one's life. PMID:25672676
21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.
Code of Federal Regulations, 2012 CFR
...applies electrical current to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists...receiver with electrodes that are placed within a patient's brain and an external transmitter for transmitting the...
21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.
Code of Federal Regulations, 2013 CFR
...applies electrical current to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists...receiver with electrodes that are placed within a patient's brain and an external transmitter for transmitting the...
21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.
Code of Federal Regulations, 2014 CFR
...applies electrical current to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists...receiver with electrodes that are placed within a patient's brain and an external transmitter for transmitting the...
Intractable yawning associated with mature teratoma of the supramedial cerebellum.
Saura, Hiroaki; Beppu, Takaaki; Matsuura, Hideki; Asahi, Shigeki; Uesugi, Noriyuki; Sasaki, Makoto; Ogasawara, Kuniaki
Yawning occurs in various conditions such as hypoxia, epilepsy, and sleep disorders including sleep apnea. Intractable yawning associated with a brain tumor has been rarely reported. A 19-year-old woman presented with intractable yawning. Magnetic resonance imaging showed a tumor in the supramedial cerebellum that compressed the dorsal side of the midbrain and upper pons. After subtotal removal of the tumor, the yawning completely disappeared. Postoperative MRI showed resolution of compression of the brainstem. The tumor was histologically diagnosed as a mature teratoma. The present case suggested that the intractable yawning resulted from the tumor compressing the dorsal side of the junction between the midbrain and pons. PMID:24878284
Theta-frequency phase-locking of single anterior cingulate cortex neurons and synchronization with the medial thalamus are modulated by visceral noxious stimulation in rats.
Wang, J; Cao, B; Yu, T R; Jelfs, B; Yan, J; Chan, R H M; Li, Y
The rodent anterior cingulate cortex (ACC) is critical for visceral pain and pain-related aversive response in chronic visceral hypersensitive (VH) state. Long-term potentiation (LTP), induced by theta burst stimulation (TBS) in the medial thalamus (MT)-ACC pathway, is blocked in VH rats. However, the neuronal intrinsic firing characteristics and the MT-ACC connectivity have not been investigated in visceral pain. Using repetitive distension of the colon and rectum (rCRD) as a sensitization paradigm, we have identified that the spontaneous firing rates of ACC neurons and the CRD-stimulated neuronal firings were increased after repetitive visceral noxious stimulation. This correlates with increases in visceral pain responses (visceromotor responses, VMRs). Two multichannel arrays of electrodes were implanted in the MT and ACC. Recordings were performed in free-moving rats before and after repeated CRD treatment. Power spectral density analysis showed that the local field potential (LFP) recorded in the ACC displayed increases in theta band power (4-10Hz) that were modulated by rCRD. Neural spike activity in the ACC becomes synchronized with ongoing theta oscillations of LFP. Furthermore, cross correlation analysis showed augmented synchronization of thalamo-ACC theta band LFPs, which was consistent with an increase of neuronal communication between the two regions. In conclusion, these results reveal theta oscillations and theta-frequency phase-locking as prominent features of neural activity in the ACC and a candidate neural mechanism underlying acute visceral pain. PMID:25899844
P2X7 receptor of rat dorsal root ganglia is involved in the effect of moxibustion on visceral hyperalgesia.
Liu, Shuangmei; Shi, Qingming; Zhu, Qicheng; Zou, Ting; Li, Guilin; Huang, An; Wu, Bing; Peng, Lichao; Song, Miaomiao; Wu, Qin; Xie, Qiuyu; Lin, Weijian; Xie, Wei; Wen, Shiyao; Zhang, Zhedong; Lv, Qiulan; Zou, Lifang; Zhang, Xi; Ying, Mofeng; Li, Guodong; Liang, Shangdong
Irritable bowel syndrome (IBS) and inflammatory bowel disease often display visceral hypersensitivity. Visceral nociceptors after inflammatory stimulation generate afferent nerve impulses through dorsal root ganglia (DRG) transmitting to the central nervous system. ATP and its activated-purinergic 2X7 (P2X7) receptor play an important role in the transmission of nociceptive signal. Purinergic signaling is involved in the sensory transmission of visceral pain. Moxibustion is a therapy applying ignited mugwort directly or indirectly at acupuncture points or other specific parts of the body to treat diseases. Heat-sensitive acupoints are the corresponding points extremely sensitive to moxa heat in disease conditions. In this study, we aimed to investigate the relationship between the analgesic effect of moxibustion on a heat-sensitive acupoint "Dachangshu" and the expression levels of P2X7 receptor in rat DRG after chronic inflammatory stimulation of colorectal distension. Heat-sensitive moxibustion at Dachangshu acupoint inhibited the nociceptive signal transmission by decreasing the upregulated expression levels of P2X7 mRNA and protein in DRG induced by visceral pain, and reversed the abnormal expression of glial fibrillary acidic protein (GFAP, a marker of satellite glial cells) in DRG. Consequently, abdominal withdrawal reflex (AWR) score in a visceral pain model was reduced, and the pain threshold was elevated. Therefore, heat-sensitive moxibustion at Dachangshu acupoint can produce a therapeutic effect on IBS via inhibiting the nociceptive transmission mediated by upregulated P2X7 receptor. PMID:25527178
Vagus nerve stimulation for intractable epilepsy in tuberous sclerosis complex
Philippe Major; Elizabeth A. Thiele
ObjectivesThe aim of the study described here was to characterize the efficacy and safety of vagus nerve stimulation in a population of patients with tuberous sclerosis complex (TSC) and intractable epilepsy.
Anastomoses between the spermatic and visceral veins:a retrospective study of 500 consecutive patients
J.-M. Bigot; A.-F. Le Blanche; M.-F. Carette; N. Gagey; M. Bazot; F. P. Boudghene
.��\\u000a Background: Do visceral�spermatic vein shunts have any clinical impact on sclerotherapy of varicoceles?\\u000a \\u000a \\u000a \\u000a Methods: The spermatic venograms of 500 consecutive patients were retrospectively reviewed to classify visceral�spermatic communications.\\u000a Men with an average age of 27.8 years (range 11�65 years old) underwent sclerotherapy of a varicocele. Of the 500 men, 445\\u000a were referred for oligoasthenospermia (89%), 45 for pain (9%),
Evaluation of the loin pain\\/hematuria syndrome treated by renal autotransplantation or radical renal neurectomy
AG Sheil; AK Chui; DJ Verran; J Boulas; LS Ibels
Some patients with the loin pain\\/hematuria syndrome suffer incapacitating flank pain. No effective therapy has been reported. Uncertainty persists concerning the authenticity of the pain and the role of surgery in treatment. Forty-six patients with loin pain\\/hematuria syndrome and intractable pain were evaluated following treatment either by renal autotransplantation (30 patients, 10 bilaterally) or by renal denervation (20 patients, four
Ultrasound-guided pulsed radiofrequency ablation of the genital branch of the genitofemoral nerve for treatment of intractable orchalgia
Terkawi, Abdullah Sulieman; Romdhane, Kamel
Chronic orchalgia is a frustrating clinical problem for both the patient and the physician. We present a 17-year-old boy with a bilateral idiopathic chronic intractable orchalgia with failed conservative treatment. For 2 years, he suffered from severe attacks of scrotal pain that affected his daily activities and caused frequent absence from school. Ultrasound-guided pulsed radiofrequency ablation (PRF) of the genital branches of the genitofemoral nerve performed after local anesthetic nerve block confirmed the diagnosis and yielded 6 weeks of symptom relief. Seven-month follow-up revealed complete satisfactory analgesia. The use of PRF is an effective and non-invasive approach to treat intractable chronic orchalgia. PMID:24843352
Neurotrophin signaling and visceral hypersensitivity
Qiao, Li-Ya
Neurotrophin family are traditionally recognized for their nerve growth promoting function and are recently identified as crucial factors in regulating neuronal activity in the central and peripheral nervous systems. The family members including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) are reported to have distinct roles in the development and maintenance of sensory phenotypes in normal states and in the modulation of sensory activity in disease. This paper highlights receptor tyrosine kinase (Trk) -mediated signal transduction by which neurotrophins regulate neuronal activity in the visceral sensory reflex pathways with emphasis on the distinct roles of NGF and BDNF signaling in physiologic and pathophysiological processes. Viscero-visceral cross-organ sensitization exists widely in human diseases. The role of neurotrophins in mediating neural cross talk and interaction in primary afferent neurons in the dorsal root ganglia (DRG) and neurotrophin signal transduction in the context of cross-organ sensitization are also discussed. PMID:25484893
Spinal Cord Stimulation for Neuropathic Pain
Executive Summary Objective The objective of this health technology policy assessment was to determine the effectiveness of spinal cord stimulation (SCS) to manage chronic intractable neuropathic pain and to evaluate the adverse events and Ontario-specific economic profile of this technology. Clinical Need SCS is a reversible pain therapy that uses low-voltage electrical pulses to manage chronic, intractable neuropathic pain of the trunk or limbs. Neuropathic pain begins or is caused by damage or dysfunction to the nervous system and can be difficult to manage. The prevalence of neuropathic pain has been estimated at about 1.5% of the population in the United States and 1% of the population in the United Kingdom. These prevalence rates are generalizable to Canada. Neuropathic pain is extremely difficult to manage. People with symptoms that persist for at least 6 months or who have symptoms that last longer than expected for tissue healing or resolution of an underlying disease are considered to have chronic pain. Chronic pain is an emotional, social, and economic burden for those living with it. Depression, reduced quality of life (QOL), absenteeism from work, and a lower household income are positively correlated with chronic pain. Although the actual number is unknown, a proportion of people with chronic neuropathic pain fail to obtain pain relief from pharmacological therapies despite adequate and reasonable efforts to use them. These people are said to have intractable neuropathic pain, and they are the target population for SCS. The most common indication for SCS in North America is chronic intractable neuropathic pain due to failed back surgery syndrome (FBSS), a term that describes persistent leg or back and leg pain in patients who have had back or spine surgery. Neuropathic pain due to complex regional pain syndrome (CRPS), which can develop in the distal aspect of a limb a minor injury, is another common indication. To a lesser extent, chronic intractable pain of postherpetic neuralgia, which is a persistent burning pain and hyperesthesia along the distribution of a cutaneous nerve after an attack of herpes zoster, is also managed with SCS. For each condition, SCS is considered as a pain management therapy only after conventional pain therapies, including pharmacological, nonpharmacological, and surgical treatments, if applicable, have been attempted and have failed. The Technology The SCS technology consists of 3 implantable components: a pulse generator, an extension cable, and a lead (a small wire). The pulse generator is the power source for the spinal cord stimulator. It generates low-voltage electrical pulses. The extension cable connects the pulse generator to the lead. The lead is a small, insulated wire that has a set of electrodes at one end. The lead is placed into the epidural space on the posterior aspect of the spinal cord, and the electrodes are positioned at the level of the nerve roots innervating the painful area. An electrical current from the electrodes induces a paresthesia, or a tingling sensation that masks the pain. Before SCS is initiated, candidates must have psychological testing to rule out major psychological illness, drug habituation, and issues of secondary gain that can negatively influence the success of the therapy. Successful candidates will have a SCS test stimulation period (trial period) to assess their responsiveness to SCS. The test stimulation takes about 1 week to complete, and candidates who obtain at least 50% pain relief during this period are deemed suitable to receive a permanent implantation of a spinal cord stimulator Review Strategy The Medical Advisory Secretariat (MAS) reviewed all published health technology assessments of spinal cord stimulation. Following this, a literature search was conducted from 2000 to January, 2005 and a systematic review of the literature was completed. The primary outcome for the systematic review was pain relief. Secondary outcomes included functional status and quality of life. After applying the predetermined inclusion and exclus
Intracranial ablative procedures for the treatment of chronic pain.
Menon, Jayant P
Three main techniques delineate a possible role for intracranial ablative procedures in patients with chronic pain. Recent studies demonstrate a continued need for clinical investigation into central mechanisms of neuroablation to best define its role in the care of patients with otherwise intractable and severe pain syndromes. Cingulotomy can result in long-term pain relief. Although it can be associated with subtle impairments of attention, there is little risk to other cognitive domains. PMID:25240655
Review of common and unusual causes of lateral ankle pain
Surabhi Choudhary; Eugene McNally
Lateral ankle pain is a common clinical presentation having several important causes, including lateral ligament injury, peroneal\\u000a tendon injury, sinus tarsi syndrome, and nerve entrapments. However, other causes should be kept in mind in patients with\\u000a unusual patterns of pain or intractable symptoms. We present a review of common and some unusual causes of lateral ankle pain\\u000a including a review
An unusual case of shoulder pain.
Slipman, C W; Shin, C H; Ellen, M I; Patel, R K; Braverman, D; Lenrow, D
Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain. PMID:16906176
Inguinoscrotal pain resistant to conventional treatment
Jain, Anuj; Agarwal, Anil
Inguinoscrotal pain (ISP) is a common complaint that affects almost all age groups. The etiology may be vascular, neurogenic, visceral, muscular or psychological. Most causes of ISP are benign, but Pott's spine as a cause of ISP, when missed, may lead to serious outcomes. PMID:25624580
Persistent visceral allodynia in rats exposed to colorectal irradiation is reversed by mesenchymal stromal cell treatment.
Durand, Christelle; Pezet, Sophie; Eutam�ne, H�l�ne; Demarquay, Christelle; Mathieu, No�lle; Moussa, Lara; Daudin, Rachel; Holler, Val�rie; Sabourin, Jean-Christophe; Milliat, Fabien; Fran�ois, Agn�s; Theodorou, Vassilia; Tamarat, Radia; Benderitter, Marc; S�mont, Alexandra
Each year, millions of people worldwide are treated for primary or recurrent pelvic malignancies, involving radiotherapy in almost 50% of cases. Delayed development of visceral complications after radiotherapy is recognized in cancer survivors. Therapeutic doses of radiation may lead to the damage of healthy tissue around the tumor and abdominal pain. Because of the lack of experimental models, the underlying mechanisms of radiation-induced long-lasting visceral pain are still unknown. This makes managing radiation-induced pain difficult, and the therapeutic strategies proposed are mostly inefficient. The aim of our study was to develop an animal model of radiation-induced visceral hypersensitivity to (1) analyze some cellular and molecular mechanisms involved and (2) to test a therapeutic strategy using mesenchymal stromal cells (MSCs). Using a single 27-Grays colorectal irradiation in rats, we showed that such exposure induces a persistent visceral allodynia that is associated with an increased spinal sensitization (enhanced p-ERK neurons), colonic neuroplasticity (as increased density of substance P nerve fibers), and colonic mast cell hyperplasia and hypertrophy. Mast cell stabilization by ketotifen provided evidence of their functional involvement in radiation-induced allodynia. Finally, intravenous injection of 1.5 million MSCs, 4 weeks after irradiation, induced a time-dependent reversion of the visceral allodynia and a reduction of the number of anatomical interactions between mast cells and PGP9.5+ nerve fibers. Moreover, unlike ketotifen, MSC treatment has the key advantage to limit radiation-induced colonic ulceration. This work provides new insights into the potential use of MSCs as cellular therapy in the treatment of pelvic radiation disease. PMID:25887464
Strain-dependent variations in visceral sensitivity: relationship to stress, anxiety and spinal glutamate transporter expression.
Moloney, R D; Dinan, T G; Cryan, J F
Responses to painful stimuli differ between populations, ethnic groups, sexes and even among individuals of a family. However, data regarding visceral pain are still lacking. Thus, we investigated differences in visceral nociception across inbred and outbred mouse strains using colorectal distension. Anxiety and depression-like behaviour were assessed using the open field and forced swim test as well as the corticosterone stress response. Possible mechanistic targets [excitatory amino acid transporter (EAAT-1), brain-derived neurotrophic factor (BDNF) and 5HT1A receptor] were also assessed using quantitative real-time polymerase chain reaction. Adult, male, inbred and outbred mouse strains were used in all assays (inbred strains; CBA/J Hsd, C3H/HeNHsd, BALB/c OlaHsd, C57 BL/6JOlaHsd, DBA/2J RccHsd, CAST/EiJ, SM/J, A/J OlaHsd, 129P2/OlaHsd, FVB/NHan Hsd and outbred strains: Swiss Webster, CD-1). mRNA expression levels of EAAT-1, BDNF and 5HT1A receptor (HTR1A) were quantified in the lumbosacral spinal cord, amygdala and hippocampus. A significant effect of strain was found in visceral sensitivity, anxiety and depressive-like behaviours. Strain differences were also seen in both baseline and stress-induced corticosterone levels. CBA/J mice consistently exhibited heightened visceral sensitivity, anxiety behaviour and depression-like behaviour which were associated with decreased spinal EAAT-1 and hippocampal BDNF and HTR1A. Our results show the CBA/J mouse strain as a novel mouse model to unravel the complex mechanisms of brain-gut axis disorders such as irritable bowel syndrome, in particular the underlying mechanisms of visceral hypersensitivity, for which there is great need. Furthermore, this study highlights the importance of genotype and the consequences for future development of transgenic strains in pain research. PMID:25851919
Systematic mechanism-orientated approach to chronic pancreatitis pain.
Bouwense, Stefan A W; de Vries, Marjan; Schreuder, Luuk T W; Olesen, S�ren S; Fr�kj�r, Jens B; Drewes, Asbj�rn M; van Goor, Harry; Wilder-Smith, Oliver H G
Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic intervention, often fails even if technically successful. If central nervous system pain processing is altered, specific treatment targeting these changes should be instituted (e.g., gabapentinoids, ketamine or tricyclic antidepressants). Suitable tools are now available to make altered central processing visible, including quantitative sensory testing, electroencephalograpy and (functional) magnetic resonance imaging. These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes. The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved. Future research should address the circumstances under which central nervous system pain processing changes in CP, and how this is influenced by ongoing nociceptive input and therapies. Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy, leading to improved treatment of chronic pain in CP and other visceral pain disorders. PMID:25574079
Lamotrigine for intractable migraine-like headaches in Sturge-Weber syndrome.
Nomura, Shohei; Shimakawa, Shuichi; Fukui, Miho; Tanabe, Takuya; Tamai, Hiroshi
We herein report that naratriptan remarkably improved intractable migraine-like headaches in a patient with Sturge-Weber syndrome (SWS) despite his past history of cerebral infarction. In addition, lamotrigine had a prophylactic effect on his visual aura and headaches. An 18-year-old male patient with SWS had intractable migraine-like headaches every several months from the age of 3years. His migraine-like headaches were characterized by pulsating attacks preceded by left homonymous hemianopsia, which persisted after headache disappearance. In addition, after 14years of age, the pulsating headaches were preceded by photophobia without homonymous hemianopsia and occurred almost daily. Headache pains were not improved by acetaminophen or loxoprofen sodium hydrate. Furthermore, various prophylactic drugs were ineffective. After obtaining informed consent, naratriptan was administered. The pain severity was reduced and the duration of headache with homonymous hemianopsia was shortened from several days to several hours. Interestingly, naratriptan also shortened the duration of homonymous hemianopsia to several hours. We confirmed that his headache attacks were not epileptic seizures by ictal electroencephalography. However, 25mg/day of lamotrigine had a prophylactic effect on the frequency of headache. Moreover, lamotrigine led to complete remission of his headache without homonymous hemianopsia. Lamotrigine may have an advantage in terms of reducing the risk of cerebrovascular disease caused by migraine-like headaches and the use of triptans. The most effective management for migraine-like headaches in patients with SWS has not been established. Lamotrigine is a potentially effective option for patients with SWS with migraine-like headaches. PMID:23877022
Donepezil-related intractable hiccups: a case report.
McGrane, Ian R; Shuman, Michael D; McDonald, Robert W
This case report describes a man with intractable hiccups probably caused by donepezil. The patient's symptoms were not responsive to commonly used medications for hiccups, but they were improved and completely relieved upon donepezil dose deescalation and discontinuation. We report two occasions in which the discontinuation of donepezil resulted in hiccup resolution and three occasions in which initiation of donepezil was associated with the onset of hiccups. This report contributes to the growing body of literature that describes an association between centrally acting medications and intractable hiccups. PMID:25756505
Symptoms and visceral perception in severe functional and organic dyspepsia
Mertz, H; Fullerton, S; Naliboff, B; Mayer, E
Background�Hypersensitivity of gastric afferent pathways may play an aetiological role in symptoms of functional dyspepsia. ?Aims�To determine whether patients with severe organic dyspepsia (associated with tissue irritation/injury) and those with functional dyspepsia (no detectable tissue irritation) differ in their perception of gastric distension and whether this difference is reflected in differences in their gastrointestinal and psychological symptoms. ?Methods�Perceptual thresholds, referral patterns, and gastrointestinal and psychological symptoms were compared in 23 patients with functional dyspepsia, 10 organic dyspeptics, and 15 healthy controls. ?Results�Fifteen (65%) functional dyspeptics and no organic dyspeptics had reduced perceptual thresholds for fullness, discomfort, or pain (odds ratio (OR) 19.56, 95% confidence interval (CI) 1.95to 476.09, p=0.0017). Either reduced perceptual thresholds or altered referral was found in 20 (87%) functional dyspeptics and four (20%) organic dyspeptics (OR 10.0, 95% CI 1.34 to 89.54,p=0.014). During sham distension fullness, discomfort and pain were reported by healthy controls, organic dyspeptics, and functional dyspeptics. A sham response of pain but no other sensation was more frequent among functional dyspeptics (43%) than healthy controls (7%) (OR 10.77, 95% CI 1.10 to 257.35, p=0.026). Gastrointestinal and psychological symptoms and gastric compliance were similar in the functional and organic groups. ?Conclusions�Alterations in the perception of gastric distension distinguishes between functional and organic dyspepsia, while symptoms do not. A total of 87% of functional dyspeptics studied had evidence of altered visceral afferent function. In this study population, psychological abnormalities or changes in compliance did not explain the findings. ?? Keywords: dyspepsia; hyperalgesia; visceral afferents PMID:9691920
Modulation of human visceral sensitivity by noninvasive magnetoelectrical neural stimulation in health and irritable bowel syndrome.
Algladi, Tarig; Harris, Mary; Whorwell, Peter J; Paine, Peter; Hamdy, Shaheen
Visceral pain is a particularly difficult symptom to manage in patients with irritable bowel syndrome (IBS). Our aim was to examine whether noninvasive neurostimulation applied to the motor cortex or lumbosacral region can modulate human visceral sensation. Sixteen healthy adult volunteers and 10 patients with IBS were evaluated. Single-pulse lumbosacral magnetic stimulation (LSMS) or transcranial magnetic stimulation (TMS) was used to assess spinal root and cortical excitability as well as the effect of neurostimulation on anorectal sensation and pain, which were provoked by a local electrical stimulus. Initially, healthy volunteers received 6 stimulation paradigms in a randomised order (3 repetitive LSMS [1 Hz, 10 Hz, and sham]) and 3 repetitive TMS (1 Hz, 10 Hz, and sham) to investigate the effects on neural function and visceral sensation over 1 hour. The most effective cortical and spinal interventions were then applied in patients with IBS. Only 1-Hz rLSMS altered healthy anal motor excitability, increasing spinal (58 � 12.3 vs 38.5 � 5.7 ?V, P = 0.04) but not cortical responses. Both 1-Hz rLSMS and 10-Hz repetitive transcranial magnetic stimulation increased healthy rectal pain thresholds for up to an hour after intervention (P < 0.05). When applied to patients with IBS, rectal pain thresholds were increased across all time points after both 1-Hz rLSMS and 10-Hz repetitive transcranial magnetic stimulation (P < 0.05) compared with sham. The application of magnetoelectric stimuli to the cortical and lumbosacral areas modulates visceral sensation in healthy subjects and patients with IBS. This proof-of-concept study provides supportive evidence for neurostimulation in managing functional gastrointestinal disorders. PMID:25867123
Biomarkers for visceral hypersensitivity identified by classification of electroencephalographic frequency alterations
NASA Astrophysics Data System (ADS)
Graversen, Carina; Brock, Christina; Mohr Drewes, Asbj�rn; Farina, Dario
Abdominal pain is frequently related to visceral hypersensitivity. This is associated with increased neuronal excitability in the central nervous system (CNS), which can be manifested as discrete electroencephalographic (EEG) alterations. In the current placebo-controlled study, visceral hypersensitivity was evoked by chemical irritation of the esophagus with acid and capsaicin perfusion. The resulting hyperexcitability of the CNS was evaluated by evoked brain potentials following painful electrical stimulations of a remote organ�the rectosigmoid colon. Alterations in individual EEG power distributions between baseline and after perfusion were quantified by extracting features from the evoked brain potentials using an optimized discrete wavelet transform. Visceral hypersensitivity was identified as increased EEG power in the delta, theta and alpha frequency bands. By applying a support vector machine in regression mode, the individual baseline corrected alterations after sensitization were discriminated from alterations caused by placebo perfusions. An accuracy of 91.7% was obtained (P < 0.01). The regression value representing the overall alteration of the EEG correlated with the degree of hyperalgesia (P = 0.03). In conclusion, this study showed that classification of EEG can be used to detect biomarkers reflecting central neuronal changes. In the future, this may be used in studies of pain physiology and pharmacological interventions.
Vagus Nerve Stimulation for Control of Intractable Seizures in Childhood
Arun Paul Amar; Michael L. Levy; J. Gordon McComb; Michael L. J. Apuzzo
Vagus nerve stimulation (VNS) is gaining increasing popularity and credibility as a treatment option for children with intractable epilepsy. VNS offers several advantages over extant treatments. Its efficacy is maintained during prolonged stimulation, and seizure control actually improves with time. There is no associated cognitive impairment and no adverse drug interactions. Unlike cerebral surgery, VNS is a potentially reversible form
Successful monotherapy of severe and intractable atopic dermatitis by photopheresis
Heike I. Richter; Claudia Billmann-Eberwein; Markus Grewe; Helger Stege; Mark Berneburg; Thomas Ruzicka; Jean Krutmann
Background: Patients with chronic atopic dermatitis can become unresponsive to standard immunosuppressive therapy and thus pose a serious therapeutic problem. Objective: Our purpose was to evaluate the therapeutic effectiveness of photopheresis in the management of patients with severe and intractable atopic dermatitis. Methods: Photopheresis was used as monotherapy in patients (n = 3) who previously did not respond to treatment
Reverse Engineering of Legacy Code is Intractable Bruce W. Weide
Reverse Engineering of Legacy Code is Intractable Bruce W. Weide Wayne D. Heym Department? By an argument that identifies key underlying sources of the difficulty, reverse engineering of legacy code should not be too enthusiastic about the ultimate value of reverse engineering as the centerpiece
Analgesic properties of oleoylethanolamide (OEA) in visceral and inflammatory pain
Margarita Suard�az; Guillermo Estivill-Torr�s; Carlos Goicoechea; Ainhoa Bilbao; Fernando Rodr�guez de Fonseca
Oleoylethanolamide (OEA) is a natural fatty acid amide that mainly modulates feeding and energy homeostasis by binding to peroxisome proliferator-activated receptor-alpha (PPAR-?) [Rodr�guez de Fonseca F, Navarro M, G�mez R, Escuredo L, Navas F, Fu J, et al. An anorexic lipid mediator regulated by feeding. Nature 2001;414:209�12; Fu J, Gaetani S, Oveisi F, Lo Verme J, Serrano A, Rodr�guez de
Supraspinal TRPV1 modulates the emotional expression of abdominal pain.
Jurik, Angela; Ressle, Andrea; Schmid, Roland M; Wotjak, Carsten T; Thoeringer, Christoph K
The transient receptor potential vanilloid receptor type-1 (TRPV1) is critically involved in peripheral nociceptive processes of somatic and visceral pain. However, the role of the capsaicin receptor in the brain regarding visceral pain remains elusive. Here, we studied the contribution of TRPV1 to abdominal pain transmission at different nociceptive pathway levels using TRPV1 knock-out mice, resiniferatoxin-mediated deletion of TRPV1-positive primary sensory neurons, and intracerebral TRPV1 antagonism. We found that constitutive genetic TRPV1 deletion or peripheral TRPV1 deletion reduced acetic acid-evoked abdominal constrictions, without affecting referred abdominal hyperalgesia or allodynia in an acute pancreatitis model of visceral pain. Notably, intracerebral TRPV1 antagonism by SB 366791 significantly reduced chemical and inflammatory spontaneous abdominal nocifensive responses, as observed by reduced expressions of nociceptive facial grimacing, illustrating the affective component of pain. In addition to the established role of cerebral TRPV1 in anxiety, fear, or emotional stress, we demonstrate here for the first time that TRPV1 in the brain modulates visceral nociception by interfering with the affective component of abdominal pain. PMID:25139591
Holistic Acupuncture approach to idiopathic refractory nausea, abdominal pain and bloating
Ann Ouyang; Lihua Xu
AIM: To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram (EGG) parameters in patients with intractable symptoms. METHODS: Twelve patients with no or mild nausea (those without nausea had bloating or pain) and 10 with a history of moderate to severe nausea were referred for acupuncture. All underwent an EGG and were treated at
Balancing immunity and pathology in visceral leishmaniasis
Cai, Long
Engwerda Experimental visceral leishmaniasis (VL) caused by infection with Leishmania donovani results: Leishmania; liver; spleen; pathology; granuloma Leishmania parasites of different species cause a broad. Leishmania parasites are obligate intra- cellular protozoan parasites that are transmitted
Scrambler therapy for patients with cancer pain - case series -.
Park, Hong Sik; Sin, Woo Kyung; Kim, Hye Young; Moon, Jee Youn; Park, Soo Young; Kim, Yong Chul; Lee, Sang Chul
More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain. PMID:23342211
Management of symptomatic spontaneous isolated visceral artery dissection: is emergent intervention mandatory?
Zhang, Wayne W; Killeen, J David; Chiriano, Jason; Bianchi, Christian; Teruya, Theodore H; Abou-Zamzam, Ahmed M
Spontaneous dissection of a visceral artery without associated aortic dissection is rare, although more cases have recently been reported because of the advancement of diagnostic techniques. The risk factors, causes, and natural history of spontaneous isolated visceral artery dissection are unclear. Treatment with open surgery, endovascular stenting, or anticoagulation therapy has been proposed; however, there is no consensus on the optimal management. We present three cases of spontaneous and isolated dissection of visceral arteries. Dissection involved the superior mesenteric artery in one and the celiac artery in two. All three patients presented with acute abdominal pain but lacked any peritoneal irritation. The patients were treated nonoperatively with anticoagulants or antiplatelets. No surgical or endovascular intervention was performed. Follow-up imaging studies demonstrated improvement of the dissection in two patients and no change in one patient. All patients were symptom-free over a mean follow-up of 17 months. Nonoperative treatment with close observation is an acceptable strategy in the management of spontaneous isolated dissection of visceral arteries. Emergent intervention is not mandatory in symptomatic patients without evidence of acute bowel ischemia or hemorrhage. PMID:18774686
Surgical repair of intractable chylous ascites following laparoscopic anterior resection
Ha, Gi Won; Lee, Min Ro
Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides and it is an unusual complication following surgical treatment of colorectal cancer. Conservative management is usually sufficient in patients with chylous ascites after surgery. However, we describe a patient with intractable chylous ascites after laparoscopic anterior resection for sigmoid colon cancer who failed initial conservative treatment. This patient was successfully managed by surgery. PMID:26019476
Intractable hiccups (singultus) abolished by risperidone, but not by haloperidol.
Nishikawa, Tadashi; Araki, Yoichiro; Hayashi, Teruo
Hiccups or singulata are rhythmic involuntary movements of the diaphragm, caused by a variety of conditions that interfere with the functions of the nerve nuclei in the medulla and supra-spinal hiccup center. Although neurotransmitters and receptors involved in the pathophysiology of hiccups are not defined well, dopamine has been considered to play an important role. In some cases, chlorpromazine or other antipsychotics are used for the treatment of intractable hiccups but their efficacy is often limited. This report involves an 18-year-old patient who experienced two episodes of intractable hiccups triggered by stress, which lasted for weeks or even months. In both episodes, haloperidol was initially used, but there was no significant effect. In contrast, risperidone, the second-generation antipsychotic that possesses a dopamine-serotonin antagonist property, completely abolished the hiccups 6 hours after administration. This is one of few case reports in which two antipsychotics were challenged for a single patient with hiccups, and the effects of the drugs were obviously different. Our finding suggests that, in addition to dopaminergic system, the serotonergic systems may be involved in the pathophysiology of some hiccup cases and that the serotonin-acting antipsychotics such as risperidone should be considered as a choice in the drug treatment of intractable hiccups. PMID:25763097
... pain that may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to ... Call 911 if: You have sudden crushing, squeezing, tightening, or ... or between your shoulder blades. You have nausea, dizziness, ...
Visceral Leishmania as Unusual Cause of Splenic Peliosis in the United States
Ghazzawi, Youssef
A 3-year-old female presented with splenomegaly and hypersplenism manifestations, including anemia, thrombocytopenia, and abdominal pain/distention. All common metabolic, hematologic, gastrointestinal, and infectious etiologies for splenomegaly were excluded. Diagnosis of idiopathic splenic peliosis was made and splenectomy was recommended. History revealed that the patient's mother had acquired a nonspecific skin infection during a visit to the Middle East 2 years prior. Serum antibodies and confirmatory PCR testing for visceral leishmaniasis were positive. After treatment with liposomal amphotericin, at 6-month follow-up her hypersplenism manifestations had resolved and her splenomegaly had significantly decreased. Visceral leishmaniasis should be considered in cases of marked splenomegaly, anemia, and thrombocytopenia, especially with a history of visiting an endemic area.
CT angiography of the visceral vessels.
Winter, T C; Nghiem, H V; Schmiedl, U P; Freeny, P C
CT angiography (CTA) is a promising new technique for vascular imaging. This review focuses first on the technique necessary for successful scanning of the visceral vessels. As in many new modalities, there are different protocols for scanning and rendering of images. The relative strengths and weaknesses of these different approaches are discussed. A discussion of the applications of CTA to depict normal and abnormal anatomy of the visceral vessels follows. These applications include celiac stenosis, splenic artery aneurysms, evaluation for hepatic arterial anatomy before liver transplantation, visceral arterial anatomy in pancreaticoduodenal surgery, the superior mesenteric artery in intestinal ischemia, vascular encasement in patients with pancreatic neoplasms, and, finally, the hepatic vessels before hepatic tumor resection. PMID:8858773
Immunopathogenesis of infection with the visceralizing Leishmania species
Mary E. Wilson; Selma M. B. Jeronimo; Richard D. Pearson
Human leishmaniasis is a spectral disease that includes asymptomatic self-resolving infection, localized skin lesions, and progressive visceral leishmaniasis. With some overlap, visceral and cutaneous leishmaniasis are usually caused by different species of Leishmania.This review focuses on host responses to infection with the species that cause visceral leishmaniasis, as they contrast with species causing localized cutaneous leishmaniasis. Data from experimental models
Changing Pattern of Visceral Leishmaniasis, United Kingdom, 1985-2004
Malik, Aeesha N.J.; John, Lawrence; Bryceson, Anthony D.M.
A 20-year (1985�2004) retrospective review of 39 patients with imported visceral leishmaniasis found that tourism to Mediterranean countries and HIV infection were associated with visceral leishmaniasis. Diagnosis was often delayed. Treatment with liposomal amphotericin B has improved prognosis. Visceral leishmaniasis should be made a reportable disease. PMID:16965709
REVIEW ARTICLE Ascending visceral regulation of cortical affective
Bruno, John P.
: acetylcholine, amygdala, anxiety, basal forebrain, memory, visceral afference Abstract Over a century ago accumulated indicating a range of visceral in�uences on higher neurobehavioural processes. This literature has of visceral feedback have become apparent on cortical activity, cerebral auditory-evoked responses, anxiety
Visceral antinociception produced by bee venom stimulation of the Zhongwan acupuncture point in mice: role of ? 2 adrenoceptors
Young-Bae Kwon; Myung-Soo Kang; Ho-Jae Han; Alvin J Beitz; Jang-Hern Lee
The goal of the present study was to determine whether bee venom (BV) injection into the Zhongwan acupoint (CV12), compared to injection into a non-acupoint, produced antinociception in an acetic acid-induced visceral pain model. This was accomplished by injecting BV subcutaneously into the Zhongwan acupoint or into a non-acupoint 30 min before intraperitoneal injection of acetic acid in ICR mice.
Intrathecal pain pumps: indications, patient selection, techniques, and outcomes.
Bolash, Robert; Mekhail, Nagy
Intrathecal drug delivery represents an advanced modality for refractory chronic pain patients as well as intractable spasticity. This article reviews the advantages and indications for intrathecal therapy, as well as recommendations for proper patient selection using a multidisciplinary team to provide a global assessment of the impact of chronic pain on the patient's well-being. The goals and expectations of trialing are discussed alongside advantages and disadvantages of several trialing techniques. A discussion of outcomes is presented for patients with chronic pain due to both malignant and nonmalignant causes. PMID:25240660
Oxcarbazepine: a new drug in the management of intractable trigeminal neuralgia.
Zakrzewska, J M; Patsalos, P N
The efficacy and tolerability of oxcarbazepine, a keto derivative of carbamazepine, has been assessed in six patients (two males, four females; mean age 61 years, range 42-77), with trigeminal neuralgia refractory to carbamazepine therapy, over a period of 6 months. An excellent therapeutic response to oxcarbazepine was seen in all patients with pain control correlating well with serum drug concentrations of oxcarbazepine and its primary active metabolite 10-OH-carbazepine. Onset of the effect was observed within 24 hours in all cases. An overall serum therapeutic concentration range, in the six patients, of 50-110 mumol/l of 10-OH-carbazepine corresponding to a daily effective dose range of 1200-2400 mg (14.6-35.6 mg/kg body weight) oxcarbazepine, was observed. There was a significant correlation between oxcarbazepine dose and serum oxcarbazepine (r = 0.695, p less than 0.05) and 10-OH-carbazepine (r = 0.957, p less than 0.001) concentrations. Oxcarbazepine was well tolerated and no significant side effects were identified, though a mild hyponatraemia was observed during high doses (greater than 28 and greater than 35 mg/kg/day) in two patients. It is concluded that oxcarbazepine has potent antineuralgic properties in the absence of significant side effects and therefore may be useful in the management of intractable trigeminal neuralgia. Images PMID:2738589
CT angiography of the visceral vessels
Thomas C Winter; Hanh V Nghiem; Udo P Schmiedl; Patrick C Freeny
CT angiography (CTA) is a promising new technique for vascular imaging. This review focuses first on the technique necessary for successful scanning of the visceral vessels. As in many new modalities, there are different protocols for scanning and rendering of images. The relative strengths and weaknesses of these different approaches are discussed. A discussion of the applications of CTA to
Out of Control: Visceral Influences on Behavior
George Loewenstein
Understanding discrepancies between behavior and perceived self-interest has been one of the major, but largely untackled, theoretical challenges confronting decision theory from its infancy to the present. People often act against their self-interest in full knowledge that they are doing so; they experience a feeling of being �out of control.� This paper attributes this phenomenon to the operation of �visceral
Intrathecal morphine delivered via subcutaneous pump for intractable pain in pancreatic cancer
Holly S Gilmer-Hill; James E Boggan; Karen A Smith; Charles F Frey; Franklin C Wagner; Larry J Hein
BACKGROUNDPain secondary to unresectable pancreatic cancer is frequently severe and extremely difficult to control with traditional methods of analgesia. This retrospective study reports the analgesic effects of intrathecal morphine sulfate by implanted infusion pumps in nine patients with unresectable adenocarcinoma of the pancreas.METHODSNine patients were implanted over a 2-year period. Preoperative morphine IV equivalents were a mean of 81.51 mg\\/day,
Cervical spinal cord stimulation treatment of deafferentation pain from brachial plexus avulsion injury complicated by complex regional pain syndrome.
Chang Chien, George C; Candido, Kenneth D; Saeed, Kashif; Knezevic, Nebojsa Nick
Brachial plexus avulsion is a rare and debilitating condition frequently associated with severe, intractable neuropathic pain. Interventional treatment modalities include dorsal root entry zone lesioning, stellate ganglion blockade, and neuromodulation such as spinal cord stimulation. We present a case of a 42-year-old woman with a traumatic left upper extremity brachial plexus avulsion injury after a motor vehicle accident and treatment of deafferentation pain complicated by complex regional pain syndrome type II. Previous unsuccessful interventions included repeated stellate ganglion blocks, transcutaneous electrical nerve stimulation, and opioid medication. After a successful trial of cervical spinal cord stimulator lead placement, she went on to an uneventful permanent implantation procedure. Spinal cord stimulation is an effective treatment for deafferentation pain and complex regional pain syndrome type II secondary to brachial plexopathy refractory to pharmacotherapy and conventional interventional attempts to modulate pain. PMID:25611136
Intractable vomiting caused by vertebral artery compressing the medulla: A case report
Gorton, Lauren; Ashour, Ahmed M.; Lebovitz, Jonathon; Cosola Di, Angela; Abdulrauf, Saleem I.
Vertebral artery compressing the medulla and causing intractable vomiting has only been reported once previously. We report a case of a 69-year-old woman with intractable nausea and vomiting causing a 50 pound weight loss and who failed medical management and whose symptoms were completely reversed following microvascular decompression (MVD). PMID:25972717
Comparison of Serum Zinc and Copper levels in Children and adolescents with Intractable and Controlled Epilepsy
KHERADMAND, Zeynab; YARALI, Bahram; ZARE, Ahad; POURPAK, Zahra; SHAMS, Sedigheh; ASHRAFI, Mahmoud Reza
Objective Trace elements such as zinc and copper have physiological effects on neuronal excitability that may play a role in the etiology of intractable epilepsy. This topic has been rarely discussed in Iranian epileptic patients. This study with the analysis of serum zinc and copper levels of children and adolescents with intractable and controlled epilepsy may identifies the potential role of these two trace elements in the development of epilepsy and intractability to antiepileptic drug treatment. Materials & Methods Seventy patients between the ages of 6 months to 15 years that referred to Children�s Medical Center with the diagnosis of epilepsy, either controlled or intractable to treatment enrolled in the study. After informed parental consent the levels of serum zinc and copper were measured with atomic absorption spectrophotometer and analyzed with SPSS version 11. Results 35 patients were enrolled in each group of intractable (IE) and controlled epilepsy (CE). 71.45% of the IE and 25.72% of the CE group had zinc deficiency that was statistically significant. 48.58% of the IE and 45.72 of the CE group were copper deficient, which was not statistically significant. Conclusion Our findings showed significant low serum zinc levels of patients with intractable epilepsy in comparison with controlled epilepsy group. We recommend that serum zinc level may play a role in the etiology of epilepsy and intractable epilepsy therefore its measurement and prescription may be regarded in the treatment of intractable epilepsy. PMID:25143774
Neural Synchrony-Monitoring Wireless Brain Implant for Intractable Epilepsy Neuromodulation
Genov, Roman
Neural Synchrony-Monitoring Wireless Brain Implant for Intractable Epilepsy Neuromodulation Karim Abstract-- A validation of a closed-loop system-on-chip (SoC) for epilepsy treatment is presented. A 12mm2 in vivo experiment validates the SoC in early seizure detection and as a closed-loop intractable epilepsy
Necessity of cooperation with government on publication of scientific research results for intractable diseases.
Inagaki, Yoshinori; Song, Peipei
The features of intractable diseases make it an important public health issue and a challenge to medical care worldwide. Investigation of intractable diseases with the support of government is urgently expected to activate clinical and pharmaceutical research to promote diagnosis and treatment for patients with intractable diseases. Moreover, linkage to the international database for research achievement is also necessary so that both researchers and other general citizens can assess research trends in the field of intractable diseases. In Japan, supportive activities for patients and researchers of intractable diseases have been well developed with the support of the Ministry of Health, Labor and Welfare (MHLW). Furthermore, in April 2013, a specific academic communication platform on intractable diseases - the Intractable and Rare Diseases Research (IRDR) Journal - was approved to join a governmental project and receive support from the Japan Society for the Promotion of Science (JSPS) under the auspices of Ministry of Education, Culture, Sports, Science and Technology (MEXT). Cooperation with the Japanese government starting this year is hoped to promote information-sharing based on an academic communication platform and further activate research on intractable diseases. PMID:25343106
Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident
Shen-Hong Qu; Min Li; Jian-Ping Liang; Zheng-Zhong Su; Shi-Qiang Chen; Xiao-Guang He
Objective: To investigate the clinical value, technique, indications and contraindications of laryngotracheal closure (LTC) and cricopharyngeal myotomy (CPM) for intractable aspiration and dysphagia secondary to a cerebrovascular accident (CVA). Materials and Methods: Patients (n = 45) with intractable aspiration and dysphagia secondary to a CVA were treated with LTC and CPM. The LTC was performed by suturing the double cords,
Successful hemostasis of intractable rectal variceal bleeding using variceal embolization
Ahn, Sung Soo; Kim, Eun Hye; Kim, Man Deuk; Lee, Won Jae; Kim, Seung Up
Portal hypertension causes portosystemic shunting along the gastrointestinal tract, resulting in gastrointestinal varices. Rectal varices and their bleeding is a rare complication, but it can be fatal without appropriate treatment. However, because of its rarity, no established treatment strategy is yet available. In the setting of intractable rectal variceal bleeding, a transjugular intravenous portosystemic shunt can be a treatment of choice to enable portal decompression and thus achieve hemostasis. However, in the case of recurrent rectal variceal bleeding despite successful transjugular intravenous portosystemic shunt, alternative measures to control bleeding are required. Here, we report on a patient with liver cirrhosis who experienced recurrent rectal variceal bleeding even after successful transjugular intravenous portosystemic shunt and was successfully treated with variceal embolization. PMID:25741168
Heart transplantation as salvage treatment of intractable infective endocarditis.
Aymami, Marie; Revest, Matthieu; Piau, Caroline; Chabanne, C�line; Le Gall, Fran�ois; Lelong, Bernard; Verhoye, Jean-Philippe; Michelet, Christian; Tattevin, Pierre; Fl�cher, Erwan
This study reports six consecutive patients who underwent heart transplantation as salvage treatment for endocarditis (Duke criteria) with extensive perivalvular lesions and end-stage heart failure. The median age was 45 years (range, 24 to 64), and the aortic valve was affected in all patients. Pathogens were Staphylococcus aureus (n�=�2), Streptococcus pneumoniae (n�=�2), Streptococcus agalactiae (n�=�1), or not documented (n�=�1). All patients survived, with no relapse, after a median follow-up of 24.5 months. The 10 patients with heart transplantation for endocarditis previously reported also survived (median follow-up, 27.5 months). Heart transplantation may be considered as salvage treatment in selected patients with intractable infective endocarditis. PMID:25630459
[Intractable bacterial infections of the genito-urinary tract].
Kawahara, M; Ohi, Y
Bacterial infection of the genito-urinary tract in the compromised host is still one of the difficulties encountered by the urologists. The problem factors of the urinary tracts, including underlying diseases in compromised uro-patients, and how to prevent a miserable outcome are discussed. In terms of adequate and timely anti-bacterial chemotherapy, retroperitoneal abscess, recurrent Pseudomonas aeruginosa urinary tract infection (UTI) and chronic bacterial prostatitis were evaluated, respectively. Recently, satisfactory anti-bacterial agents and therapeutic alternatives are available. Nevertheless, the Pseudomonas aeruginosa UTI associated with bio-film formation in catheterized, uro-patients is intractable. Adjuvant modality, as well as antibacterial chemotherapy, is recommended for successful strategy in so-called total therapy. PMID:8126905
Profile of intractable epilepsy in a tertiary referral center.
Singhvi, J P; Sawhney, I M; Lal, V; Pathak, A; Prabhakar, S
This study was undertaken to find out the profile of intractable epilepsy (IE) in a tertiary referral centre. 100 patients (males 67; females 33) with IE attending the epilepsy clinic were evaluated. Detailed history, examination, investigations like EEG and CT scan and details regarding pharmacotherapy were analysed. The age of the patients ranged from 5 to 70 yrs (mean=23.2 yrs). Mean duration of seizures was 11.44 years. Commonest seizure type was partial seizures (74%). Amongst patients with generalised seizures (26%), 14% had multiple seizure types. The seizure frequency was 12.39 +/- 21.57 (mean +/- SD) per month. Fifty seven patients were in the symptomatic group with CNS infections being the leading cause (19%) of epilepsy. Fifty patients had one or more abnormal predictors of IE. There was no difference in the severity of epilepsy in patients with no abnormal feature when compared with patients having abnormal features. EEG was abnormal in 69% cases with background abnormality in 20% and focal abnormality in 36% cases. CT scan was abnormal in 41% cases with commonest abnormality being neurocysticercosis (11%) followed by gliosis (9%) and chronic infarct (9%). Sixty patients were receiving a combination of two drugs, 32 patients 3 drugs and 8 patients were on 4 drugs. There was no difference in seizure control in patients who were on 2 drugs or more than 2 drugs. Partial seizures were the commonest seizure type leading to IE; CNS infection being the leading aetiological factor. The presence or absence of predictors of intractability does not predict severity of epilepsy. Addition of third primary drug to existing combination only increases adverse effects without better control of seizures. PMID:11146600
Frank Andrasik; Carla Rime
In adults, pain is one of the most common physical complaints. For example, a comprehensive review of available epidemiological\\u000a studies yielded a median point prevalence of chronic benign pain of 15% in adults, with individual study values ranging from\\u000a 2�40% (Verhaak, Kerssens, Dekker, Sorbi, & Bensing, 1998). Unfortunately, pain is not limited to the adult years, as estimates\\u000a of pain
Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or ... Pain that starts in the face may be caused by a nerve problem, ... Face pain may also begin other places in the body. Abscessed ...
Dendritic spine dysgenesis in neuropathic pain.
Tan, Andrew M; Waxman, Stephen G
Neuropathic pain is a significant unmet medical need in patients with variety of injury or disease insults to the nervous system. Neuropathic pain often presents as a painful sensation described as electrical, burning, or tingling. Currently available treatments have limited effectiveness and narrow therapeutic windows for safety. More powerful analgesics, e.g., opioids, carry a high risk for chemical dependence. Thus, a major challenge for pain research is the elucidation of the mechanisms that underlie neuropathic pain and developing targeted strategies to alleviate pathological pain. The mechanistic link between dendritic spine structure and circuit function could explain why neuropathic pain is difficult to treat, since nociceptive processing pathways are adversely "hard-wired" through the reorganization of dendritic spines. Several studies in animal models of neuropathic pain have begun to reveal the functional contribution of dendritic spine dysgenesis in neuropathic pain. Previous reports have demonstrated three primary changes in dendritic spine structure on nociceptive dorsal horn neurons following injury or disease, which accompany chronic intractable pain: (I) increased density of dendritic spines, particularly mature mushroom-spine spines, (II) redistribution of spines toward dendritic branch locations close to the cell body, and (III) enlargement of the spine head diameter, which generally presents as a mushroom-shaped spine. Given the important functional implications of spine distribution, density, and shape for synaptic and neuronal function, the study of dendritic spine abnormality may provide a new perspective for investigating pain, and the identification of specific molecular players that regulate spine morphology may guide the development of more effective and long-lasting therapies. PMID:25445354
Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain
Zhang, Ruixin; Lao, Lixing; Ren, Ke; Berman, Brian M.
In the last decade, preclinical investigations of electroacupuncture mechanisms on persistent tissue-injury (inflammatory), nerve-injury (neuropathic), cancer, and visceral pain have increased. These studies show that electroacupuncture activates the nervous system differently in health than in pain conditions, alleviates both sensory and affective inflammatory pain, and inhibits inflammatory and neuropathic pain more effectively at 2�10 Hz than at 100 Hz. Electroacupuncture blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce pro-inflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal n-methyl-d-aspartate receptor subunit GluN1 phosphorylation. Additional studies suggest that electroacupuncture, when combined with low dosages of conventional analgesics, provides effective pain management that can forestall the side effects of often-debilitating pharmaceuticals. PMID:24322588
EDICALLY intractable epilepsy develops in approx-imately 15,000 to 30,000 people each year in the
Hampton, Robert
EDICALLY intractable epilepsy develops in approx- imately 15,000 to 30,000 people each year in the US. Epilepsy is considered intractable when it significantly reduces the quality of a person's life.34 In most cases of surgically remediable medically intractable epilepsy, the pathological disorder
[Intrathecal morphine treatment in advanced cancer pain patients].
Hattori, Seiji; Sano, Hiromi; Tanaka, Kiyotaka; Yokota, Miyuki
For more than 20 years morphine for spinal analgesia in patients with refractory cancer pain has been one of the cornerstones for the management of chronic, medically intractable pain. In general, most types of cancer pain are treatable following the guideline of Cancer Pain Relief well established by the WHO. However, some patient are unable to tolerate pain only following the guideline and often suffer with side-effects from high doses of opioid and from prescribed multiple adjuvant drugs. Due to the proximity to the receptor sites, the therapeutic efficacy of intrathecal opioid application lasts longer and also reduces systemic side effects. Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients with limited life expectancy. However, an intensive training of physicians, careful patient selection, awareness of specific complications, and arrangement of social back-up medical system are essential to commence intrathecal morphine application using implantable access port. This article introduces the basic idea of intrathecal morphine therapy with implantable access port (not pumps) as cost effective, alternative therapy for cancer patient suffering from intractable pain. PMID:19928505
Non-closure of visceral peritoneum at abdominal hysterectomy.
Kucuk, M; Okman, T K
Our purpose was to determine whether non-closure of the visceral peritoneum alters post-operative outcome at abdominal hysterectomy. A prospective, randomized trial was performed. Of the 100 evaluable subjects, 50 had the visceral peritoneum left open whereas 50 were closed. Patients were observed for evidence of morbidity after the operation. Analysis of data was performed with use of the unpaired t-test for continuous variables. The visceral peritonization process at abdominal hysterectomy does not provide immediate post-operative benefits while unnecessarily lengthening surgical time and anesthesia exposure. We suggest that visceral peritonization process can be abolished at abdominal hysterectomy. PMID:11728498
The endocrinology of hypothalamic hamartoma surgery for intractable epilepsy.
Freeman, Jeremy L; Zacharin, Margaret; Rosenfeld, Jeffrey V; Harvey, A Simon
Intractable epilepsy has replaced central precocious puberty (CPP) as the main indication for surgery in patients with hypothalamic hamartoma (HH). However, concern about endocrine complications and the paucity of published endocrine data may dissuade clinicians from recommending HH surgery. We report the preoperative endocrine status and postoperative endocrine findings of patients undergoing HH surgery at our centre. Twenty-nine patients aged 4-23 years (mean 10 years) underwent detailed clinical assessment and biochemical testing of the hypothalamic-pituitary axis before and after transcallosal resection of their HH. The perioperative evaluation included comprehensive evaluation of pubertal status, growth, weight, thyroid and adrenal function, and osmoregulation. Forty-five percent of patients had CPP at presentation and this was not altered by HH surgery. Asymptomatic deficiencies in thyroid hormone, growth hormone and cortisol response were identified in several patients prior to surgery, and biochemical CPP was present in four, clinically prepubertal children. Free thyroxine fell after surgery in the majority, and to clinically significant levels prompting treatment in 5 patients. Low growth hormone was present in 5/8 patients who had had previous HH surgery and in 6/29 following transcallosal surgery at our centre; short stature did not result during the period of follow-up. Hypernatraemia developed in most patients postoperatively with sodium >150 mmol/L seen in 16 (55%) patients; however, this was asymptomatic, not often associated with polyuria, and transient; no patient required ongoing antidiuretic hormone replacement. Appetite stimulation and early postoperative weight gain occurred in 45% patients, but resolved in half. Disturbance of endocrine function may be clinically silent and should be routinely evaluated prior to HH surgery for intractable epilepsy. Following surgery, hypernatraemia, low thyroxine, low growth hormone, and weight gain are the main endocrine problems encountered. Prior, unsuccessful surgery may be a risk factor for endocrinopathy. Except for weight gain in some patients, these postoperative endocrine disturbances appear to be transient, mild or asymptomatic, and easily treated where necessary. Long term follow-up of growth and sexual development in a large series of patients is required. PMID:14975793
Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.
Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk. PMID:19400724
[The mechanism and control of neuropathic pain].
Inoue, Kazuhide
Neuropathic pain is a debilitating pain that occurs after nerve injury and is generally resistant to currently available treatments including morphine. Such pain involves aberrant excitability in dorsal horn neurons after nerve injury. Emerging evidence indicate that the enhanced activity of dorsal horn neurons requires a communication with microglia. Results of our laboratory have shown that activating P2X4R upregulated in spinal microglia after nerve injury contributes to neuropathic pain through a release of BDNF from microglia, which is a crucial factor to signal to dorsal horn neurons to cause neuronal hyperexcitability. Activated spinal microglia also express P2Y12R, and P2Y12R-KO mice display impaired neuropathic pain. The mechanisms of microglia activation are unknown, but our recent study shows that interferon-gamma (IFN-gamma) can be an important factor that causes spinal microglia activation after nerve injury. IFN-beta upregulates P2X4R in microglia and causes P2X4R-dependent allodynia. These findings suggest that purinoceptors in spinal microglia is crucial for pathological intractable pain. PMID:20030208
Molecular Hydrogen Attenuates Neuropathic Pain in Mice
Kawaguchi, Masanori; Satoh, Yasushi; Otsubo, Yukiko; Kazama, Tomiei
Neuropathic pain remains intractable and the development of new therapeutic strategies are urgently required. Accumulating evidence indicates that overproduction of oxidative stress is a key event in the pathogenesis of neuropathic pain. However, repeated intra-peritoneal or intrathecal injections of antioxidants are unsuitable for continuous use in therapy. Here we show a novel therapeutic method against neuropathic pain: drinking water containing molecular hydrogen (H2) as antioxidant. The effect of hydrogen on neuropathic pain was investigated using a partial sciatic nerve ligation model in mice. As indicators of neuropathic pain, temporal aspects of mechanical allodynia and thermal hyperalgesia were analysed for 3 weeks after ligation. Mechanical allodynia and thermal hyperalgesia were measured using the von Frey test and the plantar test, respectively. When mice were allowed to drink water containing hydrogen at a saturated level ad libitum after ligation, both allodynia and hyperalgesia were alleviated. These symptoms were also alleviated when hydrogen was administered only for the induction phase (from day 0 to 4 after ligation). When hydrogen was administered only for the maintenance phase (from day 4 to 21 after ligation), hyperalgesia but not allodynia was alleviated. Immunohistochemical staining for the oxidative stress marker, 4-hydroxy-2-nonenal and 8-hydroxydeoxyguanosine, showed that hydrogen administration suppressed oxidative stress induced by ligation in the spinal cord and the dorsal root ganglion. In conclusion, oral administration of hydrogen water may be useful for alleviating neuropathic pain in a clinical setting. PMID:24941001
Molecular hydrogen attenuates neuropathic pain in mice.
Kawaguchi, Masanori; Satoh, Yasushi; Otsubo, Yukiko; Kazama, Tomiei
Neuropathic pain remains intractable and the development of new therapeutic strategies are urgently required. Accumulating evidence indicates that overproduction of oxidative stress is a key event in the pathogenesis of neuropathic pain. However, repeated intra-peritoneal or intrathecal injections of antioxidants are unsuitable for continuous use in therapy. Here we show a novel therapeutic method against neuropathic pain: drinking water containing molecular hydrogen (H2) as antioxidant. The effect of hydrogen on neuropathic pain was investigated using a partial sciatic nerve ligation model in mice. As indicators of neuropathic pain, temporal aspects of mechanical allodynia and thermal hyperalgesia were analysed for 3 weeks after ligation. Mechanical allodynia and thermal hyperalgesia were measured using the von Frey test and the plantar test, respectively. When mice were allowed to drink water containing hydrogen at a saturated level ad libitum after ligation, both allodynia and hyperalgesia were alleviated. These symptoms were also alleviated when hydrogen was administered only for the induction phase (from day 0 to 4 after ligation). When hydrogen was administered only for the maintenance phase (from day 4 to 21 after ligation), hyperalgesia but not allodynia was alleviated. Immunohistochemical staining for the oxidative stress marker, 4-hydroxy-2-nonenal and 8-hydroxydeoxyguanosine, showed that hydrogen administration suppressed oxidative stress induced by ligation in the spinal cord and the dorsal root ganglion. In conclusion, oral administration of hydrogen water may be useful for alleviating neuropathic pain in a clinical setting. PMID:24941001
Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum - a case report and literature review
Background Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed. Case presentation A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10�months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10�months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful. We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients. Conclusion Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed. PMID:24917191
Ancient origin of somatic and visceral neurons
Background A key to understanding the evolution of the nervous system on a large phylogenetic scale is the identification of homologous neuronal types. Here, we focus this search on the sensory and motor neurons of bilaterians, exploiting their well-defined molecular signatures in vertebrates. Sensorimotor circuits in vertebrates are of two types: somatic (that sense the environment and respond by shaping bodily motions) and visceral (that sense the interior milieu and respond by regulating vital functions). These circuits differ by a small set of largely dedicated transcriptional determinants: Brn3 is expressed in many somatic sensory neurons, first and second order (among which mechanoreceptors are uniquely marked by the Brn3+/Islet1+/Drgx+ signature), somatic motoneurons uniquely co-express Lhx3/4 and Mnx1, while the vast majority of neurons, sensory and motor, involved in respiration, blood circulation or digestion are molecularly defined by their expression and dependence on the pan-visceral determinant Phox2b. Results We explore the status of the sensorimotor transcriptional code of vertebrates in mollusks, a lophotrochozoa clade that provides a rich repertoire of physiologically identified neurons. In the gastropods Lymnaea stagnalis and Aplysia californica, we show that homologues of Brn3, Drgx, Islet1, Mnx1, Lhx3/4 and Phox2b differentially mark neurons with mechanoreceptive, locomotory and cardiorespiratory functions. Moreover, in the cephalopod Sepia officinalis, we show that Phox2 marks the stellate ganglion (in line with the respiratory � that is, visceral� ancestral role of the mantle, its target organ), while the anterior pedal ganglion, which controls the prehensile and locomotory arms, expresses Mnx. Conclusions Despite considerable divergence in overall neural architecture, a molecular underpinning for the functional allocation of neurons to interactions with the environment or to homeostasis was inherited from the urbilaterian ancestor by contemporary protostomes and deuterostomes. PMID:23631531
Pharmacologic management of pain at the end of life.
Groninger, Hunter; Vijayan, Jaya
Although many patients experience debilitating pain at the end of life, there are many options to improve analgesia and quality of life. Pain assessment using a validated tool, with attention to patient function and specific goals, helps tailor individual treatment plans. The World Health Organization pain ladder offers a stepwise guideline for approaching pain management. However, for many patients with terminal illness, strong opioids are necessary for efficient and effective analgesia. Equianalgesic dosing tables and expert guidelines aid in initiating, monitoring, and adjusting doses of oral and parenteral opioids. Clinicians should feel comfortable administering a repeat dose after the time to peak analgesic effect if the patient is still in pain. In patients with constant pain, using scheduled long-acting opioids may significantly improve pain control. Among pain subtypes, visceral pain management usually requires multiple drugs. Neuropathic pain responds well to adjuvant pharmacotherapies, such as anticonvulsants or antidepressants, in addition to opioids. Opioid-induced hyperalgesia can occur with any dose of an opioid, but is more common with higher doses of parenteral morphine and hydromorphone. With appropriate counseling, most patients with a history of substance abuse will comply with a pain treatment plan. PMID:25077499
Use of an Oral Elemental Diet in Infants with Severe Intractable Diarrhea
ERIC Educational Resources Information Center
Sherman, Joseph O.; And Others
Evaluated was the use of an oral elemental diet consisting of crystalline amino acids, glucose, electrolytes, and vitamins to control severe intractable diarrhea in 27 infants (1-day to 9-months of age). (DB)
Endovascular treatment of visceral artery aneurysms.
Huang, Y; Banga, P; Reis De Souza, L; Oderich, G S
Visceral artery aneurysms (VAAs) are a rare entity; however, aneurysm rupture can be a catastrophic complication, which may lead to a mortality rate up to 90%. With the advent of endovascular technology and rapid development of endovascular materials, tailored endovascular therapy including embolization and placement of stents or stent grafts according to clinical presentation, anatomy of the aneurysm, and downstream organ, has become a promising alternative to open surgery. This review article summarizes the current state-of-the-art on endovascular treatment of VAAs. PMID:25752257
Abdominal visceral calcification in primary amyloidosis: CT findings
J. E. Jacobs; B. A. Birnbaum; E. E. Furth
.�� The computed tomographic (CT) findings of extensive visceral calcification involving both the liver and spleen in a patient\\u000a with primary amyloidosis are presented. Although the CT imaging appearances of amyloidosis are often nonspecific, visceral\\u000a calcification represents an important diagnostic clue for differentiating this entity from other infiltrative parenchymal\\u000a diseases.
Abdominal visceral calcification in primary amyloidosis: CT findings.
Jacobs, J E; Birnbaum, B A; Furth, E E
The computed tomographic (CT) findings of extensive visceral calcification involving both the liver and spleen in a patient with primary amyloidosis are presented. Although the CT imaging appearances of amyloidosis are often nonspecific, visceral calcification represents an important diagnostic clue for differentiating this entity from other infiltrative parenchymal diseases. PMID:9233892
Pain frequency moderates the relationship between pain catastrophizing and pain
Kj�gx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene
Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089
Tom Foulkes; John N. Wood
Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating
Darracott, John
Most neck pain is treated with a varying degree of confidence and success. A better understanding of what constitutes neck pain, a pertinent history and examination, critical interpretation of investigations and treatment modalities will provide family physicians, who treat the majority of these patients, with a confident disciplined approach which can reduce morbidity.
Ultrasonography for the evaluation of visceral fat and cardiovascular risk.
Ribeiro-Filho, F F; Faria, A N; Kohlmann, O; Ajzen, S; Ribeiro, A B; Zanella, M T; Ferreira, S R
Visceral fat accumulation is associated with increased cardiovascular risk. Clinical evaluation of visceral fat is limited because of the lack of reliable and low-cost methods. To assess the correlation between ultrasonography and computed tomography (CT) for the evaluation of visceral fat, 101 obese women, age 50.5+/-7.7 years with a body mass index of 39.2+/-5.4 kg/m(2), were submitted to ultrasonograph and CT scans. Visceral fat measured by ultrasonography, 1 cm above the umbilical knot, showed a high correlation with CT-determined visceral fat (r=0.67, P<0.0001). The ultrasonograph method showed good reproducibility with an intra-observer variation coefficient of <2%. Both ultrasonograph and CT visceral fat values were correlated with fasting insulin (r=0.29 and r=0.27, P<0.01) and plasma glucose 2 hours after oral glucose load (r=0.22 and r=0.34, P<0.05), indicating that ultrasonography is a useful method to evaluate cardiovascular risk. A significant correlation was also found between visceral fat by CT and serum sodium (r=0.18, P<0.05). A ultrasonograph-determined visceral-to-subcutaneous fat ratio of 2.50 was established as a cutoff value to define patients with abdominal visceral obesity. This value also identified patients with higher levels of plasma glucose, serum insulin and triglycerides and lower levels of HDL-cholesterol, which are metabolic abnormalities characteristic of the metabolic syndrome. Our data demonstrate that ultrasonography is a precise and reliable method for evaluation of visceral fat and identification of patients with adverse metabolic profile. PMID:11566963
Genetically Modified Organisms and Visceral Leishmaniasis
Chhajer, Rudra; Ali, Nahid
Vaccination is the most effective method of preventing infectious diseases. Since the eradication of small pox in 1976, many other potentially life compromising if not threatening diseases have been dealt with subsequently. This event was a major leap not only in the scientific world already burdened with many diseases but also in the mindset of the common man who became more receptive to novel treatment options. Among the many protozoan diseases, the leishmaniases have emerged as one of the largest parasite killers of the world, second only to malaria. There are three types of leishmaniasis namely cutaneous (CL), mucocutaneous (ML), and visceral (VL), caused by a group of more than 20 species of Leishmania parasites. Visceral leishmaniasis, also known as kala-azar is the most severe form and almost fatal if untreated. Since the first attempts at leishmanization, we have killed parasite vaccines, subunit protein, or DNA vaccines, and now we have live recombinant carrier vaccines and live attenuated parasite vaccines under various stages of development. Although some research has shown promising results, many more potential genes need to be evaluated as live attenuated vaccine candidates. This mini-review attempts to summarize the success and failures of genetically modified organisms used in vaccination against some of major parasitic diseases for their application in leishmaniasis. PMID:24860575
Shugan-decoction relieves visceral hyperalgesia and reduces TRPV1 and SP colon expression
Shang, Jing-Juan; Yuan, Jian-Ye; Xu, Hui; Tang, Rong-Zhu; Dong, Yue-Bin; Xie, Jian-Qun
AIM: To evaluate the therapeutic effect of Shugan-decoction (SGD) on visceral hyperalgesia and colon gene expressions using a rat model. METHODS: Ninety-six adult male Wistar rats were randomized into six equal groups for assessment of SGD effects on psychological stress-induced changes using the classic water avoidance stress (WAS) test. Untreated model rats were exposed to chronic (1 h/d for 10 d consecutive) WAS conditions; experimental treatment model rats were administered with intragastric SGD at 1 h before WAS on consecutive days 4-10 (low-dose: 0.1 g/mL; mid-dose: 0.2 g/mL; high-dose: 0.4 g/mL); control treatment model rats were similarly administered with the irritable bowel syndrome drug, dicetel (0.0042 g/mL); untreated normal control rats received no drug and were not subjected to the WAS test. At the end of the 10-d WAS testing period, a semi-quantitative measurement of visceral sensitivity was made by assessing the abdominal withdrawal reflex (AWR) to colorectal balloon-induced distension (at 5 mmHg increments) to determine the pain pressure threshold (PPT, evidenced by pain behavior). Subsequently, the animals were sacrificed and colonic tissues collected for assessment of changes in expressions of proteins related to visceral hypersensitivity (transient receptor potential vanilloid 1, TRPV1) and sustained visceral hyperalgesia (substance P, SP) by immunohistochemistry and real-time polymerase chain reaction. Inter-group differences were assessed by paired t test or repeated measures analysis of variance. RESULTS: The WAS test successfully induced visceral hypersensitivity, as evidenced by a significantly reduced AWR pressure in the untreated model group as compared to the untreated normal control group (190.4 � 3.48 mmHg vs 224.0 � 4.99 mmHg, P < 0.001). SGD treatments at mid-dose and high-dose and the dicetel treatment significantly increased the WAS-reduced PPT (212.5 � 2.54, 216.5 � 3.50 and 217.7 � 2.83 mmHg respectively, all P < 0.001); however, the low-dose SGD treatment produced no significant effect on the WAS-reduced PPT (198.3 � 1.78 mmHg, P > 0.05). These trends corresponded to the differential expressions observed for both TRPV1 protein (mid-dose: 1.64 � 0.08 and high-dose: 1.69 � 0.12 vs untreated model: 3.65 � 0.32, P < 0.001) and mRNA (0.44 � 0.16 and 0.15 � 0.03 vs 1.39 � 0.15, P < 0.001) and SP protein (0.99 � 0.20 and 1.03 � 0.23 vs 2.03 � 0.12, P < 0.01) and mRNA (1.64 � 0.19 and 1.32 � 0.14 vs 2.60 � 0.33, P < 0.05). These differential expressions of TRPV1 and SP related to mid- and high-dose SGD treatments were statistically similar to the changes induced by dicetel treatment. No signs of overt damage to the rat system were observed for any of the SGD dosages. CONCLUSION: Shugan-decoction can reduce chronic stress-induced visceral hypersensitivity in rats, and the regulatory mechanism may involve mediating the expressions of TRPV1 and SP in colon tissues. PMID:24307802
Lasheen, Wael; Walsh, Declan; Sarhill, Nabeel; Davis, Mellar
Aim We report the characteristics of intermittent cancer pain. And propose a new clinically based classification. Methods Consecutive cancer patients referred to our palliative medicine service were consented, and underwent a comprehensive pain evaluation including available laboratory and radiological studies, at the time of initial contact. Results and Discussion 100 consecutive patients reported 158 different pain sites. Pain temporal pattern observed: 60% of patients had continuous (CP) plus intermittent (IP) pain; 29% IP alone; and 11% CP alone. The etiology of IP was somatic (58%), visceral (24%), neuropathic (7%), and mixed (11%). Median duration of IP was four months with a median daily frequency of four episodes. Consequently we propose that IP be classified into: IP alone or non-breakthrough pain (NBP; since there is no underlying CP or around the clock opioids used), and breakthrough pain (BP; since there is underlying CP or / and around the clock opioids used). We propose that both BP and NBP be each sub-classified into 3 categories :(1) incident (2) non incident (3)mixed. And a fourth category exclusive to BP: end of dose failure. Incident pains made up (N=42, 47%) nearly half of all IP. According to our classification incident pain was part of BP in 41% (N=25) or NBP in 58% (N=17). Incident NBP received less treatment than incident BP, and it was less controlled. CONCLUSION 1) IP is a major problem in cancer patients 2) NBP is a common but under-recognized form of cancer pain 3) NBP is a less defined and controlled than BP 4) Incident NBP accounts for 40% of all incident cancer pain 5) Variable IP definitions and classifications makes comparisons between studies difficult PMID:20008824
Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...
VEGF induces sensory and motor peripheral plasticity, alters bladder function, and promotes visceral sensitivity
Background This work tests the hypothesis that bladder instillation with vascular endothelial growth factor (VEGF) modulates sensory and motor nerve plasticity, and, consequently, bladder function and visceral sensitivity. In addition to C57BL/6J, ChAT-cre mice were used for visualization of bladder cholinergic nerves. The direct effect of VEGF on the density of sensory nerves expressing the transient receptor potential vanilloid subfamily 1 (TRPV1) and cholinergic nerves (ChAT) was studied one week after one or two intravesical instillations of the growth factor. To study the effects of VEGF on bladder function, mice were intravesically instilled with VEGF and urodynamic evaluation was assessed. VEGF-induced alteration in bladder dorsal root ganglion (DRG) neurons was performed on retrogradly labeled urinary bladder afferents by patch-clamp recording of voltage gated Na+ currents. Determination of VEGF-induced changes in sensitivity to abdominal mechanostimulation was performed by application of von Frey filaments. Results In addition to an overwhelming increase in TRPV1 immunoreactivity, VEGF instillation resulted in an increase in ChAT-directed expression of a fluorescent protein in several layers of the urinary bladder. Intravesical VEGF caused a profound change in the function of the urinary bladder: acute VEGF (1 week post VEGF treatment) reduced micturition pressure and longer treatment (2 weeks post-VEGF instillation) caused a substantial reduction in inter-micturition interval. In addition, intravesical VEGF resulted in an up-regulation of voltage gated Na+ channels (VGSC) in bladder DRG neurons and enhanced abdominal sensitivity to mechanical stimulation. Conclusions For the first time, evidence is presented indicating that VEGF instillation into the mouse bladder promotes a significant increase in peripheral nerve density together with alterations in bladder function and visceral sensitivity. The VEGF pathway is being proposed as a key modulator of neural plasticity in the pelvis and enhanced VEGF content may be associated with visceral hyperalgesia, abdominal discomfort, and/or pelvic pain. PMID:23249422
Activation of Anterior Cingulate Cortex Extracellular Signal-Regulated Kinase-1 and -2 (ERK1/2) Regulates Acetic Acid-Induced, Pain-Related Anxiety in Adult Female Mice
Zhong, Xiao-Lin; Wei, Rong; Zhou, Pei; Luo, Yan-Wei; Wang, Xue-Qin; Duan, Juan; Bi, Fang-Fang; Zhang, Jian-Yi; Li, Chang-Qi; Dai, Ru-Ping; Li, Fang
In visceral pain, anxiety and pain occur simultaneously, but the etiogenesis of this effect is not yet well-described. The anterior cingulate cortex (ACC) is known to be associated with the affective response to noxious stimuli. The aim of the current study is to define the role of ACC extracellular signal-regulated (ERK)-1 and-2 (ERK1/2) activity in the development of pain-related anxiety/depression and the nocifensive response in acetic acid (AA)-elicited visceral pain. The model of visceral pain was created by intraperitoneal (ip) injection of AA to female Kunming mice. We found that AA injection resulted in a dynamic, bilateral ERK1/2 activation pattern in the ACC. Inhibition of ERK1/2 activation 2 hr after AA injection by subcutaneous (sc) injection of the mitogen-activating extracellular kinase (MEK) inhibitor, SL327, had no effect on the nocifensive responses, but did attenuate anxiety-like behavior, as determined by elevated plus-maze and open-field testing results. These data suggest that AA-induced visceral pain activates expression of ACC ERK1/2, which regulates visceral pain-related anxiety, but not the nocifensive response. PMID:23012487
Activation of Anterior Cingulate Cortex Extracellular Signal-Regulated Kinase-1 and -2 (ERK1/2) Regulates Acetic Acid-Induced, Pain-Related Anxiety in Adult Female Mice.
Zhong, Xiao-Lin; Wei, Rong; Zhou, Pei; Luo, Yan-Wei; Wang, Xue-Qin; Duan, Juan; Bi, Fang-Fang; Zhang, Jian-Yi; Li, Chang-Qi; Dai, Ru-Ping; Li, Fang
In visceral pain, anxiety and pain occur simultaneously, but the etiogenesis of this effect is not yet well-described. The anterior cingulate cortex (ACC) is known to be associated with the affective response to noxious stimuli. The aim of the current study is to define the role of ACC extracellular signal-regulated (ERK)-1 and-2 (ERK1/2) activity in the development of pain-related anxiety/depression and the nocifensive response in acetic acid (AA)-elicited visceral pain. The model of visceral pain was created by intraperitoneal (ip) injection of AA to female Kunming mice. We found that AA injection resulted in a dynamic, bilateral ERK1/2 activation pattern in the ACC. Inhibition of ERK1/2 activation 2 hr after AA injection by subcutaneous (sc) injection of the mitogen-activating extracellular kinase (MEK) inhibitor, SL327, had no effect on the nocifensive responses, but did attenuate anxiety-like behavior, as determined by elevated plus-maze and open-field testing results. These data suggest that AA-induced visceral pain activates expression of ACC ERK1/2, which regulates visceral pain-related anxiety, but not the nocifensive response. PMID:23012487
... know that it can erode quality of life. Communication Tools View All Everyday Tools During Your Visit ... pain. Online Tool Printable Tool (PDF) Show More Communication Tools Where Does It Hurt? / Nerve Man With ...
[Chronic intestinal pseudoobstruction due to visceral myopathy].
Kov�cs, M�rta; Veres, G�bor; Sz�nyi, L�szl�; Dezs�fi, Antal; Bod�nszky, Hedvig; Illy�s, Gy�rgy; Schaff, Zsuzsa; Arat�, Andr�s
A case is reported of a chronic intestinal pseudoobstruction with lethal outcome in a 6-year-old boy. The clinical symptoms and radiology examination showed ileus without mechanical obstruction. During the observation the patient developed left sided mydriasis and grand mal seizures with lactacidosis. He was treated conservatively which included total parenteral nutrition, fluid-sodium supplements, intravenous erythromycin and somatostatin, correction of acidosis. On the 48th day he died suddenly of cardiac failure at the intensive care unit. The gastrointestinal and neurologic symptoms with lactacidosis suggested the possibility of mitochondrial myopathy. Postmortem histopathology showed visceral myopathy. Molecular genetic analysis could not confirm the presence of the mDNA mutation. PMID:17611183
Aneurysms of the visceral and renal arteries.
Panayiotopoulos, Y. P.; Assadourian, R.; Taylor, P. R.
Visceral aneurysms represent a rare clinical entity; however, 10-20% will rupture and this is accompanied by a significant mortality rate of 20-70%, depending on the location of the aneurysm. The incidence, pathogenesis and clinical aspects of splanchnic and renal artery aneurysms are reviewed from the available literature and the problems of diagnosis and treatment are discussed. Their incidence is increasing and controversy still exists regarding their treatment. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, surgery is advisable. An alternative treatment is the use of endovascular techniques, ie embolisation, or graft stent insertion. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 PMID:8881722
Disseminated visceral coccidiosis in sandhill cranes
Carpenter, J.W.; Novilla, M.N.; Fayer, R.; Iverson, G.C.
Disseminated visceral coccidiosis (DVC) caused by Eimeria spp was first recognized as a disease entity in captive sandhill cranes (Grus canadensis) and whooping cranes (G americana) at the Patuxent Wildlife Research Center. Because cranes produced at the Center are reintroduced to the wild to augment wild populations, studies involving both experimentally induced and natural infections were initiated to determine the potential or actual occurrence of DVC in wild Gruidae. Nine sandhill cranes dosed orally with eimerian oocysts of wild origin developed lesions characteristic of DVC. Extraintestinal granulomas associated with developing schizonts were found in 6 birds. Similar lesions were observed in wild sandhill cranes throughout parts of midwestern United States, Alaska, and Saskatchewan. These studies revealed the wide geographic distribution and the high frequency of occurrence of DVC in wild cranes.
Effect of DA-9701 on Colorectal Distension-Induced Visceral Hypersensitivity in a Rat Model
Kim, Eun Ran; Min, Byung-Hoon; Lee, Tae Ho; Son, Miwon; Rhee, Poong-Lyul
Background/Aims DA-9701 is a newly developed drug made from the vegetal extracts of Pharbitidis semen and Co-rydalis tuber. The aim of this study was to evaluate the effect of DA-9701 on colorectal distension (CRD)-induced visceral hypersensitivity in a rat model. Methods Male Sprague-Dawley rats were subjected to neonatal colon irritation (CI) using CRD at 1 week after birth (CI group). At 6 weeks after birth, CRD was applied to these rats with a pressure of 20 to 90 mm Hg, and changes in the mean arterial pressure (MAP) were measured at baseline (i.e., without any drug administration) and after the administration of different doses of DA-9701. Results In the absence of DA-9701, the MAP changes after CRD were significantly higher in the CI group than in the control group at all applied pressures. In the control group, MAP changes after CRD were not significantly affected by the administration of DA-9701. In the CI group, however, the administration of DA-9701 resulted in a significant decrease in MAP changes after CRD. The administration of DA-9701 at a dose of 1.0 mg/kg produced a more significant decrease in MAP changes than the 0.3 mg/kg dose. Conclusions The administration of DA-9701 resulted in a significant increase in pain threshold in rats with CRD-induced visceral hypersensitivity. PMID:25071903
Exploration of cancer pain treatment by morphine infusion through an embedded device.
Yang, Yang; Li, Ying; Huang, Xin-En; Lu, Yan-Yan; Wu, Xue-Yan
Cancer pain treatment with morphine presents particular problems in patients with renal failure needing haemodialysis. We here explore the various possibilities of intrathecal opioid administration for intractable chronic and acute cancer pain. Morphine, as the only opioid approved by the Food and Drug Agency for administration, has been increasingly utilized for this purpose. For over 3 decades, there have been numerous reports on non- nociceptive side effects associated with ever increasing long-term intrathecal morphine usage. Our review of the literature and our own experience suggests that a subarachnoid device allows good pain control effect after patient controlled intravenous infusion failure at the time of haemodialysis. PMID:22394006
Corticotropin-releasing factor receptor 1 mediates acute and delayed stress-induced visceral hyperalgesia in maternally separated Long-Evans rats.
Schwetz, Ines; McRoberts, James A; Coutinho, Santosh V; Bradesi, Sylvie; Gale, Greg; Fanselow, Michael; Million, Mulugeta; Ohning, Gordon; Tach�, Yvette; Plotsky, Paul M; Mayer, Emeran A
In rodents, maternal pup interactions play an important role in programming the stress responsiveness of the adult organism. The aims of this study were 1) to determine the effect of different neonatal rearing conditions on acute and delayed stress-induced visceral sensitivity as well as on other measures of stress sensitivity of the adult animal; and 2) to determine the role of corticotropin-releasing factor receptor (CRF-R) subtype 1 (CRF(1)R) in mediating visceral hypersensitivity. Three groups of male Long-Evans rat pups were used: separation from their dam for 180 min daily from postnatal days 2-14 (MS180), daily separation (handling) for 15 min (H), or no handling. The visceromotor responses (VMR) to colorectal distension, stress-induced colonic motility, and anxiety-like behavior were assessed in the adult rats. The VMR was assessed at baseline, immediately after a 1-h water avoidance (WA) stress, and 24 h poststress. Astressin B, a nonselective CRF-R antagonist, or CP-154,526, a selective CRF(1)R antagonist, was administered before the stressor and/or before the 24-h measurement. MS rats developed acute and delayed stress-induced visceral hyperalgesia. In contrast, H rats showed hypoalgesia immediately after WA and no change in VMR on day 2. MS rats with visceral hyperalgesia also exhibited enhanced stress-induced colonic motility and increased anxiety-like behavior. In MS rats, both CRF-R antagonists abolished acute and delayed increases in VMR. Rearing conditions have a significant effect on adult stress responsiveness including immediate and delayed visceral pain responses to an acute stressor. Both acute and delayed stress-induced visceral hypersensitivity in MS rats are mediated by the CRF/CRF(1)R system. PMID:15994424
Neuron-glial communication mediated by TNF-? and glial activation in dorsal root ganglia in visceral inflammatory hypersensitivity.
Song, Dan-dan; Li, Yong; Tang, Dong; Huang, Li-ya; Yuan, Yao-zong
Communication between neurons and glia in the dorsal root ganglia (DRG) and the central nervous system is critical for nociception. Both glial activation and proinflammatory cytokine induction underlie this communication. We investigated whether satellite glial cell (SGC) and tumor necrosis factor-? (TNF-?) activation in DRG participates in a 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced rat model of visceral hyperalgesia. In TNBS-treated rats, TNF-? expression increased in DRG and was colocalized to SGCs enveloping a given neuron. These SGCs were activated as visualized under electron microscopy: they had more elongated processes projecting into the connective tissue space and more gap junctions. When nerves attached to DRG (L6-S1) were stimulated with a series of electrical stimulations, TNF-? were released from DRG in TNBS-treated animals compared with controls. Using a current clamp, we noted that exogenous TNF-? (2.5 ng/ml) increased DRG neuron activity, and visceral pain behavioral responses were reversed by intrathecal administration of anti-TNF-? (10 ?g�kg(-1)�day(-1)). Based on our findings, TNF-? and SGC activation in neuron-glial communication are critical in inflammatory visceral hyperalgesia. PMID:24627565
[Treatment of severe hemophagocytic syndrome associated with visceral leishmaniasis].
Bouguila, J; Chabchoub, I; Moncef, Y; Mlika, A; Saghrouni, F; Boughamoura, L; Essoussi, A S
The association of hemophagocytic syndrome (HS) and visceral leishmaniasis is a frequent disorder during infancy in endemic areas such as Tunisia. The range of severity of HS secondary to visceral leishmaniasis includes both pure biological forms that resolve with antimicrobial therapy and life-threatening emergencies that require specific treatment. We describe 2 cases of severe HS secondary to visceral leishmaniasis. The diagnosis of HS was based on the HLH-2004 diagnostic criteria. Therapy involved pentavalent antimonial (Glucantime) in both cases. The combination of corticosteroids with immunoglobulins, used in the 1st case, but introduced late, led to an unfavorable course and death. In the 2nd case, the specific treatment of HS was based on immunochemotherapy including etoposide and corticosteroids. Progression was favorable with a follow-up of 24 months. Etoposide containing therapeutic regimens can be proposed in severe forms of HS associated with visceral leishmaniasis. PMID:20880678
[Syndrome of inappropriate macrophage activation associated with infantile visceral leishmaniasis].
Thabet, F; Tabarki, B; Fehem, R; Yacoub, M; Selmi, H; Essoussi, A S
Hemophagocytosis has already been in cases of visceral leishmaniasis and thus may complicate search for diagnosis. We report a case of hemophagocytosis in a 20 month-old boy presenting with fever, hepatosplenomegaly, pancytopenia and coagulopathy. An initial diagnosis of kala-azar was refuted because of absence of biological inflammatory syndrome and negativity of bone-marrow aspiration. Specific serology for visceral leishmaniasis become positive. The boy was given stibogluconate for 21 days; he improves gradually with complete remission. PMID:10730157
Non-closure of visceral peritoneum at abdominal hysterectomy
M Kucuk; T. K Okman
Our purpose was to determine whether non-closure of the visceral peritoneum alters post-operative outcome at abdominal hysterectomy. A prospective, randomized trial was performed. Of the 100 evaluable subjects, 50 had the visceral peritoneum left open whereas 50 were closed. Patients were observed for evidence of morbidity after the operation. Analysis of data was performed with use of the unpaired t-test
Familial visceral myopathy associated with a mitochondrial myopathy.
Lowsky, R; Davidson, G; Wolman, S; Jeejeebhoy, K N; Hegele, R A
A 27 year old man with intestinal pseudo-obstruction who developed parenteral nutrition induced hyperlipidaemia and who also had ophthalmoplegia and an undifferentiated myopathy is described. Histological examination of biopsy specimens and molecular analysis show that this patient had both familial visceral myopathy and a mitochondrial myopathy, suggesting that a mitochondrial DNA mutation is the molecular lesion in familial visceral myopathy. Images Figure 2 Figure 3 Figure 4 Figure 5 PMID:8432486
Chemotherapy for Generalized Infantile Myofibromatosis With Visceral Involvement.
Wu, Susan Y; McCavit, Timothy L; Cederberg, Kevin; Galindo, Rene L; Leavey, Patrick J
Infantile myofibromatosis (IM) is most commonly limited to cutaneous lesions that resolve spontaneously. However, generalized IM with visceral involvement, which has a reported mortality rate as high as 73%, has been successfully treated with a combination of methotrexate and vinblastine. Here we report the further efficacy of low-dose methotrexate and vinblastine in 2 pediatric patients with IM and visceral involvement and review the literature describing chemotherapy for these patients. PMID:24608078
A Transgenic Model of Visceral Obesity and the Metabolic Syndrome
Hiroaki Masuzaki; Janice Paterson; Hiroshi Shinyama; Nicholas M. Morton; John J. Mullins; Jonathan R. Seckl; Jeffrey S. Flier
The adverse metabolic consequences of obesity are best predicted by the quantity of visceral fat. Excess glucocorticoids produce visceral obesity and diabetes, but circulating glucocorticoid levels are normal in typical obesity. Glucocorticoids can be produced locally from inactive 11-keto forms through the enzyme 11beta hydroxysteroid dehydrogenase type 1 (11beta HSD-1). We created transgenic mice overexpressing 11beta HSD-1 selectively in adipose
Current management and surgical outcomes of medically intractable epilepsy.
Ramey, Wyatt L; Martirosyan, Nikolay L; Lieu, Corinne M; Hasham, Hasnain A; Lemole, G Michael; Weinand, Martin E
Epilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10-15 years in particular has seen several major advances. As shown in relatively recent studies, resection is more effective for medically intractable epilepsy (MIE) than AED treatment alone, which is why most clinicians now endorse a neurosurgical consultation after approximately two failed regimens of AEDs, ultimately leading to decreased healthcare costs and increased quality of life. Temporal lobe epilepsy (TLE) is the most common form of MIE and comprises about 80% of epilepsy surgeries with the majority of patients gaining complete seizure-freedom. As the number of procedures and different approaches continues to grow, temporal lobectomy remains consistently focused on resection of mesial structures such as the amygdala, hippocampus, and parahippocampal gyrus while preserving as much of the neocortex as possible resulting in optimum seizure control with minimal neurological deficits. MIE originating outside the temporal lobe is also effectively treated with resection. Though not as successful as TLE surgery because of their frequent proximity to eloquent brain structures and more diffuse pathology, epileptogenic foci located extratemporally also benefit from resection. Favorable seizure outcome in each of these procedures has heavily relied on pre-operative imaging, especially since the massive surge in MRI technology just over 20 years ago. However, in the absence of visible lesions on MRI, recent improvements in secondary imaging modalities such as fluorodeoxyglucose positron emission computed tomography (FDG-PET) and single-photon emission computed tomography (SPECT) have lead to progressively better long-term seizure outcomes by increasing the neurosurgeon's visualization of supposed non-lesional foci. Additionally, being historically viewed as a drastic surgical intervention for MIE, hemispherectomy has been extensively used quite successfully for diffuse epilepsies often found in pediatric patients. Although total anatomic hemispherectomy is not utilized as commonly today, it has given rise to current disconnective techniques such as hemispherotomy. Therefore, severe forms of hemispheric developmental epilepsy can now be surgically treated while substantially decreasing the amount of potential long-term complications resulting from cavitation of the brain following anatomical hemispherectomy. Despite the rapid pace at which we are gaining further knowledge about epilepsy and its surgical treatment, there remains a sizeable underutilization of such procedures. By reviewing the recent literature on resective treatment of MIE, we provide a recent up-date on epilepsy surgery while focusing on historical perspectives, techniques, prognostic indicators, outcomes, and complications associated with several different types of procedures. PMID:24169149
Ripamonti, C I
Despite published guidelines and educational programs on the assessment and treatment of cancer-related pain, in any stage of oncological disease, unrelieved pain continues to be a substantial worldwide public health concern either in patients with solid and haematological malignancies. The proper and regular self-reporting assessment of pain is the first step for an effective and individualized treatment. Opioids are the mainstay of analgesic therapy and can be associated with non-opioids drugs such as paracetamol or non-steroidal anti-inflammatory drugs and to adjuvant drugs (for neuropathic pain and symptom control). The role and the utility of weak opioids (i.e. codeine, dihydrocodeine, tramadol) are a controversy point. Morphine has been placed by World Health Organization on its Essential Drug List. In the comparative study with other strong opioids (hydromorphone, oxycodone), there is no evidence to show superiority or inferiority with morphine as the first choice opioid. Oral methadone is a useful and safe alternative to morphine. Methadone presents the potential to control pain difficult to manage with other opioids. although the oral route of opioid administration is considered the one of choice, intravenous, subcutaneous, rectal, transdermal, sublingual, intranasal, and spinal routes must be used in particular situation. Transdermal opioids such as fentanyl and buprenorphine are best reserved for patients whose opioid requirements are stable. Switching from one opioid to another can improve analgesia and tolerability. PMID:22987980
Central sympathetic innervations to visceral and subcutaneous white adipose tissue
Nguyen, Ngoc Ly T.; Randall, Jessica; Banfield, Bruce W.
There is a link between visceral white adipose tissue (WAT) and the metabolic syndrome in humans, with health improvements produced with small visceral WAT reduction. By contrast, subcutaneous WAT provides a site for lipid storage that is rather innocuous relative to ectopic lipid storage in muscle or liver. The sympathetic nervous system (SNS) is the principal initiator for lipolysis in WAT by mammals. Nothing is known, however, about the central origins of the SNS circuitry innervating the only true visceral WAT in rodents, mesenteric WAT (MWAT), which drains into the hepatic portal vein. We tested whether the central sympathetic circuits to subcutaneous [inguinal WAT (IWAT)] and visceral WAT (MWAT) are separate or shared and whether they possess differential sympathetic drives with food deprivation in Siberian hamsters. Using two isogenic strains of pseudorabies virus, a retrograde transneuronal viral tract tracer within the same hamsters, we found some overlap (?20�55% doubly infected neurons) between the two circuitries across the neural axis with lesser overlap proximal to the depots (spinal cord and sympathetic chain) and with more neurons involved in the innervation of IWAT than MWAT in some brain regions. Food deprivation triggered a greater sympathetic drive to subcutaneous (IWAT) than visceral (MWAT) depots. Collectively, we demonstrated both shared and separate populations of brain, spinal cord, and sympathetic chain neurons ultimately project to a subcutaneous WAT depot (IWAT) and the only visceral WAT depot in rodents (MWAT). In addition, the lipolytic stimulus of food deprivation only increased SNS drive to subcutaneous fat (IWAT). PMID:24452544
Management of chronic neuropathic pain with methadone: a review of 13 cases.
Altier, Nad�ge; Dion, Dominique; Boulanger, Aline; Choini�re, Manon
The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly neuropathic pain. Unfortunately, the evidence for its use in the management of neuropathic pain is limited to a few case studies. We examined retrospectively during a 12-month study period the clinical response of all 13 patients at our pain clinic who were prescribed methadone in an attempt to control neuropathic pain resistant to conventional analgesics. A questionnaire was also administered to the 9 patients who continued to take methadone at 12 months posttreatment. A total of 4 patients (31%) discontinued it by the end of the 12-month study period. Patients discontinued methadone due to the absence of pain relief and due to various intractable, undesirable side effects. Somnolence was the most common adverse effect reported, followed by nausea, constipation, and vomiting. All patients took coanalgesics (eg, amitriptyline, gabapentin) or other analgesics (eg, morphine, nonsteroidal anti-inflammatory drugs) during methadone treatment to control pain. The 9 patients who continued to take methadone at 12 months reported experiencing on average 43% pain relief (range 0-80%), 47% improvement in quality of life (range 0-100%), and 30% improvement in quality of sleep (range 0-60%). Methadone was effective at relieving pain and ameliorating quality of life and sleep in 62% of patients. These findings suggest that methadone can offer an acceptable success rate for the treatment of neuropathic pain. Prospective randomized, placebo-controlled studies are now needed to examine more rigorously the benefits of methadone for this type of pain. PMID:15951657
Vagus nerve stimulation in children with intractable epilepsy: indications, complications and outcome
S. M. R. Kabir; C. Rajaraman; C. Rittey; H. S. Zaki; A. A. Kemeny; J. McMullan
Purpose��To analyze the indication, complications and outcome of vagus nerve stimulation in intractable childhood epilepsy.\\u000a \\u000a \\u000a \\u000a Materials and methods��We retrospectively reviewed the data of 69 children who had insertion of vagal nerve stimulator (VNS) between June 1995 and\\u000a August 2006 for medically intractable epilepsy. Outcome was based on the Engel's classification. Statistical analysis of the\\u000a data was also done to see
Peroxisome proliferator-activated receptor agonists modulate neuropathic pain: a link to chemokines?
Freitag, Caroline M.; Miller, Richard J.
Chronic pain presents a widespread and intractable medical problem. While numerous pharmaceuticals are used to treat chronic pain, drugs that are safe for extended use and highly effective at treating the most severe pain do not yet exist. Chronic pain resulting from nervous system injury (neuropathic pain) is common in conditions ranging from multiple sclerosis to HIV-1 infection to type II diabetes. Inflammation caused by neuropathy is believed to contribute to the generation and maintenance of neuropathic pain. Chemokines are key inflammatory mediators, several of which (MCP-1, RANTES, MIP-1?, fractalkine, SDF-1 among others) have been linked to chronic, neuropathic pain in both human conditions and animal models. The important roles chemokines play in inflammation and pain make them an attractive therapeutic target. Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear receptors known for their roles in metabolism. Recent research has revealed that PPARs also play a role in inflammatory gene repression. PPAR agonists have wide-ranging effects including inhibition of chemokine expression and pain behavior reduction in animal models. Experimental evidence suggests a connection between the pain ameliorating effects of PPAR agonists and suppression of inflammatory gene expression, including chemokines. In early clinical research, one PPAR? agonist, palmitoylethanolamide (PEA), shows promise in relieving chronic pain. If this link can be better established, PPAR agonists may represent a new drug therapy for neuropathic pain. PMID:25191225
[Visceral leishmaniasis in Algeria. Evolution of visceral leishmaniasis in the Grande Kabylie area (1985-1990)].
Harrat, Z; Berrouane, Y; Ben Abdesslam, S; Belkaid, M; Tabet-Derraz, O
The authors report 285 cases of visceral leishmaniasis recorded over a 6 year-period from 1985-1990 in the Wilaya of Tizi-Ouzou (Grande Kabylie). The authors report a resurgence of this disease during the last years, with a 5 human cases per 100,000 annual prevalence and a 6 per cent of rate death, the most active part of mediterranean area appears to be the region of Grand-Kabylie. A control program in the Wilaya of Tizi-Ouzou is proposed. PMID:1309141
... Pain Management Programs Pain Management Programs Assessment Communication Education Program Outcomes Conclusion Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going ...
Gamma Knife thalamotomy for the treatment of persistent pain.
Young, R F; Vermeulen, S S; Grimm, P; Posewitz, A E; Jacques, D B; Rand, R W; Copcutt, B G
Twenty patients who suffered persistent intractable pain from a variety of disorders underwent medial thalamotomy with the Leksell Gamma Knife. The lesions were directed at the intralaminar nuclei, the lateral portion of the medial dorsal nucleus, the centromedian and the parafascicular nuclei. Lesions were made with radiation doses from 140 to 180 Gy using a 4-mm beam collimator helmet and either a single isocenter (1 patient), two isocenters (17 patients) or three isocenters (2 patients). Two thirds of the patients experienced either excellent or good pain relief in a follow-up period between 1 and 22 months. One patient showed temporary complications which resolved, and 2 other patients also suffered complications which currently are improving. One patient died due to radiation necrosis following a bilateral thalamotomy. Gamma Knife thalamotomy may offer a potentially safe and effective alternative for the treatment of certain difficult persistent pain problems. PMID:8584825
... pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly ...
Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, ... embolism Costochondritis - an inflammation of joints in your chest Some of these problems can be serious. Get ...
Human visceral leishmaniasis: a picture from Italy.
Abdalmaula, Giuma Harun; Barbadoro, Pamela; Marigliano, Anna; Illuminati, Diego; Di Stanislao, Francesco; D'Errico, Marcello Mario; Prospero, Emilia
The aim of our study was to describe the distribution of Visceral Leishmaniasis (VL) in Italy, focusing on HIV-infected patients, to estimate the burden of the disease and the public health actions that should be undertaken. A review of official notifications and hospitalization data has been performed. From 2006 to 2008, a total of 289 cases of VL were notified; the overall notification rate was 1.63/1,000,000 (95% CI 1.45-1.83). In total, 1192 VL-associated hospitalizations were detected, with a hospitalization rate of 6.71/1,000,000 (95% CI 6.34-7.10). For the age group "? 24 years", a statistically significant increase was detected (p<0.05). A total of 68.9% (n = 821) of hospitalizations were detected in HIV-positive patients. The geographic distribution of rates revealed a significant increase in the north-eastern area of the country. Our study confirms that the epidemiological pattern of VL is changing and that, in Italy, control measures and preventive strategies should be based on not only the official notification system but also hospital data. This would lead to the identification of areas of parasite spread and to the creation of awareness campaigns geared toward general practitioners in the affected areas. Easy case detection would allow for timely public health actions and strategies for the implementation of more effective interventions for reservoir control. PMID:23999330
Clinical Issues in Pain Management Clinical Issues in Pain Management
Meagher, Mary
Pain Clinical Issues in Pain Management #12;Clinical Issues in Pain Management: Acute Pain #12;Clinical Issues in Pain Management: Chronic Pain Chronic Pain Typically begins with an acute in Pain Management: Chronic Pain Chronic benign pain Persists more than 6 months Varies in severity
The genetic influences on oxycodone response characteristics in human experimental pain.
Olesen, Anne E; Sato, Hiroe; Nielsen, Lecia M; Staahl, Camilla; Droney, Joanne; Gretton, Sophy; Branford, Ruth; Drewes, Asbj�rn M; Arendt-Nielsen, Lars; Riley, Julia; Ross, Joy
Human experimental pain studies are of value to study basic pain mechanisms under controlled conditions. The aim of this study was to investigate whether genetic variation across selected mu-, kappa- and delta-opioid receptor genes (OPRM1, OPRK1and OPRD1, respectively) influenced analgesic response to oxycodone in healthy volunteers. Experimental multimodal, multitissue pain data from previously published studies carried out in Caucasian volunteers were used. Data on thermal skin pain tolerance threshold (PTT) (n�=�37), muscle pressure PTT (n�=�31), mechanical visceral PTT (n�=�43) and thermal visceral PTT (n�=�41) were included. Genetic associations with pain outcomes were explored. Nineteen opioid receptor genetic polymorphisms were included in this study. Variability in oxycodone response to skin heat was associated with OPRM1 single-nucleotide polymorphisms (SNPs) rs589046 (P�<�0.0001) and rs563649 (P�<�0.0001). Variability in oxycodone response to visceral pressure was associated with four OPRM1 SNPs: rs589046 (P�=�0.015), rs1799971 (P�=�0.045), rs9479757 (P�=�0.009) and rs533586 (P�=�0.046). OPRM1 SNPs were not associated with oxycodone visceral heat threshold, however, one OPRD1 rs419335 reached significance (P�=�0.015). Another OPRD1 SNP rs2234918 (P�=�0.041) was associated with muscle pressure. There were no associations with OPRK1 SNPs and oxycodone response for any of the pain modalities. Associations were found between analgesic effects of oxycodone and OPRM1 and OPRD1 SNPs; therefore, variation in opioid receptor genes may partly explain responder characteristics to oxycodone. PMID:26042474
A Modified Atkins Diet Is Effective for the Treatment of Intractable Pediatric Epilepsy
Eric H. Kossoff; Jane R. McGrogan; Renee M. Bluml; Diana J. Pillas; James E. Rubenstein; Eileen P. Vining
Summary: Purpose: The Atkins diet may induce ketosis as does the ketogenic diet, without restrictions on calories, fluids, protein, or need for an inpatient fast and admission. Our objective was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy. Methods: Twenty children were treated prospectively in a hospital-based ambulatory clinic from September 2003 to
Neuropathologic findings in cortical resections (including hemispherectomies) performed for the treatment of intractable childhood epilepsy
M. A. Farrell; M. J. DeRosa; J. G. Curran; D. Lenard Secor; M. E. Cornford; Y. G. Comair; W. J. Peacock; W. D. Shields; H. V. Vinters
Despit� the use of hemispherectomy in the treatment of medically refractory seizures since the early 1950's, few studies published have documented neuropathologic findings in the resected specimens. This report describes the neuropathologic findings in 38 children who underwent either hemispherectomy or multilobar cortical resection as treatment for medically intractable epilepsy between 1986 and 1990. Examination of the resected specimens revealed
Growth Failure in Children with Intractable Epilepsy Is Not Due to Increased Resting Energy Expenditure
ERIC Educational Resources Information Center
Bergqvist, A. G. Christina; Trabulsi, Jillian; Schall, Joan I.; Stallings, Virginia A.
The aim of this study was to evaluate the resting energy expenditure (REE) of children with intractable epilepsy (IE) compared with healthy children, and to determine factors that contribute to the pattern of REE. REE, growth status, and body composition were assessed in 25 prepubertal children with IE (15 males, 10 females; mean age 5y 5mo [SD 2y�
CS 170: Efficient Algorithms and Intractable Problems (Spring 2001) Course Overview
California at Berkeley, University of
CS 170: Efficient Algorithms and Intractable Problems (Spring 2001) Course Overview Profs. James of computer science, CS 170 is a full exploration of it. In CS 170, you will study the design and analysis, and policies on academic misconduct. There is a class Web page at http://www.cs.berkeley.edu/#24;jrs/170
Vagus nerve stimulation for treatment of medically intractable seizures. Evaluation of long-term outcome
Paolo Tanganelli; Sergio Ferrero; Patrizio Colotto; Giovanni Regesta
Vagus nerve stimulation (VNS) constitutes an adjunctive, modern management of medically intractable seizures, especially when surgery is inadvisable. Objective: To evaluate the long-term results as regards efficacy, safety and tolerability of VNS in epileptic subjects, with focal and\\/or generalised seizures, refractory to old and new AEDs, without indication for resective surgery. Patients: 51 epileptic subjects (30 males, 21 females), aged
Endovascular Therapy of Intractable Epistaxis Complicated by Carotid Artery Occlusive Disease
Robert J. Ernst; Robert V. Bulas; Mary Gaskill-Shipley; Thomas A. Tomsick
Summary: Three cases of intractable spontaneous posterior ep- istaxis refractory to nasal packing and complicated by ipsilateral carotid artery occlusive disease were successfully treated with internal maxillary artery occlusion with microcoils. There were no complications and no recurrent episodes of epistaxis at a mean follow-up of 12 months. The presence of ipsilateral carotid artery disease requires modification of standard distal
Endoscopic management of an unusual foreign body in the urinary bladder leading to intractable symptoms
G. Nabi; A. K. Hemal; A. Khaitan
A 70-year old female patient presented with intractable lower abdominal painand recurrent urinary tract infection following an endoscopic bladder necksuspension. Investigations revealed it to be a case of suture and pledgetmigration leading to foreign body granuloma in urinary bladder. It is beingreported as an uncommon complication of endoscopic bladder necksuspension. An early endoscopic evaluation should be carried out in casesof
Developing Agency through Peacebuilding in the Midst of Intractable Conflict: The Case of Israel and Palestine
ERIC Educational Resources Information Center
Plonski, Sharri
This paper discusses the presence of "peacebuilding islands" within civil society as potential agents of transformation in the midst of intractable conflict. Focusing on the particular case of the Israeli-Palestinian conflict, the argument stems from a deconstruction of the legacy of national myopia perpetuated through social and political�
Corpus callosum section in the treatment of intractable seizures in the Sturge-Weber syndrome
Z. H. Rappaport
The Sturge-Weber syndrome includes unilateral cerebral cortical angiomatosis, which often leads to progressive cerebral dysfunction and epileptic seizures that are medically difficult to control. Cerebral resections and hemispherectomy have been successfully performed in the past in intractable epileptic cases. Two children with medically unresponsive generalized seizure activity secondary to the Sturge-Weber syndrome have been surgically treated by dividing their corpus
Case report: a case of intractable Meniere's disease treated with autogenic training
Fumiyuki Goto; Kimiko Nakai; Takanobu Kunihiro; Kaoru Ogawa
BACKGROUND: Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject
Gastrointestinal (GI) permeability is associated with trait anxiety in children with functional abdominal pain (FAP) and Irritable Bowel Syndrome (IBS)
Technology Transfer Automated Retrieval System (TEKTRAN)
FAP and IBS affect 10-15% of school age children and bear many physiological similarities to irritable bowel syndrome (IBS) in adults (e.g., functional pain, visceral hyperalgesia). Animal models of IBS have suggested a relationship between neonatal stress and increased GI permeability later in life...
Technique of stereotactic medial thalamotomy with the Leksell Gamma Knife for treatment of chronic pain.
Young, R F; Jacques, D S; Rand, R W; Copcutt, B C; Vermeulen, S S; Posewitz, A E
Nineteen patients underwent a total of 24 medial thalamic lesions made with the Leksell Gamma Knife for the treatment of chronic intractable pain after extensive prior medical and surgical intervention had failed to provide pain relief. The lesion locations were based on prior experience with open radiofrequency medial thalamotomies for the treatment of pain and were directed at the intralaminar, mediodorsal, centromedian, and parafascicular nuclei. All lesions were made with the 4 mm collimator helmet at radiosurgical doses from 140-180 Gray. Follow-up MRI scans indicated anatomically distinct lesions which developed 3-6 weeks after the procedure and were fully formed by 8-12 weeks. The lesion volumes averaged 300-400 mm3 for a single isocentre, 600-900 mm3 for two isocentres, and 900-1100 mm3 for three isocentres. One patient developed a lesion 5500 mm3 in volume after a two isocentre lesion at 160 Gray. Of 15 patients who have been followed for more than 3 months (average follow-up 12 months) four patients (27%) are virtually pain free and functioning normally, whereas five other patients (33%) achieved greater than 50% pain relief. Thus 9/15 patients (60%) have had worthwhile benefit from medial thalamotomy with the Gamma Knife. Medial thalamotomy with the Gamma Knife produces thalamic lesions which are reliable in size, shape and location with a low complication rate and offers a minimally invasive, cost effective treatment for certain selected patients with chronic intractable pain. PMID:7746344
Novel Arylimidamides for Treatment of Visceral Leishmaniasis? �
Wang, Michael Zhuo; Zhu, Xiaohua; Srivastava, Anuradha; Liu, Qiang; Sweat, J. Mark; Pandharkar, Trupti; Stephens, Chad E.; Riccio, Ed; Parman, Toufan; Munde, Manoj; Mandal, Swati; Madhubala, Rentala; Tidwell, Richard R.; Wilson, W. David; Boykin, David W.; Hall, James Edwin; Kyle, Dennis E.; Werbovetz, Karl A.
Arylimidamides (AIAs) represent a new class of molecules that exhibit potent antileishmanial activity (50% inhibitory concentration [IC50], <1 ?M) against both Leishmania donovani axenic amastigotes and intracellular Leishmania, the causative agent for human visceral leishmaniasis (VL). A systematic lead discovery program was employed to characterize in vitro and in vivo antileishmanial activities, pharmacokinetics, mutagenicities, and toxicities of two novel AIAs, DB745 and DB766. They were exceptionally active (IC50 ? 0.12 ?M) against intracellular L. donovani, Leishmania amazonensis, and Leishmania major and did not exhibit mutagenicity in an Ames screen. DB745 and DB766, given orally, produced a dose-dependent inhibition of liver parasitemia in two efficacy models, L. donovani-infected mice and hamsters. Most notably, DB766 (100 mg/kg of body weight/day for 5 days) reduced liver parasitemia in mice and hamsters by 71% and 89%, respectively. Marked reduction of parasitemia in the spleen (79%) and bone marrow (92%) of hamsters was also observed. Furthermore, these compounds distributed to target tissues (liver and spleen) and had a moderate oral bioavailability (up to 25%), a large volume of distribution, and an elimination half-life ranging from 1 to 2 days in mice. In a repeat-dose toxicity study of mice, there was no indication of liver or kidney toxicity for DB766 from serum chemistries, although mild hepatic cell eosinophilia, hypertrophy, and fatty changes were noted. These results demonstrated that arylimidamides are a promising class of molecules that possess good antileishmanial activity and desirable pharmacokinetics and should be considered for further preclinical development as an oral treatment for VL. PMID:20368397
A case of relapsed visceral Kaposi's sarcoma with bilateral chylothoraces successfully treated with paclitaxel.
Natarajan, Pavithra; Miller, Alastair
Chylothorax is a rare complication of visceral Kaposi's sarcoma. We report a case with bilateral chylothoraces secondary to relapsed visceral Kaposi's sarcoma who was successfully treated with paclitaxel chemotherapy. PMID:25122577
Markman, Stanley
Comprehending orofacial referred pain requires an understanding of the neuroanatomy of the trigeminal nerve and associated cranial nerves. It also requires knowledge of the concept of neuronal convergence as well as the recognition that the caudalis is laminated and is therefore responsible for sensory receptive fields-that one interneuron may receive multiple sensory inputs and that structures within a lamina have sensory neurons which project into the caudalis and may share the same interneuron. PMID:25141487
Burning mouth syndrome as a trigeminal small fibre neuropathy: Increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score
Z. Yilmaz; T. Renton; Y. Yiangou; J. Zakrzewska; I. P. Chessell; C. Bountra; P. Anand
Burning mouth syndrome (BMS) is often an idiopathic chronic and intractable pain condition, affecting 1.5�5.5% of middle-aged and elderly women. We have studied the heat and capsaicin receptor TRPV1, and its regulator nerve growth factor (NGF), in BMS. Patients with BMS (n=10) and controls (n=10) were assessed for baseline and post-topical capsaicin pain scores, and their tongue biopsies immunostained for
Presentation of AIDS with Disseminated Cutaneous and Visceral Leishmaniasis in Iran
Davarpanah, Mohammadali; Rassaei, Masumeh; Sari aslani, Fatemeh
Leishmaniasis is an infectious disease in form of visceral (VL), cutaneous (CL), and mucocutaneous (MCL) leishmaniasis. Immunocompromised patients have increased risk of Leishmania infection, especially in endemic areas for visceral leishmaniasis, where in the world HIV/VL coinfection has become endemic. The case here suffers from both AIDS and visceral-cutaneous leishmaniasis. We report an Iranian woman with disseminated cutaneous and visceral leishmaniasis who became positive for HIV test.
Multiple roles for NaV1.9 in the activation of visceral afferents by noxious inflammatory, mechanical, and human disease�derived stimuli
Hockley, James R.F.; Boundouki, George; Cibert-Goton, Vincent; McGuire, Cian; Yip, Ping K.; Chan, Christopher; Tranter, Michael; Wood, John N.; Nassar, Mohammed A.; Blackshaw, L. Ashley; Aziz, Qasim; Michael, Gregory J.; Baker, Mark D.; Winchester, Wendy J.; Knowles, Charles H.; Bulmer, David C.
Chronic visceral pain affects millions of individuals worldwide and remains poorly understood, with current therapeutic options constrained by gastrointestinal adverse effects. Visceral pain is strongly associated with inflammation and distension of the gut. Here we report that the voltage-gated sodium channel subtype NaV1.9 is expressed in half of gut-projecting rodent dorsal root ganglia sensory neurons. We show that NaV1.9 is required for normal mechanosensation, for direct excitation and for sensitization of mouse colonic afferents by mediators from inflammatory bowel disease tissues, and by noxious inflammatory mediators individually. Excitatory responses to ATP or PGE2 were substantially reduced in NaV1.9?/? mice. Deletion of NaV1.9 substantially attenuates excitation and subsequent mechanical hypersensitivity after application of inflammatory soup (IS) (bradykinin, ATP, histamine, PGE2, and 5HT) to visceral nociceptors located in the serosa and mesentery. Responses to mechanical stimulation of mesenteric afferents were also reduced by loss of NaV1.9, and there was a rightward shift in stimulus�response function to ramp colonic distension. By contrast, responses to rapid, high-intensity phasic distension of the colon are initially unaffected; however, run-down of responses to repeat phasic distension were exacerbated in NaV1.9?/? afferents. Finally colonic afferent activation by supernatants derived from inflamed human tissue was greatly reduced in NaV1.9?/? mice. These results demonstrate that NaV1.9 is required for persistence of responses to intense mechanical stimulation, contributes to inflammatory mechanical hypersensitivity, and is essential for activation by noxious inflammatory mediators, including those from diseased human bowel. These observations indicate that NaV1.9 represents a high-value target for development of visceral analgesics. PMID:24972070
Leishmania tropica: Another Etiological Agent of Canine Visceral Leishmaniasis in Iran
H Hajjaran; M Mohebali; Z Zarei
Background: Dogs have been previously reported to be reservoirs of Leishmania infantum as the etiological agent of human visceral leishmaniasis in Iran. We report a case of canine visceral leishmaniasis (VL) caused by L. tropica from the north- west of Iran where human visceral leishmaniasis is endemic. Methods: The canine VL was initially screened by dipstick rK39 and direct agglutination
Serotonergic and non-serotonergic targets in the pharmacotherapy of visceral hypersensitivity.
Bueno, L; de Ponti, F; Fried, M; Kullak-Ublick, G A; Kwiatek, M A; Pohl, D; Quigley, E M M; Tack, J; Talley, N J
Visceral hypersensitivity is considered a key mechanism in the pathogenesis of functional gastrointestinal (GI) disorders. Targeting visceral hypersensitivity seems an attractive approach to the development of drugs for functional GI disorders. This review summarizes current knowledge on targets for the treatment of visceral hypersensitivity, and the status of current and future drug and probiotic treatment development, and the role of pharmacogenomic factors. PMID:17280587
Diagnosis of Visceral Pleural Invasion in Resected Lung Cancer Using a Jet Stream of Saline Solution
Yukito Ichinose; Tokujiro Yano; Hiroshi Asoh; Hideki Yokoyama; Yasuro Fukuyama; Yasaburo Katsuda
Background. Visceral pleural invasion by the tumor is an important prognostic factor in patients undergoing resection for lung cancer. We developed a method to detect more accurately the presence of visceral pleural invasion in resected lung cancer.Methods. The surface of the visceral pleura over 90 resected peripheral tumors was irrigated twice with a jet stream of saline solution using a
Epidemiology of visceral leishmaniasis in Georgia.
Babuadze, Giorgi; Alvar, Jorge; Argaw, Daniel; de Koning, Harry P; Iosava, Merab; Kekelidze, Merab; Tsertsvadze, Nikoloz; Tsereteli, David; Chakhunashvili, Giorgi; Mamatsashvili, Tamar; Beria, Nino; Kalandadze, Irine; Ejov, Mikhail; Imnadze, Paata
This study investigated the transmission and prevalence of Leishmania parasite infection of humans in two foci of Visceral Leishmaniasis (VL) in Georgia, the well known focus in Tbilisi in the East, and in Kutaisi, a new focus in the West of the country. The seroprevalence of canine leishmaniasis was investigated in order to understand the zoonotic transmission. Blood samples of 1575 dogs (stray and pet) and 77 wild canids were tested for VL by Kalazar Detect rK39 rapid diagnostic tests. Three districts were investigated in Tbilisi and one in Kutaisi. The highest proportions of seropositive pet dogs were present in District #2 (28.1%, 82/292) and District #1 (26.9%, 24/89) in Tbilisi, compared to 17.3% (26/150) of pet dogs in Kutaisi. The percentage of seropositive stray dogs was also twice as high in Tbilisi (16.1%, n?=?670) than in Kutaisi (8%, n?=?50); only 2/58 wild animals screened were seropositive (2. 6%). A total of 873 Phlebotomine sand flies were collected, with 5 different species identified in Tbilisi and 3 species in Kutaisi; 2.3% of the females were positive for Leishmania parasites. The Leishmanin Skin Test (LST) was performed on 981 human subjects in VL foci in urban areas in Tbilisi and Kutaisi. A particularly high prevalence of LST positives was observed in Tbilisi District #1 (22.2%, 37.5% and 19.5% for ages 5-9, 15-24 and 25-59, respectively); lower prevalence was observed in Kutaisi (0%, 3.2% and 5.2%, respectively; P<0.05). This study shows that Tbilisi is an active focus for leishmaniasis and that the infection prevalence is very high in dogs and in humans. Although exposure is as yet not as high in Kutaisi, this is a new VL focus. The overall situation in the country is alarming and new control measures are urgently needed. PMID:24603768
Lovich-Sapola, Jessica; Smith, Charles E; Brandt, Christopher P
Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction. PMID:25814108
Eberhardt, Mirjam; Nakajima, Julika; Klinger, Alexandra B.; Neacsu, Cristian; H�hne, Kathrin; O'Reilly, Andrias O.; Kist, Andreas M.; Lampe, Anne K.; Fischer, Kerstin; Gibson, Jane; Nau, Carla; Winterpacht, Andreas; Lampert, Angelika
Inherited erythromelalgia (IEM) causes debilitating episodic neuropathic pain characterized by burning in the extremities. Inherited �paroxysmal extreme pain disorder� (PEPD) differs in its clinical picture and affects proximal body areas like the rectal, ocular, or jaw regions. Both pain syndromes have been linked to mutations in the voltage-gated sodium channel Nav1.7. Electrophysiological characterization shows that IEM-causing mutations generally enhance activation, whereas mutations leading to PEPD alter fast inactivation. Previously, an A1632E mutation of a patient with overlapping symptoms of IEM and PEPD was reported (Estacion, M., Dib-Hajj, S. D., Benke, P. J., Te Morsche, R. H., Eastman, E. M., Macala, L. J., Drenth, J. P., and Waxman, S. G. (2008) NaV1.7 Gain-of-function mutations as a continuum. A1632E displays physiological changes associated with erythromelalgia and paroxysmal extreme pain disorder mutations and produces symptoms of both disorders. J. Neurosci. 28, 11079�11088), displaying a shift of both activation and fast inactivation. Here, we characterize a new mutation of Nav1.7, A1632T, found in a patient suffering from IEM. Although transfection of A1632T in sensory neurons resulted in hyperexcitability and spontaneous firing of dorsal root ganglia (DRG) neurons, whole-cell patch clamp of transfected HEK cells revealed that Nav1.7 activation was unaltered by the A1632T mutation but that steady-state fast inactivation was shifted to more depolarized potentials. This is a characteristic normally attributed to PEPD-causing mutations. In contrast to the IEM/PEPD crossover mutation A1632E, A1632T failed to slow current decay (i.e. open-state inactivation) and did not increase resurgent currents, which have been suggested to contribute to high-frequency firing in physiological and pathological conditions. Reduced fast inactivation without increased resurgent currents induces symptoms of IEM, not PEPD, in the new Nav1.7 mutation, A1632T. Therefore, persistent and resurgent currents are likely to determine whether a mutation in Nav1.7 leads to IEM or PEPD. PMID:24311784
Valentine, A.
as he tried to get me out from under the truck. I remember the anguish on his face when he saw that nothing was 195 "Phantom Pain" working. The wind and rain were lashing both of our faces and the water was getting higher and higher. The cell... phones wouldn't work and the wreck had totaled the truck's radio. Something was burning ... I'm not sure what... It made a surreal light around the place but all I remember was wondering how it could keep burning in ali that rain and wind and water...
Descending pain modulation and chronification of pain
Ossipov, Michael H.; Morimura, Kozo; Porreca, Frank
Purpose of review Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain �chronification�. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. Recent findings Descending pain modulatory systems have been studied and characterized in animal models. Human brain imaging techniques, deep brain stimulation and the mechanisms of action of drugs that are effective in the treatment of pain confirm the clinical relevance of top-down pain modulatory circuits. Growing evidence supports the concept that chronic pain is associated with a dysregulation in descending pain modulation. Disruption of the balance of descending modulatory circuits to favour facilitation may promote and maintain chronic pain. Recent findings suggest that diminished descending inhibition is likely to be an important element in determining whether pain may become chronic. This view is consistent with the clinical success of drugs that enhance spinal noradrenergic activity, such as serotonin/norepinephrine reuptake inhibitors (SNRIs), in the treatment of chronic pain states. Consistent with this concept, a robust descending inhibitory system may be normally engaged to protect against the development of chronic pain. Imaging studies show that higher cortical and subcortical centres that govern emotional, motivational and cognitive processes communicate directly with descending pain modulatory circuits providing a mechanistic basis to explain how exogenous factors can influence the expression of chronic pain in a susceptible individual. Summary Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced our understanding of brain circuits that modulate pain. Descending pain facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms that can be engaged to promote or protect against pain �chronification�. These systems interact with higher centres, thus providing a means through which exogenous factors can influence the risk of pain chronification. A greater understanding of the role of descending pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant processes that can lead to chronic pain. PMID:24752199
How common is painful sex? Pain during intercourse is very common�nearly 3 out of 4 women have pain during intercourse at some time during ... a long-term problem. What causes pain during sex? Pain during sex may be a sign of ...
Jianren Mao; Lucy L. Chen
role of gabapentin in pain treatment will be discussed with an attempt to identify pain symptoms that are likely to be responsive to gabapentin; 2) animal stud- ies of gabapentin on neuropathic pain and other pain behaviors will be evaluated; and 3) possible mecha- nisms of gabapentin actions will be considered in re- lation to mechanisms of neuropathic pain in
Add-on trial of clobazam in intractable adult epilepsy with plasma level correlations.
Guberman, A; Couture, M; Blaschuk, K; Sherwin, A
Clobazam, a novel benzodiazepine, was used as an add-on agent in 47 adult patients with intractable epilepsy and a variety of seizure types. A greater than 75% reduction in seizure frequency was observed in 42% (18) of the patients and a greater than 50% reduction in 65% (29) of the patients which was sustained over a mean follow-up period of 13.3 (+/- 5.6) months. Nine patients had to discontinue the drug due to minor adverse effects or increased seizures. Possible tolerance developed in 6 patients. Plasma levels of the active metabolite N-desmethylclobazam were linearly related to dosage and appeared to correlate with both therapeutic and toxic responses. Clobazam appears to be a safe and effective add-on antiepileptic for a wide variety of seizure types in intractable epilepsy. PMID:2207887
X-linked immune dysregulation, neonatal insulin dependent diabetes, and intractable diarrhoea.
Peake, J. E.; McCrossin, R. B.; Byrne, G.; Shepherd, R.
Four related male infants presented with neonatal diabetes mellitus, immune dysregulation with extremely high concentrations of immunoglobulin E, and intractable diarrhoea. They were all from one family, and all of them died. As far as is known this X-linked recessive disorder has not been described before. It is suggested that this is a new immunodeficiency in which type 2 T helper responses predominate. PMID:8777684
Percutaneous Cyanoacrylate Glue Injection into the Renal Pseudoaneurysm to Control Intractable Hematuria After Percutaneous Nephrolithotomy
Lal, Anupam, E-mail: email@example.com; Kumar, Ajay; Prakash, Mahesh; Singhal, Manphool [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Radiodiagnosis and Imaging (India); Agarwal, Mayank Mohan; Sarkar, Debansu [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Urology (India); Khandelwal, Niranjan [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Radiodiagnosis and Imaging (India)
We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.
Neuroprotective effects of vagus nerve stimulation on hippocampal neurons in intractable epilepsy.
Chen, Ning; Zhang, Hong; Gao, Xiang-dong; Yan, Na; Ma, Yu; Yu, Chun-jiang
Vagus nerve stimulation (VNS) and electroacupuncture (EA) at specific acupoints have both shown promising anticonvulsant effects in intractable epilepsy patients. The differences between these therapies are target selection and stimulation parameter modulation. It has been demonstrated that EA of the extremities results in stimulation of the VN and protection of hippocampus neurons, possibly by an anti-inflammatory response. Similarly, VNS can also suppress neural inflammatory responses, implying that VNS may protect hippocampal neurons against seizure-induced damage. PMID:24176140
Renal Manifestations and Visceral Adiposity in Apparently Healthy Korean Women
Ji-Won Lee; Urhee Bae; Duk-Chul Lee; Hye-Ree Lee; Jae-Yong Shim; John A. Linton
Aims: It was the aim of this study to investigate the relationship between normal renal function � estimated glomerular filtration rate (GFR) � and visceral adiposity measured by CT in apparently healthy Korean women. Methods: A total of 425 apparently healthy women were recruited. We assessed body composition with CT and divided the study population into 2 groups based on
Larger Amounts of Visceral Adipose Tissue in Asian Americans
Yong-Woo Park; David B. Allison; Steven B. Heymsfield; Dympna Gallagher
Objective: Excess visceral adipose tissue (VAT) is recognized as an important risk factor for the development of coronary heart disease and type 2 diabetes. Several studies have reported less VAT in African Americans compared with whites. As little is known about the levels of VAT in Asians, we compared whole-body VAT in Asian Americans with European Americans.Research Methods and Procedures:
Glomerulonephritis and cryoglobulinemia: first manifestation of visceral leishmaniasis.
Ortiz, Milagros; Mon, Carmen; Herrero, Juan Carlos; Oliet, Aniana; Rodr�guez, Isabel; Ortega, Olimpia; Gallar, Paloma; Hinostroza, Julie; Cobo, Gabriela; Del Alamo, Manuel; Jim�nez, Juana; Torres, Rafael; Digiogia, Cristina; San Martin, Juan; Vigil, Ana I; Blanco, Julia
Visceral leishmaniasis due to Leishmania Infantum is an endemic parasitic infection in the Mediterranean area. Since 2009, Europe's largest outbreak of Leishmaniasis has been reported in the region of Madrid (Spain). Renal involvement is an unusual complication. Different forms of renal disease have been described: interstitial, glomerular, and vascular damage. Direct invasion of renal parenchyma by the parasite has been described as a mechanism of kidney damage, especially in the immunocompromised. Immune complex deposition and T cells adhesion molecules activation have demonstrated that a pathogenic role in glomerulonephritis related to visceral leishmaniasis. The association between mixed cryoglobulinemia and visceral leishmaniasis has been previously reported in six patients. Renal involvement is only described in one of them. From July 2009 to October 2012, 4 patients with membranoproliferative glomerulonephritis and mixed cryoglobulinemia with negative serology for hepatitis B and C were diagnosed in our hospital. Serology of Leishmania in serum bank samples was performed; it was positive in 3 patients. Leishmania parasite was confirmed by other tests. We present 3 patients with mixed cryoglobulinemia and membranoproliferative glomerulonephritis as first clinical manifestation of visceral leishmaniasis. PMID:25600859
Obesity reduces methionine sulfoxide reductase activity in visceral adipose tissue
Technology Transfer Automated Retrieval System (TEKTRAN)
Visceral obesity is linked to the development of comorbidities including insulin resistance and cardiovascular disease. Elevated levels of oxidative stress are observed in obese individuals and in animal models of obesity, pointing to a mechanistic role of oxidative stress. A recent genetic study in...
Visceral leshmaniasis diagnosed on duodenal biopsy in a child.
Boukthir, S; Mejri, A; M'rad, S; Barsaoui, S
Visceral leishmaniasis is usually easy to recognize when clinical presentation is complete: splenomegaly, fever and palor associated to pancytopenia, hypoalbuminaemia and hypergamma globulinemia. Bone marrow smears, culture and serology confirm the diagnosis. We report the case of an infant in whom clinical and biological findings are suggestive of leishmaniasis and the diagnosis confirmed only by duodenal biopsy. PMID:14618961
[Metabolic difference between visceral fat and subcutaneous abdominal fat].
Bj�rntorp, P
Obesity stands as a public health issue. Obesity prevalence is increasing throughout every industrialized country. Android obesity is linked with an increased cardiovascular mortality and with type 2 diabetes mellitis, thus calling for an early management of this disease. Several studies showed a significant association between an android fat distribution and an increased cortisol secretion, raising the still debated question of a causal relationship between the development of android obesity and hypercorticism. Moreover, android obese subjects exhibit reduced plasma testosterone and growth hormone levels, meaning complex hormonal abnormalities in these subjects. Current hypotheses suggest that android fat distribution depends on the association of these hormonal abnormalities. Android obese patients have supranormal free fatty acid plasma concentrations. Visceral fat tissue, through its portal drainage, could be an important source for free fatty acids that may exert complex metabolic effects: involvement in hepatic lipogenesis, increase in hepatic neoglucogenic flux, reduction in insulin metabolic clearance and involvement in peripheral insulin resistance through a competition mechanism described by Randle. Technics in vitro (isolated adipocytes) and in vivo in human (labelled fatty acid flux) showed that visceral fatty acid flux was increased in obese patients and subcutaneous adipose tissue, as opposed to common opinion, was also involved in free fatty acid pool in obese patients. Thus, visceral obesity and diabetes could be linked through an enhanced fatty acid availability from adipose tissues (visceral and subcutaneous) in otherwise genetically type 2 diabetes-prone individuals. PMID:10945144
Visceral adipose tissue: a critical review of intervention strategies
JJ Zachwieja; Steven R. Smith
OBJECTIVE: To review the published literature regarding the effect of caloric restriction, pharmacologic intervention, and exercise to promote the loss of visceral adipose tissue (VAT)DESIGN: A review was conducted of published studies which measured VAT using computed tomography or magnetic resonance imaging before and after caloric restriction, pharmacologic therapy, or exercise.STUDIES REVIEWED: 23 separate studies were reviewed. Men represented 38%
[Temporal bone pathology in neonates with severe visceral anomalies].
Koyama, S; Iino, Y; Ohkura, S; Kaga, K; Ohhira, Y; Ogawa, Y
It is well known that hearing loss is often associated with anomalads, syndromes involving multiple anomalies. The incidence is especially high in severe cases of facial and visceral malformations. However, otologic features remain unclear in patients with a sequence of various anomalies which can not be classified into any known syndrome. We examined 11 temporal bones from 6 patients with severe visceral anomalies, which could not be classified into any known systemic bone diseases, chromosomal abnormalities, or congenital metabolic disorders. Temporal bone pathology was compared with external and visceral anomalies in each case. The temporal bones had been removed at autopsy, fixed in 10% formaldehyde, decalcified and embedded in celloidin. Serial horizontal sections were made at 20 microns and every tenth section was stained with hematoxylin eosin. Most abnormalities in the middle and inner ear were found to have an ectodermal or mesodermal origin. Inner ear abnormalities were noted in 6 temporal bones from 3 patients; the predominant feature was hypoplasia of the semicircular canals. Middle ear abnormalities excluding residual mesenchymal tissue were noted in 5 temporal bones from 4 patients; the predominant feature was an abnormal course of the facial nerve. It was also suspected that auricular and maxillomandibular abnormalities, which are often associated with severe visceral anomalies, indicate a high incidence of disorders affecting the auditory and vestibular systems. PMID:8831230
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Palliative care - managing pain
End of life - pain management; Hospice - pain management ... or if you have side effects from your pain treatments. ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Medicine . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap ...
... in relieving pelvic pain, especially dysmenorrhea . � Physical therapy�Acupuncture, acupressure, and nerve stimulation therapies may be useful in treating pain caused by dysmenorrhea. Physical therapy that eases trigger points may give relief of muscular pain. Some types ...
... some types of treatments for chronic back pain. Hot or Cold Packs (or Both) Hot or cold packs can soothe sore, stiff backs. ... helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this ...
Mutation screening of the CDKL5 gene in cryptogenic infantile intractable epilepsy and review of clinical sensitivity
Utcharee Intusoma; Fadell Hayeeduereh; Thanya Sripo; Punnee Vasiknanonte; Supachai Janjindamai; Apasri Lusawat; Sasipa Thammongkol; Anannit Visudtibhan; Pornprot Limprasert
PurposesTo perform CDKL5 mutation screening in Thai children with cryptogenic infantile intractable epilepsy and to determine the clinical sensitivity of CDKL5 screening when different inclusion criteria were applied.
Physical Feature Encoding and Word Recognition Abilities Are Altered in Children with Intractable Epilepsy: Preliminary Neuromagnetic Evidence
Pardos, Maria; Korostenskaja, Milena; Xiang, Jing; Fujiwara, Hisako; Lee, Ki H.; Horn, Paul S.; Byars, Anna; Vannest, Jennifer; Wang, Yingying; Hemasilpin, Nat; Rose, Douglas F.
Objective evaluation of language function is critical for children with intractable epilepsy under consideration for epilepsy surgery. The purpose of this preliminary study was to evaluate word recognition in children with intractable epilepsy by using magnetoencephalography (MEG). Ten children with intractable epilepsy (M/F 6/4, mean � SD 13.4 � 2.2 years) were matched on age and sex to healthy controls. Common nouns were presented simultaneously from visual and auditory sensory inputs in �match� and �mismatch� conditions. Neuromagnetic responses M1, M2, M3, M4, and M5 with latencies of ~100?ms, ~150?ms, ~250?ms, ~350?ms, and ~450?ms, respectively, elicited during the �match� condition were identified. Compared to healthy children, epilepsy patients had both significantly delayed latency of the M1 and reduced amplitudes of M3 and M5 responses. These results provide neurophysiologic evidence of altered word recognition in children with intractable epilepsy. PMID:26146459
Pickering, G; Eschalier, A; Dubray, C
Literature on pain management in Alzheimer's disease is slowly emerging and this review deals with different aspects of pain in this growing population. Clinical pain, experimental pain and assessment of pain in cognitively impaired patients are presented. Treatment of pain is also discussed. This review calls for more studies and clinical trials with a view to improve the comfort and quality of life of patients suffering from Alzheimer's disease. PMID:10965178
Quality of Life after Vagus Nerve Stimulation for Intractable Epilepsy: Is Seizure Control the Only Contributing Factor?
Richard S. McLachlan; Mark Sadler; Neelan Pillay; Alan Guberman; Michael Jones; Samuel Wiebe; Jack Schneiderman
We assessed the impact of vagus nerve stimulation on a cohort of patients with intractable epilepsy. A 1-year prospective trial of vagus nerve stimulation for intractable epilepsy was done in 26 patients. Seizure frequency, anti-epileptic drugs, and quality of life were assessed using QOLIE-89, ELDQOL, and a Likert scale of impact of treatment. Seizures were reduced by more than 50%
Involvement of Subtypes ? and ? of Protein Kinase C in Colon Pain Induced by Formalin Injection
Zhang, Yanbo; Gong, Kerui; Zhou, Weihua; Shao, Guo; Li, Sijie; Lin, Qing; Li, Jingjin
Protein kinase C (PKC) has been widely reported to participate in somatic pain; however, its role in visceral pain remains largely unclear. Using a colon inflammatory pain model by intracolonic injection of formalin in rats, the present study was to examine the role of PKC in visceral pain and determine which subtypes may be involved. The colon pain behavior induced by formalin injection could be enhanced by intrathecal pretreatment with a PKC activator (PMA), and alleviated by a PKC inhibitor (H-7). Wide dynamic range (WDR) neurons in the L6-S1 spinal dorsal horn that were responsive to colorectal distension were recorded extracellularly. It was found that neuronal activity was greatly increased following formalin injection. Microdialysis of PMA near the recorded neuron in the spinal dorsal horn facilitated the enhanced responsive activity induced by formalin injection, while H-7 inhibited significantly the enhanced response induced by formalin injection. Western blot analysis revealed that membrane translocation of PKC-? and PKC-?, but not other subtypes, in the spinal cord was obviously increased following formalin injection. Therefore, our findings suggest that PKC is actively involved in the colon pain induced by intracolonic injection of formalin. PKC-? and PKC-? subtypes seem to significantly contribute to this process. PMID:21701146
Evaluation of the loin pain/hematuria syndrome treated by renal autotransplantation or radical renal neurectomy.
Sheil, A G; Chui, A K; Verran, D J; Boulas, J; Ibels, L S
Some patients with the loin pain/hematuria syndrome suffer incapacitating flank pain. No effective therapy has been reported. Uncertainty persists concerning the authenticity of the pain and the role of surgery in treatment. Forty-six patients with loin pain/hematuria syndrome and intractable pain were evaluated following treatment either by renal autotransplantation (30 patients, 10 bilaterally) or by renal denervation (20 patients, four bilaterally) over a 13-year period. All patients had concomitant renal nerve excision and ligation and capsulotomy. There were 37 (80%) women and nine men aged 18 to 61 years (mean age, 33 years). Excretion urography and angiography were normal in all patients. Nineteen of 25 (76%) patients in whom renal autotransplantation was successfully accomplished and who completed a follow-up questionnaire were free of pain, including eight of 10 with bilateral procedures. The follow-up periods ranged from 1 to 13 years (mean, 8.4 years). Six patients have been free of pain for 10 to 13 years. Of 18 patients treated with renal neurectomy who were available for follow-up examination, 12 (67%) developed recurrent renal pain, including four who had pain relief on the other side following previous renal autotransplantation. The follow-up period for these patients ranged from 6 to 9.9 years (mean, 8.0 years). Three of four patients with recurrent renal pain following neurectomy were treated successfully by renal autotransplantation. The loin pain/hematuria syndrome is a rare cause of incapacitation, predominantly of relatively young females. The pain of the syndrome is organic. Renal autotransplantation achieves pain relief in three quarters of patients, but the procedure is often (30%) required bilaterally and has significant complications. Renal neurectomy is followed by an excessive incidence of recurrent renal pain. PMID:9708604
Opioids in chronic noncancer pain: More faces from the crowd
Watson, C Peter N
BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains very controversial. There are several randomized controlled trials, mostly in neuropathic pain, reporting efficacy and safety in the short term, but more long-term data are needed. Randomized controlled trials may be limited in providing data about the patients who benefit from often high-dose opioids over the long term. The present article provides details of these patients and adds to a previous case series. METHODS: The present article contains 17 case reports of 11 CNCP conditions (followed to 2011) selected to illustrate specific issues from a survey of 84 patients with intractable CNCP treated with opioids and followed every three months for a median of 11 years. The previous published survey of this group reported outcomes of pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life (HRQL), immune status and sexual function. The outcome measures for that study included a numerical rating scale for pain, the Hospital Anxiety and Depression Scale, the Brief Pain Inventory Interference Scale, the Pain Disability Index and, for HRQL, the Short-Form Health Survey 12 version 2. Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability. Scores for functional status and HRQL were not severely affected. Problematic use, tolerance and serious adverse effects, including constipation, were not major issues. These selected patient reports were chosen, not to illustrate optimal results, but rather important aspects of the diagnoses, opioids and doses, the paucity of intolerable adverse effects, particular issues (concurrent addiction history, bipolar disorder and combination therapy), disease-specific and other outcomes and duration of follow-up with complex pain problems. RESULTS: Opioids were found to be safe and useful in the long term for these particular patients, as well as in the larger group from which they originated. INTERPRETATION: These 17 reports of patients with intractable CNCP treated with opioids with some success over many years puts a face on more of the participants in the larger survey of 84 subjects, suggesting that this approach is effective and safe for some patients over many years. PMID:22891192
Retroperitoneal myoma and chronic pelvic pain: case report and literature review
Malina Lukanova; Ehab Akkary; Yordan Popov; Dimitar Stoykov; Margarita Nikolova
We present a case of a postmenopausal diabetic hypertensive female with a solitary retroperitoneal myoma (2,025�g) and no\\u000a smooth muscle (myomatic) nodules on visceral and parietal peritoneum. She complained of chronic pelvic pain in absence of\\u000a internal female genitalia (except uterine cervix), high frequency of urination, pelvic discomfort, and feeling of heaviness.\\u000a The patient had undergone hysterectomy with bilateral adnexectomies
Rapid tests for the diagnosis of visceral leishmaniasis in patients with suspected disease
Boelaert, Marleen; Verdonck, Kristien; Menten, Joris; Sunyoto, Temmy; van Griensven, Johan; Chappuis, Francois; Rijal, Suman
Background The diagnosis of visceral leishmaniasis (VL) in patients with fever and a large spleen relies on showing Leishmania parasites in tissue samples and on serological tests. Parasitological techniques are invasive, require sophisticated laboratories, consume time, or lack accuracy. Recently, rapid diagnostic tests that are easy to perform have become available. Objectives To determine the diagnostic accuracy of rapid tests for diagnosing VL in patients with suspected disease presenting at health services in endemic areas. Search methods We searched MEDLINE, EMBASE, LILACS, CIDG SR, CENTRAL, SCI-expanded, Medion, Arif, CCT, and the WHO trials register on 3 December 2013, without applying language or date limits. Selection criteria This review includes original, phase III, diagnostic accuracy studies of rapid tests in patients clinically suspected to have VL. As reference standards, we accepted: (1) direct smear or culture of spleen aspirate; (2) composite reference standard based on one or more of the following: parasitology, serology, or response to treatment; and (3) latent class analysis. Data collection and analysis Two review authors independently extracted data and assessed quality of included studies using the QUADAS-2 tool. Discrepancies were resolved by a third author. We carried out a meta-analysis to estimate sensitivity and specificity of rapid tests, using a bivariate normal model with a complementary log-log link function. We analysed each index test separately. As possible sources of heterogeneity, we explored: geographical area, commercial brand of index test, type of reference standard, disease prevalence, study size, and risk of bias (QUADAS-2). We also undertook a sensitivity analysis to assess the influence of imperfect reference standards. Main results Twenty-four studies containing information about five index tests (rK39 immunochromatographic test (ICT), KAtex latex agglutination test in urine, FAST agglutination test, rK26 ICT, and rKE16 ICT) recruiting 4271 participants (2605 with VL) were included. We carried out a meta-analysis for the rK39 ICT (including 18 studies; 3622 participants) and the latex agglutination test (six studies; 1374 participants). The results showed considerable heterogeneity. For the rK39 ICT, the overall sensitivity was 91.9% (95% confidence interval (95% CI) 84.8 to 96.5) and the specificity 92.4% (95% CI 85.6 to 96.8). The sensitivity was lower in East Africa (85.3%; 95% CI 74.5 to 93.2) than in the Indian subcontinent (97.0%; 95% CI 90.0 to 99.5). For the latex agglutination test, overall sensitivity was 63.6% (95% CI 40.9 to 85.6) and specificity 92.9% (95% CI 76.7 to 99.2). Authors' conclusions The rK39 ICT shows high sensitivity and specificity for the diagnosis of visceral leishmaniasis in patients with febrile splenomegaly and no previous history of the disease, but the sensitivity is notably lower in east Africa than in the Indian subcontinent. Other rapid tests lack accuracy, validation, or both. PLAIN LANGUAGE SUMMARY Rapid diagnostic tests for visceral leishmaniasis Visceral leishmaniasis (or kala-azar) is caused by a parasite, results in fever, a large spleen and other health problems, occuring in India, Bangladesh and Nepal, east Africa, the Mediterranean region and Brazil. Without treatment people die, and proper treatment can result in cure, so diagnosis is important. Many of the tests that are used to determine if a person has visceral leishmaniasis are complicated, costly, painful and sometimes dangerous for the patients. Now rapid diagnostic tests that are safe and easy to perform are available. This Cochrane review describes how accurate these rapid diagnostic tests are for diagnosing visceral leishmaniasis. We summarize those studies that evaluated the rapid tests in people who, according to their physicians, could have the disease. We only included studies in which the researchers had used established methods to distinguish the people with visceral leishmaniasis from those who did not have the disease. We found 24 studies, which contained infor
Chronic prenatal stress epigenetically modifies spinal cord BDNF expression to induce sex specific visceral hypersensitivity in offspring
Winston, John H.; Li, Qingjie; Sarna, Sushil K.
Background Irritable bowel syndrome (IBS) is a heterogeneous disorder with abdomen pain as one of the primary symptoms. The etiology of IBS remains unknown. Epidemiological studies found that a subset of these patients have a history of adverse early-life events. We tested the hypothesis that chronic prenatal stress (CPS) epigenetically enhances brain-derived neurotrophic factor (BDNF) in spinal cord to aggravate colon sensitivity to colorectal distension (CRD) differentially in male and female offspring. Methods We used heterotypic intermittent chronic stress (HeICS) protocols in pregnant dams from E11 until delivery. Results CPS induced significant visceral hypersensitivity (VHS) to CRD in male and female offspring. A second exposure to HeICS in adult offspring exacerbated VHS greater in female offspring that persisted longer than in male offspring. CPS upregulated BDNF expression in the lumbar-sacral dorsal horn that correlated with the exacerbation of VHS in female, but not in male offspring. The upregulation of BDNF was due to a significant increase in RNA Pol II binding, histone H3 acetylation and significant decrease in histone deacetylase 1 association with the core promoter of BDNF in female offspring. Other chronic prenatal and neonatal stress protocols were less effective than HeICS. Conclusion & Inferences The development of visceral hypersensitivity, which contributes to the symptom of intermittent abdominal pain, is a two-step process, chronic in utero stress followed by chronic stress in adult-life. This two-step process induces aggravated and persistent colon hypersensitivity in female than in male offspring. Our preclinical model explains several clinical features in IBS patients. PMID:24588943
AHMAD, Asma Hayati; ABDUL AZIZ, Che Badariah
Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies. PMID:25941463
Sphingosine Lysolipids in the CNS: Endogenous Cannabinoid Antagonists or a Parallel Pain Modulatory System?
Selley, Dana E.; Welch, Sandra P.; Sim-Selley, Laura J.
A significant number of patients experience chronic pain and the intractable side effects of currently prescribed pain medications. Recent evidence indicates important pain modulatory roles for two classes of G-protein-coupled receptors that are activated by endogenous lipid ligands, the endocannabinoid (eCB) and sphingosine-1-phosphate (S1P) receptors, which are widely expressed in both the immune and nervous systems. In the central nervous system (CNS), CB1 cannabinoid and S1P1 receptors are most abundantly expressed and exhibit overlapping anatomical distributions and similar signaling mechanisms. The eCB system has emerged as a potential target for treatment of chronic pain, but comparatively little is known about the roles of S1P in pain regulation. Both eCB and S1P systems modulate pain perception via the central and peripheral nervous systems. In most paradigms studied, the eCB system mainly inhibits pain perception. In contrast, S1P acting peripherally at S1P1 and S1P3 receptors can enhance sensitivity to various pain stimuli or elicit spontaneous pain. However, S1P acting at S1P1 receptors and possibly other targets in the CNS can attenuate sensitivity to various pain stimuli. Interestingly, other endogenous sphingolipid derivatives might play a role in central pain sensitization. Moreover, these sphingolipids can also act as CB1 cannabinoid receptor antagonists, but the physiological relevance of this interaction is unknown. Overall, both eCB and sphingolipid systems offer promising targets for the treatment of chronic pain. This review compares and contrasts the eCB and S1P systems with a focus on their roles in pain modulation, and considers possible points of interaction between these systems. PMID:23782998
Jean R�gis; Fabrice Bartolomei; Patrick Chauvel
\\u000a There are convincing arguments for investigating the potential role of radiosurgery in epilepsy surgery. We know that:\\u000a \\u000a \\u000a \\u000a \\u000a ��\\u000a \\u000a \\u000a Radiosurgery (since its introduction in the 1950s) has been demonstrated to have advantages in terms of safety and efficacy,\\u000a for the treatment of numerous small, deeply seated intracerebral lesions.\\u000a \\u000a \\u000a \\u000a \\u000a ��\\u000a \\u000a \\u000a Radiosurgical treatment of small cortico-subcortical lesions associated with epilepsy has been demonstrated
Transient receptor potential ankyrin 1 mediates chronic pancreatitis pain in mice
Cattaruzza, Fiore; Johnson, Cali; Leggit, Alan; Grady, Eileen; Schenk, A. Katrin; Cevikbas, Ferda; Cedron, Wendy; Bondada, Sandhya; Kirkwood, Rebekah; Malone, Brian; Steinhoff, Martin; Bunnett, Nigel
Chronic pancreatitis (CP) is a devastating disease characterized by persistent and uncontrolled abdominal pain. Our lack of understanding is partially due to the lack of experimental models that mimic the human disease and also to the lack of validated behavioral measures of visceral pain. The ligand-gated cation channel transient receptor potential ankyrin 1 (TRPA1) mediates inflammation and pain in early experimental pancreatitis. It is unknown if TRPA1 causes fibrosis and sustained pancreatic pain. We induced CP by injecting the chemical agent trinitrobenzene sulfonic acid (TNBS), which causes severe acute pancreatitis, into the pancreatic duct of C57BL/6 trpa1+/+ and trpa1-/- mice. Chronic inflammatory changes and pain behaviors were assessed after 2�3 wk. TNBS injection caused marked pancreatic fibrosis with increased collagen-staining intensity, atrophy, fatty replacement, monocyte infiltration, and pancreatic stellate cell activation, and these changes were reflected by increased histological damage scores. TNBS-injected animals showed mechanical hypersensitivity during von Frey filament probing of the abdomen, decreased daily voluntary wheel-running activity, and increased immobility scores during open-field testing. Pancreatic TNBS also reduced the threshold to hindpaw withdrawal to von Frey filament probing, suggesting central sensitization. Inflammatory changes and pain indexes were significantly reduced in trpa1-/- mice. In conclusion, we have characterized in mice a model of CP that resembles the human condition, with marked histological changes and behavioral measures of pain. We have demonstrated, using novel and objective pain measurements, that TRPA1 mediates inflammation and visceral hypersensitivity in CP and could be a therapeutic target for the treatment of sustained inflammatory abdominal pain. PMID:23558009
Control of visceral leishmaniasis in Brazil: recommendations from Brasileish
On 26 October 2012, veterinary medicine clinicians and researchers, members of Brasileish - Study Group about Animal Leishmaniasis - met at the Regional Council of Veterinary Medicine of Minas Gerais, in the city Belo Horizonte, in order to discuss many aspects of the situation of canine visceral leishmaniasis (CVL) in Brazil. In the face of recent national and international scientific evidence, we, the members of Brasileish, have elaborated some recommendations for the management and control of CVL in Brazil. PMID:23311342
Blood pressure rhythmicity and visceral fat in children with hypertension.
Niemirska, Anna; Litwin, Mieczys?aw; Feber, Janusz; Jurkiewicz, El?bieta
Primary hypertension is associated with disturbed activity of the sympathetic nervous system and altered blood pressure rhythmicity. We analyzed changes in cardiovascular rhythmicity and its relation with target organ damage during 12 months of antihypertensive treatment in 50 boys with hypertension (median, 15.0 years). The following parameters were obtained before and after 12 months of antihypertensive treatment: 24-hour ambulatory blood pressure, left ventricular mass, carotid intima-media thickness, and MRI for visceral and subcutaneous adipose tissue. Amplitudes and acrophases of mean arterial pressure and heart rate rhythms were obtained for 24-, 12-, and 8-hour periods. After 1 year of treatment, 68% of patients were normotensive, and left ventricular mass and carotid intima-media thickness decreased in 60% and 62% of patients, respectively. Blood pressure and heart rate rhythmicity patterns did not change. Changes in blood pressure amplitude correlated with the decrease of waist circumference (P=0.035). Moreover, the decrease of visceral fat correlated with the decrease of 24-hour mean arterial pressure and heart rate acrophases (both P<0.05). There were no differences in changes of blood pressure and heart rate rhythms between patients who achieved or did not achieve normotension and regression of left ventricular mass and carotid intima-media thickness. It was concluded that abnormal cardiovascular rhythmicity persists in children with primary hypertension despite effective antihypertensive treatment, which suggests that it may be the primary abnormality. The correlation between changes in cardiovascular rhythmicity and visceral obesity may indicate that the visceral fat plays an important role in the sympathetic activity of adolescents with hypertension. PMID:23959553
Characterization of intractable juvenile myoclonic epilepsy: new perspectives on primarily generalized seizures.
Dasheiff, R M; Ritaccio, A L
Twelve patients were identified at an epilepsy center who had medically intractable juvenile myoclonic epilepsy. Significant characterization of this group included the long duration of their epilepsy (averaging 21 years) during which the diagnosis and appropriate treatment was delayed. A high percentage of these patients had asymmetries or focal discharges on scalp EEG (6 of 9 patients). A review of the literature and the findings in these 12 patients lead to the conclusion that juvenile myoclonic epilepsy is not necessarily a benign epilepsy. Alternative therapies, such as epilepsy surgery, may be indicated in such extreme cases. PMID:8162368
Von-Willebrand Disease Presenting as Intractable Epistaxis after Nasal Polypectomy
Park, Jeong Jin; Kim, Chang-Hoon; Lee, Jeung-Gweon
Von-Willebrand disease (VWD) is one of the platelet dysfunction disorders that results from a deficiency of Von-Willebrand factor, which is essential for hemostasis. VWD patients typically have normal laboratory results on screening for bleeding disorders. To suspect and diagnose VWD, a careful review of past medical history and laboratory tests is critical. A 59-year-old male patient presented with intractable nasal bleeding after nasal polypectomy. The bleeding was controlled by platelet transfusion, and he was later diagnosed with VWD. PMID:25243089
Gene Therapy for the Treatment of Chronic Peripheral Nervous System Pain
Goins, William F.; Cohen, Justus B.; Glorioso, Joseph C.
Chronic pain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronic pain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases, autoimmune-related syndromes and surgery. Current pharmacotherapies have not provided an effective long-term solution as they are limited by drug tolerance and potential abuse. These concerns have led to the development and testing of gene therapy approaches to treat chronic pain. The potential efficacy of gene therapy for pain has been reported in numerous pre-clinical studies that demonstrate pain control at the level of the spinal cord. This promise has been recently supported by a Phase-I human trial in which a replication-defective herpes simplex virus (HSV) vector was used to deliver the human pre-proenkephalin (hPPE) gene, encoding the natural opioid peptides met- and leu-enkephalin (ENK), to cancer patients with intractable pain resulting from bone metastases (Fink et al., 2011). The study showed that the therapy was well tolerated and that patients receiving the higher doses of therapeutic vector experienced a substantial reduction in their overall pain scores for up to a month post vector injection. These exciting early clinical results await further patient testing to demonstrate treatment efficacy and will likely pave the way for other gene therapies to treat chronic pain. PMID:22668775
Genome-Wide Association for Abdominal Subcutaneous and Visceral Adipose Reveals a Novel Locus for Visceral Fat in Women
Caroline S. Fox; Yongmei Liu; Charles C. White; Mary Feitosa; Albert V. Smith; Nancy Heard-Costa; Kurt Lohman; Andrew D. Johnson; Meredith C. Foster; Danielle M. Greenawalt; Paula Griffin; Jinghong Ding; Anne B. Newman; Fran Tylavsky; Iva Miljkovic; Stephen B. Kritchevsky; Lenore Launer; Melissa Garcia; Gudny Eiriksdottir; J. Jeffrey Carr; Vilmunder Gudnason; Tamara B. Harris; L. Adrienne Cupples; Ingrid B. Borecki
Body fat distribution, particularly centralized obesity, is associated with metabolic risk above and beyond total adiposity. We performed genome-wide association of abdominal adipose depots quantified using computed tomography (CT) to uncover novel loci for body fat distribution among participants of European ancestry. Subcutaneous and visceral fat were quantified in 5,560 women and 4,997 men from 4 population-based studies. Genome-wide genotyping
Pain and the ethics of pain management.
Edwards, R B
In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern. PMID:6710192
Chiropractic care for back pain
... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...
Managing your chronic back pain
... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...
Epidural injections for back pain
... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...
Lederhaas, G
It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997
Absence of the medial sesamoid bone associated with metatarsophalangeal pain.
Kanatli, Ulunay; Ozturk, Akif Muhtar; Ercan, Nil Gulizar Tokgoz; Ozalay, Metin; Daglar, Bulent; Yetkin, Haluk
Pain at the first metatarsophalangeal (MTP) joint can result from inflammation, chondromalacia, flexor hallucis brevis tendinitis, osteochondritis dessecans, fracture of a sesamoid bone, avascular necrosis of sesamoids, inflamed bursae, intractable keratoses, infection, sesamoiditis, gout arthropathy, and rheumatoid arthritis. Congenital absence of a sesamoid bone is extremely rare. We present a 17-year-old male patient with pain at the plantar aspect of the right MTP joint associated with congenital absence of the medial sesamoid. There was tenderness and the range of motion was minimally restricted. He described the pain as necessitating changes in his social life. On radiographs, the medial hallucial sesamoid was absent on the right side. The MTP joint was also evaluated using magnetic resonance imaging (MRI). A metatarsal pad was prescribed and the patient was satisfied with the treatment at the 2 months follow-up period. MRI revealed no pathological tissue at the medial sesamoid site. Hallucial sesamoids absorb pressure, reduce friction, protect the tendons, act like a fulcrum to increase the mechanical force of the tendons, and provide a dynamic function to the great toe by elevating first metatarsal head. Congenital absence of these bones is very rare but we must consider it in a patient with MTP joint pain. PMID:16506237
Pulsed radiofrequency to the great occipital nerve for the treatment of intractable postherpetic itch: a case report
Ding, De-Fang; Li, Rong-Chun; Xiong, Qiu-Ju; Zhou, Ling; Xiang, Hong-Bing
A patient with intractable postherpetic itch lasting for 1 year was reported. The itch was mainly from the left vertex, frontal and ophthalmic regions and extended to the left neck area. The patient had negative response to the ophthalmic nerve block. Under the initial positive response to the great occipital nerve block, pulsed radiofrequency (PRF) was performed on the position of the great occipital nerve. After 4 months treatment, the itch was completely vanished. This case study demonstrates the effectiveness of PRF for intractable postherpetic itch originating in the head and neck. However, more samples needed to verify this management. PMID:25419389
Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain
Alappattu, Meryl J; George, Steven Z; Robinson, Michael E; Fillingim, Roger B; Moawad, Nashat; LeBrun, Emily Weber; Bishop, Mark D
Introduction Evidence suggests that painful intercourse, pain-related psychosocial factors, and altered pain processing magnify the pain experience, but it is not clear how these factors are related to each other. Aim The aims were to (i) characterize differences between women with pelvic pain and pain-free women using a battery of pain-related psychosocial measures, clinical pain ratings, and evoked local and remote pain sensitivity; and (ii) examine the relationship between intercourse pain, clinical pain, and local and remote evoked pain sensitivity. Methods Women with pelvic pain lasting at least 3 months and pain-free women completed questionnaires and underwent pain sensitivity testing. Self-report measures included clinical pain intensity, pain catastrophizing, pain-related fear, pain anxiety, depression, sexual function, and self-efficacy. Pain sensitivity measures included threshold and tolerance and temporal summation of pain. Separate analyses of variance (anova) were used to test group differences in self-report and pain sensitivity measures. Correlations were calculated among dyspareunia, psychosocial factors, and evoked pain. Main Outcome Measures Self-reported pain and pain sensitivity measures. Results Twenty-eight pain-free women and 14 women with pelvic pain participated in this study. Women with pelvic pain reported greater pain intensity and greater psychosocial involvement compared with pain-free women. No differences existed between groups for thermal or pressure measures, but women with pelvic pain rated their pain with pain testing significantly higher than pain-free women. Intercourse pain was significantly associated with affective and sensory pain and pressure pain ratings at the puborectalis, vulvar vestibule, adductor longus tendons, and tibialis anterior muscle. Conclusions Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14�23. PMID:25844171
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Kucyi, Aaron; Davis, Karen D
Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic 'pain connectome' in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain-attention interactions must be accounted for in the contemporary search for a 'neural signature' of the pain connectome. PMID:25541287
... manage pain. Distraction � engaging activities (such as hobbies, video games and movies) that change the patient's focus can help relieve stress and pain. Psychotherapy � speaking with a mental health professional about the stress and frustration of sickle ...
... or "heaviness" or �misery.� Look for behavior or body language that looks like a response to pain. An ... to communicate about pain in words. Behaviors or body language to look for include facial expressions such as ...
Pain Characteristics of Painful Ophthalmoplegia (The Tolosa-Hunt Syndrome)
Jan Hannerz
Pain characteristics of the Tolosa-Hunt syndrome were abstracted from the observations of five patients with repeated incidents of painful ophthalmoplegia. The pain was experienced either as pressure behind the ophthalmoplegic eye or as boring pain in one orbital region, fluctuating in intensity, sometimes worsening to knife stab-like pain in the eye. The unilateral pain did not shift side during a
Integrating the Concept of Pain Interference into Pain Management
Marian Wilson
Undertreatment of pain is a significant problem. Nursing pain assessments have been identified as an area for improvement. This concept analysis sought to examine the use of pain interference as a measurement to assist pain management practices. Existing literature including the term pain interference was reviewed for the years 2000-2010. Pain interference is a common outcome measurement in clinical research.
Managing Chemotherapy Side Effects: Pain
... anD human services national institutes of health Managing Chemotherapy Side Effects Pain �I was worried about getting ... need help to pay for pain medicine. Managing Chemotherapy Side Effects: Pain Keep track of the pain. ...
... Types of Pain Defining Pain Pain is a perception that signals the individual that tissue damage has ... in the body that are involved in the perception of pain are called "nociception." Basic and clinical ...
... of the American Medical Association JAMA PATIENT PAGE Chest Pain C hest pain can have many causes. ... about cardiac causes of chest pain. CAUSES OF CHEST PAIN FOR MORE INFORMATION � National Heart, Lung, and ...
Paul D. Thielking
Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and\\u000a behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than\\u000a cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree\\u000a of anxiety is a normal response to
Posttonsillectomy pain in children.
Sutters, Kimberly A; Isaacson, Glenn
Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence. PMID:24445532
Zhang, Suyi; Seymour, Ben
Technology developed for chronic pain management has been fast evolving and offers new stand-alone prospects for the diagnosis and treatment of pain, rather than simply addressing the limitations of pharmacology-based approaches. There are two central challenges to be tackled: developing objective measures that capture the subjectivity of pain experience, and providing technology-based interventions that offer new approaches for pain management. Here we highlight recent developments that hold promise in addressing both of these challenges. PMID:25247372
Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP)
... on Complex Regional Pain Syndrome (CRPS), August 31-September 1, 2015. The conference aims to provide a summary of ... presents Integrative Pain Care for the 21st Century, September 25-27, in Orlando, FL. Read More � Posted June 16, 2015 Pain Interprofessional Curriculum Design (PICD) Workshop PICD invites ...
Jeanetta C Rains; Donald B Penzien
Objective: The ?-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who
Bernard Calvino; Rose Marie Grilo
We describe the anatomic and physiological components involved in pain physiology, with the goal of providing readers with the background information needed to understand central pain control mechanisms. These include spinal segmental controls, supraspinal excitatory and inhibitory controls, and diffuse noxious inhibitory controls (DNICs). Pain is a subjective sensation produced by an emotionally unpleasant experience considered to originate in adaptive
ERIC Educational Resources Information Center
Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.
This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs�
Accounting for False Positive HIV Tests: Is Visceral Leishmaniasis Responsible?
Shanks, Leslie; Ritmeijer, Koert; Piriou, Erwan; Siddiqui, M. Ruby; Kliescikova, Jarmila; Pearce, Neil; Ariti, Cono; Muluneh, Libsework; Masiga, Johnson; Abebe, Almaz
Background Co-infection with HIV and visceral leishmaniasis is an important consideration in treatment of either disease in endemic areas. Diagnosis of HIV in resource-limited settings relies on rapid diagnostic tests used together in an algorithm. A limitation of the HIV diagnostic algorithm is that it is vulnerable to falsely positive reactions due to cross reactivity. It has been postulated that visceral leishmaniasis (VL) infection can increase this risk of false positive HIV results. This cross sectional study compared the risk of false positive HIV results in VL patients with non-VL individuals. Methodology/Principal Findings Participants were recruited from 2 sites in Ethiopia. The Ethiopian algorithm of a tiebreaker using 3 rapid diagnostic tests (RDTs) was used to test for HIV. The gold standard test was the Western Blot, with indeterminate results resolved by PCR testing. Every RDT screen positive individual was included for testing with the gold standard along with 10% of all negatives. The final analysis included 89 VL and 405 non-VL patients. HIV prevalence was found to be 12.8% (47/ 367) in the VL group compared to 7.9% (200/2526) in the non-VL group. The RDT algorithm in the VL group yielded 47 positives, 4 false positives, and 38 negatives. The same algorithm for those without VL had 200 positives, 14 false positives, and 191 negatives. Specificity and positive predictive value for the group with VL was less than the non-VL group; however, the difference was not found to be significant (p = 0.52 and p = 0.76, respectively). Conclusion The test algorithm yielded a high number of HIV false positive results. However, we were unable to demonstrate a significant difference between groups with and without VL disease. This suggests that the presence of endemic visceral leishmaniasis alone cannot account for the high number of false positive HIV results in our study. PMID:26161864
Aneurysm-osteoarthritis syndrome with visceral and iliac artery aneurysms
van der Linde, Denise; Verhagen, Hence J. M.; Moelker, Adriaan; van de Laar, Ingrid M. B. H.; Van Herzeele, Isabelle; De Backer, Julie; Dietz, Harry C.; Roos-Hesselink, Jolien W.
Objective Aneurysms-osteoarthritis syndrome (AOS), caused by SMAD3 mutations, is a recently described autosomal-dominant syndrome characterized by arterial aneurysms, tortuosity, and aortic dissections in combination with osteoarthritis. Our objective was to evaluate the AOS-related vascular consequences in the visceral and iliac arteries and raise awareness for this aggressive syndrome among vascular specialists. Methods All AOS patients were monitored regularly according to our clinical AOS protocol. The study included those with one or more visceral aneurysms or tortuosity, or both. Clinical and surgical data were obtained from record abstraction. Results The study included 17 AOS patients (47% men) aged 47 � 13 years. A total of 73 aneurysms were encountered, of which 46 were located in the abdomen. The common iliac artery was most commonly affected (37%), followed by the superior mesenteric artery (15%), celiac trunk (11%), and splenic artery (9%). Rapid aneurysm growth ?1 year was found in three arteries (gastric, hepatic, and vertebral artery). Furthermore, arterial tortuosity was noted in 94% of patients. Four patients underwent six elective (endo) vascular interventions for aneurysms in the iliac, hepatic, gastric, or splenic artery, without major perioperative or postoperative complications. Conclusions AOS predisposes patients to widespread visceral and iliac artery aneurysms and extreme arterial tortuosity. Early elective aneurysm repair should be considered because the risk of aneurysm rupture is estimated to be very high and elective (endo) vascular interventions were not complicated by fragility of arterial tissue. Given the aggressive behavior of AOS, it is of utmost importance that vascular specialists are aware of this new syndrome. PMID:22975338
Effects of mu- and kappa-2 opioid receptor agonists on pain and rearing behaviors
Neubert, John K; Rossi, Heather L; Pogar, Jonathan; Jenkins, Alan C; Caudle, Robert M
Background Management of pain involves a balance between inhibition of pain and minimization of side effects; therefore, in developing new analgesic compounds, one must consider the effects of treatment on both pain processing and behavior. The purpose of this study was to evaluate the effects of the mu and kappa-2 opioid receptor agonists on general and pain behavioral outcomes. Methods As a general behavioral assessment, we modified the cylinder rearing assay and recorded the number and duration of rearing events. Thermal sensitivity was evaluated using either a reflexive measure of hindpaw withdrawal latency to a radiant heat source or using an orofacial operant thermal assay. Acetic acid-induced visceral pain and capsaicin-induced neurogenic inflammatory pain were used as painful stimuli. The mu-opioid receptor agonist, morphine or the kappa-2 receptor agonist GR89696 was administered 30 min prior to testing. A general linear model repeated measures analysis was completed for baseline session comparisons and an analysis of variance was used to evaluate the effects of treatment on each outcome measure (SPSS Inc). When significant differences were found, post-hoc comparisons were made using the Tukey honestly significant difference test. *P < 0.05 was considered significant in all instances. Results We found that morphine and GR89,696 dose-dependently decreased the number of reaching events and rearing duration. Rearing behavior was not affected at 0.5 mg/kg for morphine, 1.25 � 10-4 mg/kg for GR89,696. Hindpaw thermal sensitivity was significantly increased only at the highest doses for each drug. At the highest dose that did not significantly influence rearing behavior, we found that visceral and neurogenic inflammatory pain was not affected following GR89,696 administration and morphine was only partially effective for blocking visceral pain. Conclusion This study demonstrated that high levels of the opioids produced significant untoward effects and made distinguishing an analgesic versus a more general effect more difficult. Quantification of rearing behavior in conjunction with standard analgesic assays can help in gaining a better appreciation of true analgesic efficacy of experimental drugs. PMID:17883847
?-synuclein pathology accumulates in sacral spinal visceral sensory pathways.
VanderHorst, Veronique G; Samardzic, Tamara; Saper, Clifford B; Anderson, Matthew P; Nag, Sukriti; Schneider, Julie A; Bennett, David A; Buchman, Aron S
Urinary urgency and frequency are common in ?-synucleinopathies such as Parkinson disease, Lewy body dementia, and multiple system atrophy. These symptoms cannot be managed with dopamine therapy, and their underlying pathophysiology is unclear. We show that in individuals with Parkinson disease, Lewy body dementia, or multiple system atrophy, ?-synuclein pathology accumulates in the lateral collateral pathway, a region of the sacral spinal dorsal horn important for the relay of pelvic visceral afferents. Deposition of ?-synuclein in this region may contribute to impaired micturition and/or constipation in Parkinson disease and other ?-synucleinopathies. Ann Neurol 2015;78:142-149. PMID:25893830
Elimination of visceral leishmaniasis in Nepal: Pipe-dreams and possibilities
Joshi AB; Pokhrel S; Jimba M; Singhasivanon P; Ashford RW
Introduction: Visceral Leishmaniasis (VL) re-emerged in the Indian subcontinent in the mid-1970s after an almost complete absence in the previous fifteen or so years. The disease was first noted in Nepal in 1978 and, since 1980, it has been reported regularly in increasing numbers. Elimination of visceral leishmaniasis by 2015 has been identified as regional priority program in the level
Culture and the Body: East�West Differences in Visceral Perception
Christine Ma-Kellams; Jim Blascovich; Cade McCall
This research investigated cross-cultural differences in the accuracy of individuals' perceptions of internal visceral states. We conducted 4 studies to test the hypothesis that Asians are less sensitive to internal physiological cues relative to European Americans. Studies 1 and 2 assessed cultural differences in visceral perception via tests of misattributions of arousal: Study 1 involved false heart rate feedback during
Source and Fate of the Zooxanthell� of the Visceral Mass of Tridacna elongata
K. Mansour
ZOOXANTHELL� have been recorded from the visceral mass of Tridacna by Yonge1, who assigned to them together with those of the mantle edge a very significant role in nutrition. According to this author the zooxanthell� are transported, by means of the blood-cells via the blood stream, from the mantle edge where they are `farmed' to the visceral mass where they
Moving with the beat: heart rate and visceral temperature of free-swimming and feeding
Schluter, Dolph
Moving with the beat: heart rate and visceral temperature of free-swimming and feeding bluefin tuna (Thunnus maccoyii ) to measure changes in the heart rate ( fH) and visceral temperature (TV) during a two, greater relative heart masses, elevated metabolic rates, and are more difficult to handle than tropical
Close correlation between visceral fat accumulation and uric acid metabolism in healthy men
S. Takahashi; T. Yamamoto; Z. Tsutsumi; Y. Moriwaki; J. Yamakita; K. Higashino
We evaluated the effect of accumulation of intraabdominal visceral fat on the metabolism of uric acid in 50 healthy male subjects to elucidate any relationship between such obesity and hyperuricemia. The area of abdominal fat (visceral fat and subcutaneous fat) was measured at the level of the umbilicus by abdominal computed tomographic scanning. Serum and urinary concentrations of uric acid
Psychologic Influence on Experimental Pain Sensitivity and Clinical Pain Intensity for Patients with Shoulder Pain
Steven Z. George; Adam T. Hirsh
Pain-related fear and pain catastrophizing are 2 central psychologic factors in fear-avoidance models. Our previous studies in healthy subjects indicated that pain-related fear, but not pain catastrophizing, was associated with cold pressor pain outcomes. The current study extends previous work by investigating pain-related fear and pain catastrophizing in a group of subjects with shoulder pain, and included concurrent measures of
Ramsook, Ryan R; Malanga, Gerard A
Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain. PMID:22945480
[Disaster medical network for the patients with intractable disease-experiences of two large earthquakes].
Nakajima, Takashi
Anti-disaster measures along with disaster medicine aims at reducing loss of property and life and facilitating grief work of the suffered people. In contrast the care system for patients with intractable disease has the same aim. According to the experiences of two large earthquakes including Chuetsu (2004) and Chuetsu-oki earthquake (2007), earthquake-resistant buildings are necessary for maintaining hospital function as well as reviving community after occurrence of large earthquake. A list of patients living with ventilator and their individual care plan designed for disaster need to be prepared to transport each patient to the hospital at appropriate timing, when electricity and visiting nurse care system are damaged. Satellite telephone is very useful for communicating with such patients and medical teams because telephone connection is limited to only the specific calling number just after occurrence of earthquake. PMID:20030235
Intractable pneumothorax managed by talc pleurodesis and bronchial occlusion with spigots.
Ishida, Atsuko; Kida, Hirotaka; Muraoka, Hiromi; Nishine, Hiroki; Mineshita, Masamichi; Miyazawa, Teruomi
Three cases of inoperable secondary spontaneous pneumothorax were diagnosed in patients with chronic obstructive pulmonary disease. Two cases initially underwent bronchial occlusion with endobronchial Watanabe spigot (EWS), while one underwent talc poudrage with pleuroscopy. As air leaks were not stopped completely in all cases with the initial procedures, we performed additional interventional treatments: pleuroscopic talc poudrage in cases when bronchial occlusion was performed first; and bronchial occlusion with EWS for a case that initially underwent talc pleurodesis. The air leaks ceased in all cases without complication. We successfully removed chest tubes 2-10 days after secondary procedure, which was 10-23 days after the first procedure. The combination of talc pleurodesis and bronchial occlusion with EWS, when a single, initial interventional treatment fails, can be considered in cases of intractable, inoperable secondary pneumothorax. PMID:25802742
Intractable pneumothorax managed by talc pleurodesis and bronchial occlusion with spigots
Ishida, Atsuko; Kida, Hirotaka; Muraoka, Hiromi; Nishine, Hiroki; Mineshita, Masamichi; Miyazawa, Teruomi
Three cases of inoperable secondary spontaneous pneumothorax were diagnosed in patients with chronic obstructive pulmonary disease. Two cases initially underwent bronchial occlusion with endobronchial Watanabe spigot (EWS), while one underwent talc poudrage with pleuroscopy. As air leaks were not stopped completely in all cases with the initial procedures, we performed additional interventional treatments: pleuroscopic talc poudrage in cases when bronchial occlusion was performed first; and bronchial occlusion with EWS for a case that initially underwent talc pleurodesis. The air leaks ceased in all cases without complication. We successfully removed chest tubes 2�10 days after secondary procedure, which was 10�23 days after the first procedure. The combination of talc pleurodesis and bronchial occlusion with EWS, when a single, initial interventional treatment fails, can be considered in cases of intractable, inoperable secondary pneumothorax. PMID:25802742
The role of steroid treatment in intractable cystitis glandularis: A case report and literature review
Yuksel, Ozgur Haki; Urkmez, Ahmet; Erdogru, Tibet; Verit, Ayhan
Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in children. We report a case of a 23-year-old female with intractable macroscopic hematuria and severe irritative bladder symptoms persisting for 13 years. The patient, who had undergone open and endoscopic bladder surgery at various medical centres, is currently being followed up at our clinic. Cystoscopy revealed multiple edematous papillary tumours on the bladder neck, trigone, and lateral wall on both sides and she underwent transurethral resection of the bladder tumour. The pathological diagnosis was cystitis glandularis in accordance with the histopathological reports obtained from the other medical centres. Her condition was resistant to transurethral resection, partial cystectomy, intravesical mitomycin, and bacillus Calmette-Guerin (BCG) treatment; it eventually could have affected the upper urinary tract. Oral steroid treatment was given for 6 months; after treatment, her symptoms improved and the cystoscopy revealed a dramatic improvement in her condition.
Homozygous nonsense mutation in SYNJ1 associated with intractable epilepsy and tau pathology.
Dyment, David A; Smith, Amanda C; Humphreys, Peter; Schwartzentruber, Jeremy; Beaulieu, Chandree L; Bulman, Dennis E; Majewski, Jacek; Woulfe, John; Michaud, Jean; Boycott, Kym M
The tauopathies are a heterogeneous group of neurodegenerative disorders characterized by the shared presence of tau aggregates and neurofibrillary tangles within the central nervous system. Here, we present a child with a severe neurodegenerative disorder characterized by intractable seizures and significant tau-immunoreactive neurofibrillary degeneration localized predominantly to the substantia nigra on neuropathology with absence of beta-amyloid plaques and Lewy or Pick bodies. Whole-exome sequencing identified a homozygous truncating mutation in Synaptojanin 1 (SYNJ1). Quantitative polymerase chain reaction and Western blot experiments demonstrated diminished SYNJ1 messenger RNA and protein. Knockout Synj1(-/-) mice have convulsions and die early in life. More recently, homozygous missense mutations have been reported in 2 families with early-onset parkinsonism and seizures. Our findings broaden the spectrum of disease associated with alteration of SYNJ1 and further implicate defects in synaptic vesicle recycling in the tauopathies. PMID:25316601
Dynamic statistical parametric mapping for analyzing ictal magnetoencephalographic spikes in patients with intractable frontal lobe epilepsy
Tanaka, Naoaki; Cole, Andrew J.; von Pechmann, Deidre; Wakeman, Daniel G.; H�m�l�inen, Matti S.; Liu, Hesheng; Madsen, Joseph R.; Bourgeois, Blaise F.; Stufflebeam, Steven M.
The purpose of this study is to assess the clinical value of spatiotemporal source analysis for analyzing ictal magnetoencephalography (MEG). Ictal MEG and simultaneous scalp EEG was recorded in five patients with medically intractable frontal lobe epilepsy. Dynamic statistical parametric maps (dSPMs) were calculated at the peak of early ictal spikes for the purpose of estimating the spatiotemporal cortical source distribution. DSPM solutions were mapped onto a cortical surface, which was derived from each patient's MRI. Equivalent current dipoles (ECDs) were calculated using a single-dipole model for comparison with dSPMs. In all patients, dSPMs tended to have a localized activation, consistent with the clinically-determined ictal onset zone, whereas most ECDs were considered to be inappropriate sources according to their goodness-of-fit values. Analyzing ictal MEG spikes by using dSPMs may provide useful information in presurgical evaluation of epilepsy. PMID:19394198
Culture and the body: East-West differences in visceral perception.
Ma-Kellams, Christine; Blascovich, Jim; McCall, Cade
This research investigated cross-cultural differences in the accuracy of individuals' perceptions of internal visceral states. We conducted 4 studies to test the hypothesis that Asians are less sensitive to internal physiological cues relative to European Americans. Studies 1 and 2 assessed cultural differences in visceral perception via tests of misattributions of arousal: Study 1 involved false heart rate feedback during an emotionally evocative slideshow and examined subsequent self-reported affective changes; Study 2 manipulated apparent physiological arousal and measured its effects on attraction via an immersive virtual environment. Study 3 directly assessed visceral perception using a heartbeat detection task. All 3 studies found Asians to be less viscerally perceptive than European Americans. Study 4 examined one possible cultural mechanism for the observed difference and found evidence for contextual dependency as a mediator of the culture-visceral perception link. PMID:22309028
Successful use of tetrabenazine in a patient with intractable hiccups after stroke.
Naro, Antonino; Bramanti, Placido; Calabr�, Rocco Salvatore
A hiccup is a myoclonic jerk of the diaphragm, and cases of hiccups may last for more than 48 hours (persistent hiccups) or even more than 2 months (intractable hiccups). Current pharmacologic treatment of persistent or intractable hiccups mainly includes antidopaminergic drugs. We describe the case of a 60-year-old man with a recent diagnosis of right insular ischemic stroke who presented with frequent, intense, and disabling hiccups for more than 1 month. As diagnosis of poststroke hiccups was assumed, the patient was treated over the next 6 months with adequate doses of various antipsychotic drugs commonly used for the treatment of hiccups; however, all were discontinued because of adverse effects. Indeed, dyskinesia after chlorpromazine (up to 75 mg/day for 4 wks), as well as somnolence and dyskinesia after haloperidol (up to 6 mg/day for 6 wks), somnolence after gabapentin (up to 1800 mg/day for 8 wks), and severe somnolence and hypotension after baclofen (up to 50 mg/day for 6 wks) were reported. The patient was then prescribed tetrabenazine at a starting dose of 12.5 mg twice/day (25 mg/day), with a nearly complete remission of the hiccup symptomatology after ~6 weeks, when a daily dose of 150 mg was reached. We therefore hypothesize that a supratentorial lesion may disrupt the modulation of dopaminergic pathways involved in the regulation of medullar centers responsible for the hiccup reflex. To our knowledge, this is the first case report of poststroke hiccups responding to tetrabenazine. The dramatic response of our patient to tetrabenazine monotherapy suggests that this drug may be a valuable pharmacologic alternative for patients with hiccups after stroke who are intolerant or unresponsive to classic antipsychotic agents. PMID:25471210
The effect of leucotomy in intractable adolescent weight phobia (primary anorexia nervosa)
Crisp, A. H.; Kalucy, R. S.
Anorexia nervosa is best construed as a phobic avoidance response to the psychosocial maturational implications of adolescent weight. Within this state, surrender to the impulse to eat and consequent weight gain is associated with panic, depression and sometimes specific intense fear of loss of control. So long as the avoidance posture can be maintained the experience of such turmoil is largely avoided. Complicated ritualistic behaviour may arise to promote and secure the posture. However, its unrewarding and lonely nature still increasingly leaves the individual liable to the experience of depression. Established treatment procedures often assist recovery from the illness but intractable cases arise and it is amongst these that the majority of deaths occur either from inanition or suicide. The basis for the changes characteristically induced by leucotomy is complex. The procedure often leads to reduced tension and release of appetitive behaviour. This is taken to be due to some direct effect of the cerebral lesion and possibly the intervention may also be construed by some patients as a licence to behave differently. In patients with anorexia nervosa such appetitive release can be expected to promote considerable weight gain. However, the adverse psychological implications of such weight gain for the patient do not appear always to be so immediately or easily relieved. They may still experience panic, shame or depression and new patterns of social avoidance, or vomiting behaviour may develop. Intensive help of a psychotherapeutic and rehabilitative kind is then still required if the patient is to have the best chance of adjusting healthily to her newly found potential for a more normal nutritional status. Four patients who have undergone such treatment are described in this paper. It is concluded that leucotomy has a small but definite place in the treatment of patients with intractable anorexia nervosa. ImagesFig. 2 PMID:4806268
[Laryngotracheal separation and tracheoesophageal diversion for intractable aspiration in ALS--usefulness and indication].
Mita, Shuji
To evaluate the usefulness of laryngotracheal separation or tracheoesophageal diversion (LTS/TED), we investigated changes in medical management after LTS/TED. We performed LTS/TED for intractable aspiration in patients with amyotrophic lateral sclerosis (ALS) and patients with other neurological diseases. Most of the subjects had already received a tracheostomy, and all the patients with ALS had tracheostomy positive pressure ventilation. However, they remained at risk of intractable aspiration, had experienced frequent suctioning of aspiration material, and could not eat. In all cases, LTS/TED was performed safely within 3 hours and without any complications. After LTS/TED, there was no aspiration of saliva in any of the patients. In most subjects, the frequency of suctioning by medical staff and caregivers was much reduced. The frequency of aspiration pneumonia was also extremely lowered. Follow-up study demonstrated that complete control over aspiration was achieved in all of the patients. Some of them were completely self-sufficient in their ability to eat. Some of the other patients were at least able to enjoy taste. Nutritional status was significantly improved. All the patients, family caregivers, and medical staff involved in this study were satisfied with the outcome. These results indicate that LTS/TED is a very useful procedure in several aspects: it benefits patients who have a fear of aspiration; it reduces the burden on patients and family caregivers; it promotes their quality of life; and it limits the aspiration-associated demands on medical staff. Based on the results, we have proposed an indication of LTS/TED for dysphasia in ALS. PMID:17969355
Interleukin-10 receptor mutations in children with neonatal-onset Crohn's disease and intractable ulcerating enterocolitis.
Shim, Jung Ok; Hwang, Solha; Yang, Hye Ran; Moon, Jin Soo; Chang, Ju Young; Ko, Jae Sung; Park, Sung Sup; Kang, Gyeong-Hoon; Kim, Woo Sun; Seo, Jeong Kee
Neonatal-onset inflammatory bowel disease (IBD) accounts for only 0.25% of pediatric IBD cases. The molecular pathogenesis of IBD remains unclear. Recently, rare Mendelian mutations have been identified in children with very early-onset Crohn's disease and ulcerative colitis. In this study, we report compound heterozygous mutations in the interleukin-10 receptor A (IL-10RA) gene in children with severe neonatal-onset IBD. Patient 1 had chronic diarrhea within the first month of life and had perianal fistulae. She was diagnosed with 'intractable ulcerating enterocolitis in infancy' and underwent subtotal colectomy at the age of 24 months because of poor response to immunosuppressant therapy. Compound heterozygous mutations, c.[301C>T];[350G>A](p.[R101W];[R117H]), were discovered in IL-10RA for this patient. Patient 2 presented symptoms within the first month of life and was diagnosed with Crohn's disease. Severe colitis and perianal and enteroenteric fistulae occurred repeatedly, and he underwent surgical management involving colectomy, colostomy, and ileostomy. We identified mutations in IL-10RA, c.[272A>G];[784C>T] (p.[Y91C];[R262C]). Patient 3 had chronic diarrhea and a rectovaginal fistula at 3 days of life and was diagnosed with Crohn's disease. She underwent fistulectomy and ileostomy, but experienced frequent relapses. Mutations, c.[272A>G];[301C>T] (p.[Y91C];[R101W]), were found in IL-10RA. This report confirms the genetic defect of IL-10RA in neonatal-onset IBD including 'intractable ulcerating enterocolitis in infancy'. PMID:23839161
Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy
Lee, Yun-Jeong; Kim, Eun-Hee; Yum, Mi-Sun; Lee, Jung Kyo; Hong, Seokho
Background and Purpose Hemispherectomy reportedly produces remarkable results in terms of seizure outcome and quality of life for medically intractable hemispheric epilepsy in children. We reviewed the neuroradiologic findings, pathologic findings, epilepsy characteristics, and clinical long-term outcomes in pediatric patients following a hemispheric disconnection. Methods We retrospectively studied 12 children (8 males) who underwent a hemispherectomy at Asan Medical Center between 1997 and 2005. Clinical, EEG, neuroradiological, and surgical data were collected. Long-term outcomes for seizure, motor functions, and cognitive functions were evaluated at a mean follow-up of 12.7 years (range, 7.6-16.2 years) after surgery. Results The mean age at epilepsy onset was 3.0 years (range, 0-7.6 years). The following epilepsy syndromes were identified in our cohort: focal symptomatic epilepsy (n=8), West syndrome (n=3), and Rasmussen's syndrome (n=1). Postoperative histopathology of our study patients revealed malformation of cortical development (n=7), encephalomalacia as a sequela of infarction or trauma (n=3), Sturge-Weber syndrome (n=1), and Rasmussen's encephalitis (n=1). The mean age at surgery was 6.5 years (range, 0.8-12.3 years). Anatomical or functional hemispherectomy was performed in 8 patients, and hemispherotomy was performed in 4 patients. Eight of our 12 children (66.7%) were seizure-free, but 3 patients with perioperative complications showed persistent seizure. Although all patients had preoperative hemiparesis and developmental delay, none had additional motor or cognitive deficits after surgery, and most achieved independent walking and improvement in daily activities. Conclusions The long-term clinical outcomes of hemispherectomy in children with intractable hemispheric epilepsy are good when careful patient selection and skilled surgical approaches are applied. PMID:24829595
Diagnostic reframing of intractable environmental problems: case of a contested multiparty public land-use conflict.
Asah, Stanley T; Bengston, David N; Wendt, Keith; Nelson, Kristen C
Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional reframing are the two major approaches to conflict transformation. These approaches have some drawbacks. Cognitive reframing does not guarantee commensurate consideration of all disputants' views about the problem. Interactional reframing is prone to inter-disputant influences that interfere with presenting the problems as accurately as they exist in disputants' minds. Inadequate consideration of other disputants' views and inter-disputant influences often lead to inaccurate problem identification and definition. This in turn leads to solving the wrong problem, enabling intractability to persist. Proper problem identification and definition requires commensurate consideration of all sides of the conflict while minimizing inter-disputant influences. From a problem diagnosis perspective, we show how Q methodology is used to reframe environmental problems, rendering them more tractable to analysis while minimizing the influence of who disputants are talking with, and without ignoring the perspectives of other disputants. Using a case of contentious All-Terrain Vehicle (ATV) use in a state-administered public land, conflicting parties reframed the problem by prioritizing issues, outlining areas and levels of consensus and disagreement, and revealing inherent unrecognized and/or unspoken agendas. The reframing process surprisingly revealed several areas of common ground in disputants' diagnosis of the problem, including lack of emphasis on environmental protection and uncoordinated management factions. Emergent frames were misaligned on some issues, such as the behaviors of ATV riders and the role of management, including political and economic influences on decision making. We discuss how the reframing process enhances tractability of multiparty environmental problems. We point to some limitations of Q methodology as a tool for the diagnostic reframing of such problems. PMID:22705762
Reddy, Madhuri; Keast, David; Fowler, Evonne; Sibbald, R Gary
Integrating pain management into a treatment paradigm for pressure ulcers can lead to improved outcomes. An approach to wound bed preparation that addresses the cause and patient-centered concerns--as well as local wound care factors of moisture balance, debridement, and bacterial balance--can be integrated with the Krasner model of chronic wound pain. The risk factors for pressure ulcers are well known, but pain may be an important contributor to immobility and the development of pressure ulcers. Pain is also an important signal of wound-related infections. Strategies must be developed to control the cyclic acute pain of dressing changes and the noncyclic acute pain of wound debridement. Spinal cord injured and elderly, cognitively impaired patients with pressure ulcers present special challenges in pain management. PMID:12856291
Uziel, Yosef; Hashkes, Philip J
Growing pains are the most common form of recurrent musculoskeletal pains in childhood and are present in 10-20% of children, mainly between the ages of 3-12 years. The diagnosis is based on typical historical clinical characteristics with a normal physical examination. The etiology is still unknown but current theories include low pain thresholds, as in fibromyalgia and local overuse pain that is supported by the finding of low bone strength in painful regions by ultrasound and hypermobility in many children with growing pains. There is also an associated familial and patient behavioral element. Treatment is conservative with patient and parental education on the benign outcome of these pains the most important element, in order to decrease anxiety. PMID:19039913
Relation of the factor to menstrual pain and musculoskeletal pain.
Lee, Jang-Won; Park, Hye-Sang
The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984
Relation of the factor to menstrual pain and musculoskeletal pain
Lee, Jang-Won; Park, Hye-Sang
The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984
Impact of Obstructive Sleep Apnea on Liver Fat Accumulation According to Sex and Visceral Obesity
Toyama, Yoshiro; Tanizawa, Kiminobu; Kubo, Takeshi; Chihara, Yuichi; Harada, Yuka; Murase, Kimihiko; Azuma, Masanori; Hamada, Satoshi; Hitomi, Takefumi; Handa, Tomohiro; Oga, Toru; Chiba, Tsutomu; Mishima, Michiaki; Chin, Kazuo
Rationale Associations between obstructive sleep apnea (OSA) and liver fat accumulation have been frequently investigated because both morbidities are common. Visceral fat was reported to be closely related to OSA and liver fat accumulation. Recently, sex differences in the association between OSA and mortality have gained much attention. Objectives To investigate the associations among OSA, liver fat accumulation as determined by computed tomography, and visceral fat area and their sex differences. Methods Studied were 188 males and 62 females who consecutively underwent polysomnography and computed tomography. Results Although the apnea-hypopnea index was positively correlated with liver fat accumulation in the total males, none of the OSA-related factors was independently associated with liver fat accumulation in either the total male or female participants in the multivariate analyses. When performing subanalyses using a specific definition for Japanese of obesity or visceral obesity (body mass index (BMI) ?25 kg/m2 or visceral fat area ?100 cm2), in only males without visceral obesity, percent sleep time with oxygen saturation <90%, in addition to BMI, insulin resistance, and serum triglyceride values, was independently correlated with liver fat accumulation (R2 = 15.1%, P<0.001). In males, percent sleep time of oxygen saturation <90% was also a determining factor for alanine aminotransferase values regardless of visceral fat area. In contrast, OSA was not associated with liver fat accumulation or alanine aminotransferase values in females whether or not visceral obesity was absent. Conclusions Sex differences in the visceral fat-dependent impact of OSA on liver fat accumulation existed. Although the mechanisms are not known and ethnic differences may exist in addition to the specific criteria of visceral obesity in Japan, the treatment of male patients with OSA might be favorable from the viewpoint of preventing liver fat accumulation and liver dysfunction even in patients without obvious visceral fat accumulation. PMID:26076443
Genome-Wide Association for Abdominal Subcutaneous and Visceral Adipose Reveals a Novel Locus for Visceral Fat in Women
White, Charles C.; Feitosa, Mary; Smith, Albert V.; Heard-Costa, Nancy; Lohman, Kurt; Johnson, Andrew D.; Foster, Meredith C.; Greenawalt, Danielle M.; Griffin, Paula; Ding, Jinghong; Newman, Anne B.; Tylavsky, Fran; Miljkovic, Iva; Kritchevsky, Stephen B.; Launer, Lenore; Garcia, Melissa; Eiriksdottir, Gudny; Carr, J. Jeffrey; Gudnason, Vilmunder; Harris, Tamara B.; Cupples, L. Adrienne; Borecki, Ingrid B.
Body fat distribution, particularly centralized obesity, is associated with metabolic risk above and beyond total adiposity. We performed genome-wide association of abdominal adipose depots quantified using computed tomography (CT) to uncover novel loci for body fat distribution among participants of European ancestry. Subcutaneous and visceral fat were quantified in 5,560 women and 4,997 men from 4 population-based studies. Genome-wide genotyping was performed using standard arrays and imputed to ?2.5 million Hapmap SNPs. Each study performed a genome-wide association analysis of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), VAT adjusted for body mass index, and VAT/SAT ratio (a metric of the propensity to store fat viscerally as compared to subcutaneously) in the overall sample and in women and men separately. A weighted z-score meta-analysis was conducted. For the VAT/SAT ratio, our most significant p-value was rs11118316 at LYPLAL1 gene (p?=?3.1�10E-09), previously identified in association with waist�hip ratio. For SAT, the most significant SNP was in the FTO gene (p?=?5.9�10E-08). Given the known gender differences in body fat distribution, we performed sex-specific analyses. Our most significant finding was for VAT in women, rs1659258 near THNSL2 (p?=?1.6�10-08), but not men (p?=?0.75). Validation of this SNP in the GIANT consortium data demonstrated a similar sex-specific pattern, with observed significance in women (p?=?0.006) but not men (p?=?0.24) for BMI and waist circumference (p?=?0.04 [women], p?=?0.49 [men]). Finally, we interrogated our data for the 14 recently published loci for body fat distribution (measured by waist�hip ratio adjusted for BMI); associations were observed at 7 of these loci. In contrast, we observed associations at only 7/32 loci previously identified in association with BMI; the majority of overlap was observed with SAT. Genome-wide association for visceral and subcutaneous fat revealed a SNP for VAT in women. More refined phenotypes for body composition and fat distribution can detect new loci not previously uncovered in large-scale GWAS of anthropometric traits. PMID:22589738
Miller, Lois L; Talerico, Karen Amann
This chapter reviews 80 published research reports of pain and pain problems in older adults by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) using the search terms pain, older adult, aged and pain, and dementia. Reports were included if published between 1985 to 2001, if conducted on samples age 60 or older, if conducted by nurses or relevant to nursing research, and if published in English. Descriptive, qualitative, correlational, longitudinal, and intervention studies were included. Key findings include the following: pain is widely prevalent in older adult populations; few studies have included minority groups; under-identification and undertreatment of pain in older adults is a consistent interpretation of research findings; pain intensity rating scales are as valid and reliable in older populations as in younger populations; current observational methods of assessing pain in cognitively impaired older adults must be used with caution; nursing intervention studies demonstrate the beneficial effects of education and interventions aimed at improved pain assessment. The main recommendations are: careful attention should be given to the conceptualization and definition of pain; examination of pain should include physiological, motivational, cognitive, and affective factors; studies evaluating undertreatment of pain should include measures of pain self-report; standardized pain measures should be used; studies of persons over the age of 85 and studies of ethnic minorities are needed; more attention should be given to nursing intervention studies and should include both pharmacological and nonpharmacological, psychosocial interventions. PMID:12092519
Pain management in the elderly.
Malec, Monica; Shega, Joseph W
Persistent pain in older adults is common, and associated with substantial morbidity. Optimal management starts with assessment, including pain presence, intensity, characteristics, and interference; painful conditions; pain behaviors; pain-related morbidity; pain treatments; and coping style. Treatment incorporates analgesics demonstrated to decrease pain and improve a patient's sense of well-being. The World Health Organization's 3-step pain ladder is widely accepted and adopted for selecting analgesics among patients with non-cancer pain. Shared decision making is essential to balance the benefits and burdens of analgesics. This article reviews pain assessment/management for older adults, focusing on commonly used analgesics. PMID:25700587
Epidemiology of Visceral Leishmaniasis in Algeria: An Update
Adel, Amel; Boughoufalah, Amel; Saegerman, Claude; De Deken, Redgi; Bouchene, Zahida; Soukehal, Abdelkrim; Berkvens, Dirk; Boelaert, Marleen
Visceral leishmaniasis (VL), a zoonotic disease caused by Leishmania infantum, is endemic in Algeria. This report describes a retrospective epidemiological study conducted on human VL to document the epidemiological profile at national level. All human VL cases notified by the National Institute of Public Health between 1998 and 2008 were investigated. In parallel all VL cases admitted to the university hospitals of Algiers were surveyed to estimate the underreporting ratio. Fifteen hundred and sixty-two human VL cases were reported in Algeria between 1998�2008 with an average annual reported incidence rate of 0.45 cases per 100,000 inhabitants, of which 81.42% were in the age range of 0�4 years. Cases were detected year-round, with a peak notification in May and June. One hundred and seventy patients were admitted to the university hospitals in Algiers in the same period, of which less than one in ten had been officially notified. Splenomegaly, fever, pallor and pancytopenia were the main clinical and laboratory features. Meglumine antimoniate was the first-line therapy for paediatric VL whereas the conventional amphotericin B was used for adult patients. Visceral leishmaniasis in Algeria shows the epidemiological profile of a paediatric disease with a decrease of the annual reported incidence rate. However, vigilance is required because of huge underreporting and an apparent propagation towards the south. PMID:24949958
Bacterial cell wall components regulate adipokine secretion from visceral adipocytes
Taira, Risa; Yamaguchi, Sayori; Shimizu, Kyoko; Nakamura, Kiminori; Ayabe, Tokiyoshi; Taira, Toshio
Recent studies suggest a relationship between intestinal microbiota and metabolic syndromes; however, the underlying mechanism remains unclear. To clarify this issue, we assessed the effects of bacterial cell wall components on adiponectin, leptin and resistin secretion from rat visceral adipocytes in vitro. We also measured the relative population of Firmicutes and Bacteroidetes in fecal microbiota and the amount of fecal mucin as an intestinal barrier function, when mice were fed a high-fat diet. In the present study, we demonstrated that bacterial cell wall components affect the secretion of adipokines, depending on the presence of antigens from gram-positive or gram-negative bacteria. Lipopolysaccharide markedly inhibited adiponectin, leptin, and resistin secretion, whereas peptidoglycan increased adiponectin secretion and decreased resistin secretion in vitro. In vivo experiments showed that the high-fat diet increased the population of Firmicutes and decreased that of Bacteroidetes. In contrast, the high-fat diet downregulated the stool output and fecal mucin content. These results demonstrate that bacterial cell wall components affect the onset of metabolic syndromes by mediating the secretion of adipokines from visceral adipose tissue. Furthermore, we believe that metabolic endotoxemia is not due to the increasing dominance of gram-negative bacteria, Bacteroidetes, but due to the depression of intestinal barrier function. PMID:25759521
Epidemiology of visceral leishmaniasis in Algeria: an update.
Adel, Amel; Boughoufalah, Amel; Saegerman, Claude; De Deken, Redgi; Bouchene, Zahida; Soukehal, Abdelkrim; Berkvens, Dirk; Boelaert, Marleen
Visceral leishmaniasis (VL), a zoonotic disease caused by Leishmania infantum, is endemic in Algeria. This report describes a retrospective epidemiological study conducted on human VL to document the epidemiological profile at national level. All human VL cases notified by the National Institute of Public Health between 1998 and 2008 were investigated. In parallel all VL cases admitted to the university hospitals of Algiers were surveyed to estimate the underreporting ratio. Fifteen hundred and sixty-two human VL cases were reported in Algeria between 1998-2008 with an average annual reported incidence rate of 0.45 cases per 100,000 inhabitants, of which 81.42% were in the age range of 0-4 years. Cases were detected year-round, with a peak notification in May and June. One hundred and seventy patients were admitted to the university hospitals in Algiers in the same period, of which less than one in ten had been officially notified. Splenomegaly, fever, pallor and pancytopenia were the main clinical and laboratory features. Meglumine antimoniate was the first-line therapy for paediatric VL whereas the conventional amphotericin B was used for adult patients. Visceral leishmaniasis in Algeria shows the epidemiological profile of a paediatric disease with a decrease of the annual reported incidence rate. However, vigilance is required because of huge underreporting and an apparent propagation towards the south. PMID:24949958
Canine visceral leishmaniasis as a systemic fibrotic disease
Silva, Lucelia C; Castro, Rodrigo S; Figueiredo, Maria M; Michalick, Marilene S M; Tafuri, Washington L; Tafuri, Wagner L
We propose that canine visceral leishmaniasis (CVL) is a systemic fibrotic disease, as evidenced by the wide distribution of fibrosis that we have found in the dogs suffering from chronic condition. The inflammatory cells apparently direct fibrosis formation. Twenty-four cases (symptomatic dogs) were identified from a total of one hundred and five cases that had been naturally infected with Leishmania chagasi and had been documented during an epidemiological survey of CVL carried out by the metropolitan area of the municipality of Belo Horizonte, MG, Brazil. The histological criterion was intralobular liver fibrosis, as has been described previously in dogs with visceral leishmaniasis. In addition to the findings in the liver, here we describe and quantify conspicuous and systemic deposition of collagen in other organs, including spleen, cervical lymph nodes, lung and kidney of all the infected symptomatic dogs. Thus we report that there is a systematic fibrotic picture in these animals, where inflammatory cells appear to direct fibrosis in all organs that have been studied. Therefore we propose that CVL is a systemic fibrotic disease. PMID:23419132
Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity
Dorn, Spencer D; Palsson, Olafur S; Thiwan, Syed I M; Kanazawa, Motoyori; Clark, W Crawford; van Tilburg, Miranda A L; Drossman, Douglas A; Scarlett, Yolanda; Levy, Rona L; Ringel, Yehuda; Crowell, Michael D; Olden, Kevin W; Whitehead, William E
Objective The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30?mm?Hg vs 34?mm?Hg distensions; psychological influences were measured by the report criterion�that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results IBS patients had lower AML pain thresholds (median: 28?mm?Hg vs 40?mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p?=?0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 (�mild� pain) vs 5.2 (�weak� pain); p?=?0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r?=??0.13; p?=?0.14), but were strongly correlated with report criterion (r?=?0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r?=??0.26; p?=?0.001) and BSI global score (r?=??0.18; p?=?0.035). Similar results were seen for the non?painful sensation of urgency. Conclusion Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity. PMID:17483191
Chronic pain management: pharmacotherapy for chronic pain.
Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried
Clinicians should combine nonpharmacologic therapies and pharmacotherapy for management of chronic pain. Safety and effectiveness determine the choice of therapy. Typically, nonopioid analgesics are first-line treatment, including acetaminophen, nonsteroidal anti-inflammatory drugs, and topical drugs. A trial of an opioid, in combination with other modalities, should be considered if pain persists. Because of the potential for serious adverse effects, opioids should be prescribed only if the clinician is familiar with their use and associated risks. If pain is not controlled, consider pharmacogenetic effects or the addition of adjuvant therapy. In states with prescription drug monitoring programs, clinicians must access these programs regularly when prescribing a controlled substance. Consider performing pill counts and random urine drug screening for monitoring drug use. Adjuvant drugs to be considered include antidepressants, buspirone, anticonvulsants, muscle relaxants, onabotulinumtoxinA, clonidine, and corticosteroids, depending on type of pain and individual characteristics. PMID:25970870
[Latest pain management for painful bony metastases].
Ikenaga, Masayuki
Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care. PMID:16582515
Glare, Paul A; Davies, Pamela S; Finlay, Esm�; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C; Paice, Judith A; Stubblefield, Michael D; Syrjala, Karen L
Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477
Glare, Paul A.; Davies, Pamela S.; Finlay, Esm�; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C.; Paice, Judith A.; Stubblefield, Michael D.; Syrjala, Karen L.
Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477
Neurological diseases and pain
Chronic pain is a frequent component of many neurological disorders, affecting 20�40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain. PMID:22067541
Disengagement from pain: the role of catastrophic thinking about pain.
Van Damme, Stefaan; Crombez, Geert; Eccleston, Christopher
This paper reports an experimental investigation of attentional engagement to and disengagement from pain. Thirty-seven pain-free volunteers performed a cueing task in which they were instructed to respond to visual target stimuli, i.e. the words 'pain' and 'tone'. Targets were preceded by pain stimuli or tone stimuli as cues. Participants were characterized as high or low pain catastrophizers, using self-reports. We found that the effect of cueing upon target detection was differential for high and low pain catastrophizers. Analyses revealed a similar amount of attentional engagement to pain in both groups. However, we also found that participants high in pain catastrophizing had difficulty disengaging from pain, whereas participants low in pain catastrophizing showed no retarded disengagement from pain. Our results provide further evidence that catastrophic thinking enhances the attentional demand of pain, particularly resulting in difficulty disengaging from pain. The clinical implications of these findings are discussed. PMID:14715391
Pain perception and assessment.
Chapman, C R
Our inability to measure pain effectively is a major barrier to progress in pain research and advancement in clinical interventions for pain. Historically, the mind-body dichotomy has constrained our thinking about pain and its quantification. One line of work has pursued pain as the sensory end product of nociception: pain is the realization of signals of tissue injury arriving at the cortex. At the other extreme, some clinicians contend that pain is ''what the patient says it is''. In other words, it is a purely mental and entirely subjective phenomenon. Research on functional brain imaging, psychophysiological research and recent neurophysiological research on animal models provide confluent evidence that both of these positions are misleading oversimplifications. Pain is the emergent product of massive, parallel, distributed processing in the brain that engages structures involved in emotion and cognition as well as in sensation. To advance pain measurement, our research team has examined Sokolov's defense response in human subjects experiencing repeated, brief painful electrical shocks delivered to a fingertip through a tiny electrode. Sokolov proposed that threatening events elicit a hypothalamically-orchestrated pattern of arousal that prepares the organism to cope with threat. Measures of sympathetic nervous system arousal and brain evoked potentials in our subjects reveal a stable pattern of this sort when we subject the data to structural equation modeling. When subjects undergo equally intense shocks delivered through a large electrode, they experience a strong vibration-like, unpleasant sensation that causes discomfort but not nociception. The non-painful shock elicits broad levels of arousal equal to those obtained with painful shocks in subjects, but structural equation modeling demonstrates that such arousal does not conform to the defense response pattern. Moreover, multivariate measures of sympathetic arousal and evoked potentials can discriminate painful from non-painful stimuli more accurately than can subjective pain reports. These observations suggest that pain may have a unique psychophysiological signature. More importantly, perhaps, this approach suggests that the combination of psychophysiological research and multivariate statistics provides an avenue for advancing pain research outside of the mind-body dichotomy. PMID:16012413
Loin pain hematuria syndrome: Pain relief with intrathecal morphine
Joshua P. Prager; Antonio DeSalles; Alan Wilkinson; Marilyn Jacobs; Marie Csete
Loin pain hematuria syndrome (LPHS) is characterized by hematuria and incapacitating loin pain. The pain experienced with LPHS is, in general, extremely difficult to treat. Many surgical and pharmacologic therapies have been directed at LPHS pain without success. This report documents successful pain control in a patient with LPHS using long-term intrathecal morphine delivered via an implantable pump. Intrathecal narcotic
Machin, K L
Analgesics are often not provided to amphibians because the presence and severity of pain may not be recognized in these animals. In addition, there is little information on the mechanism of action of analgesic agents in amphibians. However, amphibians possess appropriate neurologic components for transmitting pain from peripheral receptors to the central nervous system and antinociceptive mechanisms to modulate pain. They are capable of displaying behavioral and physiologic modification of pain systems in response to analgesic pharmacologic agents. Therefore, pain perception in amphibians is likely analogous to that in mammals and invasive, potentially painful procedures should be accompanied by appropriate analgesia and anesthesia. Although specific doses have not been established in clinical trials, basic research into the mechanisms and regulation of endogenous opioid systems demonstrates the potential clinical benefit for the use of opioids in these animals. Other analgesics such as alpha2-agonists, ketamine, and tricaine methanesulfonate have also demonstrated analgesic potential. PMID:10367638
Hall, Richard W; Anand, Kanwaljeet J S
As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns. PMID:25459780
Bhalla, Tarun; Shepherd, Ed; Tobias, Joseph D.
The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions. PMID:25538531
Surgical treatment of low back pain in spine instability.
Bradford, D S
Spinal instability is a loosely used term resulting from a variety of traumatic, developmental, neoplastic, hereditary, and degenerative insults to the axial skeleton. As defined by White and Panjabi, lumbar instability would imply the loss of the spine's ability, under physiological loads, to maintain its patterns of displacement so as to avoid neurologic deficits, incapacitating deformity, and intractable pain. Although from a strict engineering standpoint, the concept of load and deformation is valid, it is not at all known what type of movement or what magnitude of movement is responsible for low back pain. In light of these considerations, the author would define instability as either acute or chronic. Acute mechanical instability would result from those conditions such as fracture, tumor infiltration, infection, postlaminectomy, and certain congenital defects where a small change in loading or deformation could lead to permanent vertebral displacement with fixed deformity and/or neurologic damage. Chronic instability would result from those low back disorders that lead to progressive deformity over a period of years, often producing back pain from degenerative osteoarthritis, and central as well as foraminal stenosis. These disorders would include lumbar scoliosis, kyphosis, and spondylolisthesis, either isthmic or degenerative type. In those situations associated with more chronic instability, the relationship of low back pain is not always discernable even with provocative discography or magnetic resonance imaging. The surgical treatment of low back pain associated with these spinal instabilities depends on the etiology of the conditions defined. Acute traumatic injuries are best managed by posterior segmental instrumentation. At the level of the upper lumbar spine, a combined approach may be desirable to support anterior column deficiency.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8076479
Treatment of painful polyneuropathies
Bruce Nicholson
The treatment of painful polpyneuropathies has begun to improve over the past several years. This is based on an evolving\\u000a understanding of the pathogenesis related to the development of diabetic neuropathy and other diseases that may lead to peripheral\\u000a nerve injury. Consensus on evaluation strategies for patients presenting with pain has furthered our ability to define neuropathic\\u000a pain and accompanying
Nespor, K
The use of yoga and yoga related techniques in pain management is reviewed and discussed. Self-awareness, relaxation, approaches which use respiration, increased self-understanding and self-acceptance, changed context of pain, increased control, life style improvements, group and social support proved beneficial. The use of yoga in pain management has its transpersonal and philosophical dimensions. Independence and self-confidence of suffering people may be protected in this way. PMID:1723397
Smith, Howard S.
Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. PMID:23861996
... where you hurt and exactly how it feels. Acute Pain and Chronic Pain There are two kinds of pain. Acute ... rheumatoid arthritis (RA) and sciatica. In some cases, chronic pain follows after acute pain from an injury or other health issue ...
Effects of Bifidobacterium infantis 35624 on Post-Inflammatory Visceral Hypersensitivity in the Rat
Anthony C. Johnson; Beverley Greenwood-Van Meerveld; John McRorie
Background��Irritable bowel syndrome patients have abnormal visceral perception. Probiotic organisms may produce beneficial effects in\\u000a these patients by reducing visceral hypersensitivity.\\u000a \\u000a \\u000a \\u000a \\u000a Aim��To investigate the effects of the probiotic organism, Bifidobacterium infantis 35624, on post-inflammatory visceral hypersensitivity in rats.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��Colitis was induced using intracolonic administration of trinitrobenzenesulfonic acid; control rats received saline (day 0).\\u000a Myeloperoxidase (MPO) levels and colonic damage scores
Treatment of Visceral Leishmaniasis with Sterically Stabilized Liposomes Containing Camptothecin
Proulx, Marie-Eve; D�sormeaux, Andr�; Marquis, Jean-Fran�ois; Olivier, Martin; Bergeron, Michel G.
The efficacy of 20(S)-camptothecin (CPT), free and incorporated into sterically stabilized liposomes, has been investigated in vitro against Leishmania donovani promastigotes and in vivo in a murine model of visceral leishmaniasis. Incubation of L. donovani promastigotes with free or liposomal CPT inhibited the growth of parasites in a dose-dependent manner. Tissue distribution studies revealed that the intraperitoneal administration of liposomal CPT was efficient for the delivery of high drug levels to the liver and spleen. Treatment of infected mice with intraperitoneal injections of free and liposomal CPT significantly reduced the parasite loads in the livers by 43 and 55%, respectively, compared with the loads for untreated controls. However, both treatments caused normochromic anemia and neutropenia. PMID:11502539
[General principles of tumour biology in visceral surgery].
Emons, G; Ghadimi, M; Grade, M
Within the last decade, there has been a tremendous progress in understanding the molecular basis of cancer. In particular, the development and the characteristic features of cancer cells are being increasingly understood. The understanding of these molecular characteristics is mandatory for the development of novel, targeted therapeutic strategies and their integration into clinical practice. In addition, tumour genetics play a critically important role for hereditary cancer syndromes, with respect to both diagnostics and clinical decision-making. The aim of this review is to highlight general principles of tumour genetics from a visceral surgeon's point of view, although a comprehensive summary of all aspects would be beyond the scope of this article due to the complexity of the topic. PMID:23918723
Visceral Obesity- The Link Among Inflammation, Hypertension, and Cardiovascular Disease
NSDL National Science Digital Library
Patrick Mathieu (Laval Hospital Research Center/Quebec Heart Institute Surgery)
The worldwide epidemic of obesity, fostered by the modern lifestyle characterized by the lack of physical activity and an energy-dense diet, has contributed to create an unprecedented condition in human history where a majority of overfed individuals will soon surpass the number of malnourished.1 Obesity-associated disorders, such as diabetes mellitus, an atherogenic dyslipidemia, and hypertension, have undoubtedly contributed to create an atherosclerosis-prone environment and thereby the development of cardiovascular disease (CVD), a leading cause of mortality in Westernized societies. A growing body of evidence indicates that obesity is a heterogeneous condition in which body fat distribution is closely associated with metabolic perturbations and, thus, with CVD risk.2 In this regard, accumulation of visceral (intra-abdominal) fat is strongly associated with insulin resistance and with a typical atherogenic dyslipidemic state.3
Secreted virulence factors and immune evasion in visceral leishmaniasis.
Lambertz, Ulrike; Silverman, Judith Maxwell; Nandan, Devki; McMaster, W Robert; Clos, Joachim; Foster, Leonard J; Reiner, Neil E
Evasion or subversion of host immune responses is a well-established paradigm in infection with visceralizing leishmania. In this review, we summarize current findings supporting a model in which leishmania target host regulatory molecules and pathways, such as the PTP SHP-1 and the PI3K/Akt signaling cascade, to prevent effective macrophage activation. Furthermore, we describe how virulence factors, secreted by leishmania, interfere with macrophage intracellular signaling. Finally, we discuss mechanisms of secretion and provide evidence that leishmania use a remarkably adept, exosome-based secretion mechanism to export and deliver effector molecules to host cells. In addition to representing a novel mechanism for trafficking of virulence factors across membranes, recent findings indicate that leishmania exosomes may have potential as vaccine candidates. PMID:22442494
Visceral Leishmaniasis: Clinical Features, Pathology, Diagnosis and Chemotherapeutic Developments.
Kumari, Seema; Ram, Vishnu Ji
Visceral leishmaniasis, or kala-azar, is a chronic disease caused by Leishmania donovani, Leishmania chagasi or Leishmania infantum. The disease is transmitted through the bite of a species of sandfly of the genus Phlebotomus, releasing amastigote parasites that invade various organs of the body and eventually result in such conditions as anemia, splenomegaly and hepatomegaly. Although no vaccine exists for the disease, diagnostic techniques based not only on pathological tests, but more sophisticated detectors such as polymerase chain reaction, enzyme-linked immunosorbent assay, latex agglutination and immunochromatographic strip testing have been developed. Traditional treatment for the disease consists of two pentavalent antimonial drugs, sodium stibogluconate and meglumine antimoniate, but the growing resistance to these drugs has compelled scientists to search for new efficient compounds. (c) 2002 Prous Science. All rights reserved. PMID:12677177
Combinations of neurokinin receptor antagonists reduce visceral hyperalgesia.
Kamp, E H; Beck, D R; Gebhart, G F
The effect of selective neurokinin receptor (NKR) antagonists for the NK1R (SR140,333), NK2R (SR48,968), and NK3R (SR142,801) on the visceromotor response to noxious colorectal distension (CRD) was examined. NKR antagonists or vehicle were given intrathecally (i.th.) to rats made hyperalgesic by intracolonic instillation of zymosan or after intracolonic instillation of saline (control). Given alone, the NK1R (up to 3 microg of SR140,333) and NK2R (up to 60 microg of SR48,968) antagonists tested failed to significantly affect responses to the noxious visceral stimulus. However, coadministration of 3 microg of SR140,333 and 60 microg of SR48,968 (both i.th.) significantly reduced responses to noxious CRD (p < 0.05 versus vehicle). The NK3R antagonist (60 microg of SR142,801) significantly reduced responses to noxious CRD when given alone to either hyperalgesic (zymosan-treated) or normal (saline-treated) rats (p < 0.05 versus vehicle for both groups). Responses of rats receiving the NK3R antagonist in combination with either the NK1R or the NK2R antagonist were not different from rats receiving the NK3R antagonist alone. These results suggest that activation of spinal NK1R and NK2R, presumably by their endogenous ligands (substance P and neurokinin A), maintain visceral hyperalgesia and support the notion that activation of NK3R (presumably by neurokinin B) is pronociceptive. PMID:11561069
TelePain: A Community of Practice for Pain Management
Meins, Alexa R.; Doorenbos, Ardith Z.; Eaton, Linda; Gordon, Debra; Theodore, Brian; Tauben, David
Introduction Comprehensive pain management services are primarily located in urban areas, limiting specialist consultation opportunities for community healthcare providers. A community of practice (CoP) for pain management could create opportunities for consultation by establishing professional relationships between community healthcare providers and pain management specialists. A CoP is a group of people with a common concern, set of problems, or a passion for something they do. Members of a CoP for pain management increase their knowledge of evidence-based pain management strategies in a way that is meaningful and relevant. In this article, we provide evidence that TelePain, an interdisciplinary, case-based pain management teleconference consultation program through the University of Washington, qualifies as a CoP and present preliminary evidence of TelePain's effectiveness as a CoP for pain management. Methods Specific behaviors and conversations gathered through participant observation during TelePain sessions were analyzed based on the 14 indicators Wegner developed to evaluate the presence of a CoP. To demonstrate preliminary effectiveness of TelePain as a CoP for pain management, descriptive statistics were used to summarize TelePain evaluation forms. Results TelePain is an example of a successful CoP for pain management as demonstrated by the presence of Wegner's 14 indicators. Additionally, evaluation forms showed that TelePain enhanced community healthcare providers' knowledge of pain management strategies and that continued participation in TelePain lead to community healthcare providers' increased confidence in their ability to provide pain management. Conclusion TelePain, a CoP for pain management, facilitates multidisciplinary collaboration and allows members to develop interdisciplinary care plans for complex pain patients through case study discussions. Evidence-based pain management strategies gained through CoP membership could be disseminated to other healthcare providers in members' clinics, which has the potential of improving the care of chronic pain patients. PMID:25964869
Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain
Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana
Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149
Haykin, Simon
experience in interventional pain management. The diagnostic and therapeutic approach to the patient. TARGET AUDIENCE Physicians from across Canada with experience in Pain Management and Physicians with experience in Pain Management pertaining to Anesthesia, Physical Medicine, Psychiatry, and Palliative Care
Adjuvant single-fraction radiotherapy is safe and effective for intractable keloids
Song, Changhoon; Wu, Hong-Gyun; Chang, Hak; Kim, Il Han; Ha, Sung W.
The aim of this study was to assess the feasibility and efficacy of high-dose, single-fraction electron beam radiotherapy for therapy-resistant keloids. Before 2010, intractable keloids were treated at our institution with post-operative irradiation of 6�15 Gy in 3�5 fractionations. For convenience and cost effectiveness, we have changed our treatment protocol to high-dose single-fraction radiotherapy. A total of 12 patients with 16 keloid lesions were treated from January 2010 to January 2013 in our department. A 10-Gy dose of electron irradiation was given within 72 h of the surgical excision. The mean follow-up period was 20 months. Treatments were well tolerated, and there was no recurrence in any of the patients. Severe adverse effects were not observed. Surgical excision of the keloid, followed by immediate, single-fraction, high-dose radiotherapy, is both safe and effective in preventing recurrence of therapy-resistant keloids. PMID:24801475
Amoeba-inspired nanoarchitectonic computing: solving intractable computational problems using nanoscale photoexcitation transfer dynamics.
Aono, Masashi; Naruse, Makoto; Kim, Song-Ju; Wakabayashi, Masamitsu; Hori, Hirokazu; Ohtsu, Motoichi; Hara, Masahiko
Biologically inspired computing devices and architectures are expected to overcome the limitations of conventional technologies in terms of solving computationally demanding problems, adapting to complex environments, reducing energy consumption, and so on. We previously demonstrated that a primitive single-celled amoeba (a plasmodial slime mold), which exhibits complex spatiotemporal oscillatory dynamics and sophisticated computing capabilities, can be used to search for a solution to a very hard combinatorial optimization problem. We successfully extracted the essential spatiotemporal dynamics by which the amoeba solves the problem. This amoeba-inspired computing paradigm can be implemented by various physical systems that exhibit suitable spatiotemporal dynamics resembling the amoeba's problem-solving process. In this Article, we demonstrate that photoexcitation transfer phenomena in certain quantum nanostructures mediated by optical near-field interactions generate the amoebalike spatiotemporal dynamics and can be used to solve the satisfiability problem (SAT), which is the problem of judging whether a given logical proposition (a Boolean formula) is self-consistent. SAT is related to diverse application problems in artificial intelligence, information security, and bioinformatics and is a crucially important nondeterministic polynomial time (NP)-complete problem, which is believed to become intractable for conventional digital computers when the problem size increases. We show that our amoeba-inspired computing paradigm dramatically outperforms a conventional stochastic search method. These results indicate the potential for developing highly versatile nanoarchitectonic computers that realize powerful solution searching with low energy consumption. PMID:23565603
Brain somatic mutations in MTOR cause focal cortical dysplasia type II leading to intractable epilepsy.
Lim, Jae Seok; Kim, Woo-il; Kang, Hoon-Chul; Kim, Se Hoon; Park, Ah Hyung; Park, Eun Kyung; Cho, Young-Wook; Kim, Sangwoo; Kim, Ho Min; Kim, Jeong A; Kim, Junho; Rhee, Hwanseok; Kang, Seok-Gu; Kim, Heung Dong; Kim, Daesoo; Kim, Dong-Seok; Lee, Jeong Ho
Focal cortical dysplasia type II (FCDII) is a sporadic developmental malformation of the cerebral cortex characterized by dysmorphic neurons, dyslamination and medically refractory epilepsy. It has been hypothesized that FCD is caused by somatic mutations in affected regions. Here, we used deep whole-exome sequencing (read depth, 412-668�) validated by site-specific amplicon sequencing (100-347,499�) in paired brain-blood DNA from four subjects with FCDII and uncovered a de novo brain somatic mutation, mechanistic target of rapamycin (MTOR) c.7280T>C (p.Leu2427Pro) in two subjects. Deep sequencing of the MTOR gene in an additional 73 subjects with FCDII using hybrid capture and PCR amplicon sequencing identified eight different somatic missense mutations found in multiple brain tissue samples of ten subjects. The identified mutations accounted for 15.6% of all subjects with FCDII studied (12 of 77). The identified mutations induced the hyperactivation of mTOR kinase. Focal cortical expression of mutant MTOR by in utero electroporation in mice was sufficient to disrupt neuronal migration and cause spontaneous seizures and cytomegalic neurons. Inhibition of mTOR with rapamycin suppressed cytomegalic neurons and epileptic seizures. This study provides, to our knowledge, the first evidence that brain somatic activating mutations in MTOR cause FCD and identifies mTOR as a treatment target for intractable epilepsy in FCD. PMID:25799227
Outcome of Gamma Knife Thalamotomy in Patients with an Intractable Tremor
Cho, Kyung Rae; Kim, Hong Rye; Im, Yong Seok; Youn, Jinyoung; Cho, Jin Whan
Objective Tremor is a common movement disorder that interferes with daily living. Since the medication for tremor has some limitations, surgical intervention is needed in many patients. In certain patients who cannot undergo aggressive surgical intervention, Gamma Knife thalamotomy (GKT) is a safe and effective alternative. Methods From June 2012 to August 2013, 7 patients with an intractable tremor underwent GKT. Four of these 7 patients had medical comorbidities, and 3 patients refused to undergo traditional surgery. Each patient was evaluated with the modified Fahn-Tolosa-Marin tremor rating scale (TRS) along with analysis of handwriting samples. All of the patients underwent GKT with a maximal dose of 130 Gy to the left ventralis intermedius (VIM) nucleus of the thalamus. Follow-up brain MRI was performed after 3 to 8 months of GKT, and evaluation with the TRS was also performed. Results Six patients showed objective improvement in the TRS score. Excluding one patient who demonstrated tremor progression, there was 28.9% improvement in the TRS score. However, five patients showed subjective improvement in their symptoms. On comparing the TRS scores between follow-up periods of more and less than 4 months, the follow-up TRS score at more than 4 months of GKT was significantly improved compared to that at less than 4 months of GKT. Follow-up MRI showed radiosurgical changes in 5 patients. Conclusion GKT with a maximal dose of 130 Gy to the VIM is a safe procedure that can replace other surgical procedures. PMID:25810859
Seizure frequency, patient-perceived seizure severity and the psychosocial consequences of intractable epilepsy.
Smith, D F; Baker, G A; Dewey, M; Jacoby, A; Chadwick, D W
It is generally recognised that the assessment of treatment effects in epilepsy using seizure frequency as the only outcome measure may lack sensitivity. A patient-based seizure severity scale has been developed and initial results confirm its reliability and validity. As part of the further development of this scale it is important to explore the relationship between seizure severity, seizure frequency and the psychosocial consequences of intractable epilepsy. One hundred patients with medically refractory partial seizures completed a quality of life questionnaire including measures of physical (seizure severity and frequency), social and psychological well-being (anxiety, depression, self-esteem, locus of control and happiness). Multivariate analysis demonstrated that individual psychological variables were best predicted by other psychological variables. However, when these were removed from analysis, seizure severity was the most significant predictor of self-esteem (P = 0.005), locus of control P = 0.039) and anxiety (P = 0.048). Seizure frequency did not contribute significantly to the variance of any of the psychological factors. These results highlight the importance of considering seizure severity when assessing treatment effects in epilepsy and provide further evidence for the construct validity of a novel patient-based seizure severity scale. PMID:1743185
Potential Use and Challenges of Functional Connectivity Mapping in Intractable Epilepsy
Constable, Robert Todd; Scheinost, Dustin; Finn, Emily S.; Shen, Xilin; Hampson, Michelle; Winstanley, F. Scott; Spencer, Dennis D.; Papademetris, Xenophon
This review focuses on the use of resting-state functional magnetic resonance imaging data to assess functional connectivity in the human brain and its application in intractable epilepsy. This approach has the potential to predict outcomes for a given surgical procedure based on the pre-surgical functional organization of the brain. Functional connectivity can also identify cortical regions that are organized differently in epilepsy patients either as a direct function of the disease or through indirect compensatory responses. Functional connectivity mapping may help identify epileptogenic tissue, whether this is a single focal location or a network of seizure-generating tissues. This review covers the basics of connectivity analysis and discusses particular issues associated with analyzing such data. These issues include how to define nodes, as well as differences between connectivity analyses of individual nodes, groups of nodes, and whole-brain assessment at the voxel level. The need for arbitrary thresholds in some connectivity analyses is discussed and a solution to this problem is reviewed. Overall, functional connectivity analysis is becoming an important tool for assessing functional brain organization in epilepsy. PMID:23734143
The roles of vitamin B12 and vitamin D in children with intractable epilepsy
Li, Xiao-Hong; Hou, Xiao-Yan; Chen, Rong
Epilepsy is a chronic neurological disorder. Antiepileptic drugs (AEDs) can cause vitamin B12 or D deficiency in children with intractable epilepsy. In this study, we measured salivary superoxide dismutase (SOD) and metalloproteinsases (MMP) levels in the patients with vitamin B12 and vitamin D treatment. Cytokines and chemokines were measured using ELISA. The mean salivary value of SOD activity in the control group was 1.75 � 0.21 U/ml. In the treatment group, the value was 1.33 � 0.18 U/ml. The salivary MMP 2, MMP 3, and MMP 9 levels of the patients with vitamin D and vitamin B12 treatment were lower than that in the patients without vitamin D and vitamin B12 treatment. Interleukin 1? (IL-1?), IL-6, IL-8, macrophage inflammatory protein 1? (MIP-1?), monocyte chemoattractant protein-1 (MCP-1) and IFN-inducible protein 10 (IP-10) were significantly decreased in the cortex of our patients with vitamin D and vitamin B12 treatment. In this study, a clear association between vitamin D and vitamin B12 treatment and epilepsy was identified. We now plan to investigate the genetic factors that underlie vitamin D and vitamin B12 treatment in patients treated with AEDs. PMID:25785055
Chemical Interventions for Pain.
ERIC Educational Resources Information Center
Aronoff, Gerald M.; And Others
Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,�
Ostler, Anneli
Reading the CPD article helped improve my understanding of the importance of identifying chronic pain. Chronic pain may occur on its own or as a feature of other chronic conditions, and it may be nociceptive or neuropathic, or a combination of the two. PMID:26058654
Painful and painless channelopathies.
Bennett, David L H; Woods, C Geoffrey
The discovery of genetic variants that substantially alter an individual's perception of pain has led to a step-change in our understanding of molecular events underlying the detection and transmission of noxious stimuli by the peripheral nervous system. For example, the voltage-gated sodium ion channel Nav1.7 is expressed selectively in sensory and autonomic neurons; inactivating mutations in SCN9A, which encodes Nav1.7, result in congenital insensitivity to pain, whereas gain-of-function mutations in this gene produce distinct pain syndromes such as inherited erythromelalgia, paroxysmal extreme pain disorder, and small-fibre neuropathy. Heterozygous mutations in TRPA1, which encodes the transient receptor potential cation channel, can cause familial episodic pain syndromes, and variants of genes coding for the voltage-gated sodium channels Nav1.8 (SCN10A) and Nav1.9 (SCN11A) lead to small-fibre neuropathy and congenital insensitivity to pain, respectively. Furthermore, other genetic polymorphisms have been identified that contribute to risk or severity of more complex pain phenotypes. Novel models of sensory disorders are in development-eg, using human sensory neurons differentiated from human induced pluripotent stem cells. Understanding rare heritable pain disorders not only improves diagnosis and treatment of patients but may also reveal new targets for analgesic drug development. PMID:24813307
David R. Patterson; Mark P. Jensen
Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute
Oliver, Douglas L.
back and forth, tense Arched, rigid or jerking CRY No cry (awake or asleep) Moans or whimpers; occasional complaint Crying steadily, screams or sobs, frequent complaints CONSOLABILITY Content, relaxed for Scoring Post-operative Pain in Young Children (1997) Pediatric Nursing. 23(3): 293-297. #12;PAIN SCALES
Henry McQuay
Dose titration and differences between clinical and laboratory pharmacology The clinical use of opioids shows a difference between their clinical pharmacology and their laboratory pharmacology. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The respiratory depression that results from the acute use of opioids
... without affecting other nervous system functions. As we learn more about the specific roles of GABA receptors, drug development may be accelerated. ... reverse and makes pain persist beyond its protective role. ... imaging technology, to locate pain precisely, and to assess the ...
Finlay, Barbara L; Syal, Supriya
Sociality and cooperation are benefits to human cultures but may carry unexpected costs. We suggest that both the human experience of pain and the expression of distress may result from many causes not experienced as painful in our close primate relatives, because human ancestors motivated to ask for help survived in greater numbers than either the thick-skinned or the stoic. PMID:25200380
Clinical application of kampo medicine (rikkunshito) for common and/or intractable symptoms of the gastrointestinal tract.
Tominaga, Kazunari; Arakawa, Tetsuo
Gastroenterological reflux disease and functional dyspepsia are usually treatable using Western medical practices. Nonetheless, some cases present with intractable symptoms that are not amenable to these therapies. Treatment with kampo, a traditional Japanese medicine, recently has been proposed as an alternative therapy for use in combination with the Western practices. In general, traditional Japanese medicines have been used empirically for intractable symptoms correctively designated as "general malaises." Accumulating lines of evidence, including basic and clinical researches, have demonstrate detailed mechanisms where traditional Japanese medicines exert pharmacological action to improve symptoms. Therefore, traditional Japanese medicines have been gaining use by various medical doctors as the specific modes of pharmacological action are recognized. This review covers both the pharmacological functions and the clinical efficacies of rikkunshito for use in treating disorders of the gastrointestinal tract. PMID:25688209
Clinical application of kampo medicine (rikkunshito) for common and/or intractable symptoms of the gastrointestinal tract
Tominaga, Kazunari; Arakawa, Tetsuo
Gastroenterological reflux disease and functional dyspepsia are usually treatable using Western medical practices. Nonetheless, some cases present with intractable symptoms that are not amenable to these therapies. Treatment with kampo, a traditional Japanese medicine, recently has been proposed as an alternative therapy for use in combination with the Western practices. In general, traditional Japanese medicines have been used empirically for intractable symptoms correctively designated as �general malaises.� Accumulating lines of evidence, including basic and clinical researches, have demonstrate detailed mechanisms where traditional Japanese medicines exert pharmacological action to improve symptoms. Therefore, traditional Japanese medicines have been gaining use by various medical doctors as the specific modes of pharmacological action are recognized. This review covers both the pharmacological functions and the clinical efficacies of rikkunshito for use in treating disorders of the gastrointestinal tract. PMID:25688209
Cancer and Referred Facial Pain.
Romero-Reyes, Marcela; Teruel, Antonia; Ye, Yi
Orofacial pain may be a symptom of diverse types of cancers as a result of local or distant tumor effects. The pain can be presented with the same characteristics as any other orofacial pain disorder, and this should be recognized by the clinician. Orofacial pain also can arise as a consequence of cancer therapy. In the present article, we review the mechanisms of cancer-associated facial pain, its clinical presentation, and cancer therapy associated with orofacial pain. PMID:26088459
NASA Astrophysics Data System (ADS)
Gruber, Dennis Michael
Pain is a discursive construct of science and medicine. Through the discourses of biopower and technoscience pain is used to construct and maintain the social body. Biopower and technoscience are discursive practices that are enveloped within the disciplines of Western society. Specifically, the disciplines of education, science, and medicine use biopower and technoscience to normalize the body and construct binaries which create the abnormal. The cyborg is a discursive practice used to implode the binaries of the disciplines which maintain the social body. Through the implosion of binaries, the binary of mind/body is no longer plausible in the explanation of pain. Neuropathic chronic pain and phantom limb pain become cyborg discourses which operate to deconstruct the pedagogies of science and medicine.
Musculoskeletal chest wall pain
Fam, Adel G.; Smythe, Hugh A.
The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, �fibrositis� syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804
Examination of visceral perception and gastric tone by gastric stimulation using air inflation during endoscopy.
Suzuki, T; Hirano, M; Yamamoto, Y
This study investigated the assessment of visceral perception and gastric tone using insufflation during endoscopy. The intragastric pressure was measured during insufflation in 16 patients with gastro-oesophageal reflux disease, 25 patients with functional dyspepsia and 24 normal controls, using a pressure transducer inserted through the forceps aperture until gastric symptoms appeared. The intragastric pressure at the visceral perception threshold, the time to threshold and the time-pressure curve gradient were measured. The visceral perception threshold was significantly reduced in the functional dyspepsia group compared with the normal controls. Balloons were also inserted into the duodenal bulbs of 10 normal controls to investigate the effect of efflux of air into the duodenum; the measured parameters were not influenced by inflation and deflation. These results suggest that it is possible to assess visceral perception and gastric tone by measuring changes in intragastric pressure, using gastric stimulation by insufflation during endoscopy. PMID:15790127
Electroacupuncture at He-Mu points reduces P2X4 receptor expression in visceral hypersensitivity
Guo, Xinxin; Chen, Jifei; Lu, Yuan; Wu, Luyi; Weng, Zhijun; Yang, Ling; Xin, Yuhu; Lin, Xianming; Liang, Yi; Fang, Jianqiao
Electroacupuncture at Shangjuxu (ST37) and Tianshu (ST25) was reported to improve visceral hypersensitivity in rats. Colorectal distension was utilized to generate a rat model of chronic visceral hypersensitivity in irritable bowel syndrome. Results showed that abdominal withdrawal reflex scores noticeably increased after model establishment. Simultaneously, P2X4 receptor immureactivity significantly increased in the colon and spinal cord. Electroacupuncture and pinaverium bromide therapy both markedly decreased abdominal withdrawal reflex scores in rats with visceral hypersensitivity, and significantly decreased P2X4 receptor immunoreactivity in the colon and spinal cord. These data suggest that electroacupuncture treatment can improve visceral hypersensitivity in rats with irritable bowel syndrome by diminishing P2X4 receptor immunoreactivity in the colon and spinal cord. PMID:25206515
Electroacupuncture at He-Mu points reduces P2X4 receptor expression in visceral hypersensitivity.
Guo, Xinxin; Chen, Jifei; Lu, Yuan; Wu, Luyi; Weng, Zhijun; Yang, Ling; Xin, Yuhu; Lin, Xianming; Liang, Yi; Fang, Jianqiao
Electroacupuncture at Shangjuxu (ST37) and Tianshu (ST25) was reported to improve visceral hypersensitivity in rats. Colorectal distension was utilized to generate a rat model of chronic visceral hypersensitivity in irritable bowel syndrome. Results showed that abdominal withdrawal reflex scores noticeably increased after model establishment. Simultaneously, P2X4 receptor immureactivity significantly increased in the colon and spinal cord. Electroacupuncture and pinaverium bromide therapy both markedly decreased abdominal withdrawal reflex scores in rats with visceral hypersensitivity, and significantly decreased P2X4 receptor immunoreactivity in the colon and spinal cord. These data suggest that electroacupuncture treatment can improve visceral hypersensitivity in rats with irritable bowel syndrome by diminishing P2X4 receptor immunoreactivity in the colon and spinal cord. PMID:25206515
Ethical and epidemiological dilemmas in the treatment of dogs for visceral leishmaniasis in Latin America.
Travi, Bruno L
In the Americas there are between 4,500 and 6,800 annual cases of severe visceral leishmaniasis, and mortality is estimated to range between 7 and 10%. However, underreporting and subclinical infections mask the real epidemiological importance of visceral leishmaniasis. Control efforts, which have typically focused on insecticide spraying of sand fly vectors and dog culling, have yielded disparate results. Nevertheless, thousands of dogs are sacrificed each year in countries endemic for visceral leishmaniasis. Additionally, current guidelines of leishmaniasis control programs have banned dog treatment with drugs of human use while therapy with other drugs resulted in high rates of relapses. Society requires that control programs take a more humanitarian approach aimed at limiting dog culling. There is an urgent need to promote responsible dog-ownership and support research on: a) novel veterinary therapies, b) low-cost molecular diagnosis of canine visceral leishmaniasis, and c) determination of dog infectivity threshold for proper reservoir management. PMID:24967853
No evidence for association between SLC11A1 and visceral leishmaniasis in India
Mehrotra, Sanjana; Oommen, Joyce; Mishra, Anshuman; Sudharshan, Medhavi; Tiwary, Puja; Jamieson, Sarra E; Fakiola, Michaela; Rani, Deepa Selvi; Thangaraj, Kumarasamy; Rai, Madhukar; Sundar, Shyam; Blackwell, Jenefer M
AbstractBackgroundSLC11A1 has pleiotropic effects on macrophage function and remains a strong candidate for infectious disease susceptibility. 5' and/or 3' polymorphisms have been associated with tuberculosis, leprosy, and visceral leishmaniasis (VL...
Distinct genetic programs guide Drosophila circular and longitudinal visceral myoblast fusion
Background The visceral musculature of Drosophila larvae comprises circular visceral muscles tightly interwoven with longitudinal visceral muscles. During myogenesis, the circular muscles arise by one-to-one fusion of a circular visceral founder cell (FC) with a visceral fusion-competent myoblast (FCM) from the trunk visceral mesoderm, and longitudinal muscles arise from FCs of the caudal visceral mesoderm. Longitudinal FCs migrate anteriorly under guidance of fibroblast growth factors during embryogenesis; it is proposed that they fuse with FCMs from the trunk visceral mesoderm to give rise to syncytia containing up to six nuclei. Results Using fluorescence in situ hybridization and immunochemical analyses, we investigated whether these fusion events during migration use the same molecular repertoire and cellular components as fusion-restricted myogenic adhesive structure (FuRMAS), the adhesive signaling center that mediates myoblast fusion in the somatic mesoderm. Longitudinal muscles were formed by the fusion of one FC with Sns-positive FCMs, and defects in FCM specification led to defects in longitudinal muscle formation. At the fusion sites, Duf/Kirre and the adaptor protein Rols7 accumulated in longitudinal FCs, and Blow and F-actin accumulated in FCMs. The accumulation of these four proteins at the fusion sites argues for FuRMAS-like adhesion and signaling centers. Longitudinal fusion was disturbed in rols and blow single, and scar wip double mutants. Mutants of wasp or its interaction partner wip had no defects in longitudinal fusion. Conclusions Our results indicated that all embryonic fusion events depend on the same cell-adhesion molecules, but that the need for Rols7 and regulators of F-actin distinctly differs. Rols7 was required for longitudinal visceral and somatic myoblast fusion but not for circular visceral fusion. Importantly, longitudinal fusion depended on Kette and SCAR/Wave but was independent of WASp-dependent Arp2/3 activation. Thus, the complexity of the players involved in muscle formation increases from binucleated circular muscles to longitudinal visceral muscles to somatic muscles. PMID:25000973
Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis
Ye, Fang; Li, Xiao-Jia; Jiang, Wan-Lin
Background and Purpose Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. Methods Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes. Results In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%. Conclusions The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet. PMID:25628734
Familial partial trisomy 15q11-13 presenting as intractable epilepsy in the child and schizophrenia in the mother.
Michelson, Marina; Eden, Avi; Vinkler, Chana; Leshinsky-Silver, Esther; Kremer, Uri; Lerman-Sagie, Tally; Lev, Dorit
Various rearrangements involve the proximal long arm of chromosome 15, including deletions, duplications, translocations, inversions and supernumerary marker chromosome of an inverted duplication. The large marker 15, that contains the Prader-Willi syndrome (PWS)/Angelman syndrome (AS) chromosome region, is usually associated with an abnormal phenotype of moderate to severe mental retardation, seizures, poor motor coordination, early-onset central hypotonia, autism and autistic-like behavior, schizophrenia and mild dysmorphic features. We report a ten year-old girl with normal intelligence prior to the onset of seizures, who developed severe intractable epilepsy at the age of seven years. Family history was significant for a mother with recurrent episodes of acute psychosis. The patient's and mother's karyotype revealed 47,XX+m. Array comparative genomic hybridization (A-CGH) identified a gain of 13 BAC clones from 15q11.2 through 15q13.1, which was then confirmed by FISH to be part of the marker chromosome. This duplicated region contains the SNRPN/UBE3A locus. This case demonstrates that a duplication of 15q11-13 can present differently in the same family either as intractable epilepsy or as a psychiatric illness and that intelligence can be preserved. We suggest that CGH microarray should be performed in cases with intractable epilepsy or schizophrenia, with or without mental retardation. PMID:21145272
P-glycoprotein alters blood�brain barrier penetration of antiepileptic drugs in rats with medically intractable epilepsy
Ma, Aimei; Wang, Cuicui; Chen, Yinghui; Yuan, Weien
P-glycoprotein is one of the earliest known multidrug transporters and plays an important role in resistance to chemotherapeutic drugs. In this study, we detected levels of P-glycoprotein and its mRNA expression in a rat brain model of medically intractable epilepsy established by amygdala kindling and drug selection. We investigated whether inhibition of P-glycoprotein affects the concentration of antiepileptic drugs in cortical extracellular fluid. We found that levels of P-glycoprotein and its mRNA expression were upregulated in epileptic cerebral tissue compared with cerebral tissue from normal rats. The concentrations of two antiepileptic drugs, carbamazepine and phenytoin, were very low in the cortical extracellular fluid of rats with medically intractable epilepsy, and were restored after blockade of P-glycoprotein by verapamil. These results show that increased P-glycoprotein levels alter the ability of carbamazepine and phenytoin to penetrate the blood�brain barrier and reduce the concentrations of these agents in extracellular cortical fluid. High P-glycoprotein levels may be involved in resistance to antiepileptic drugs in medically intractable epilepsy. PMID:24348021
[Epidemiology of leishmaniasis in Algeria. 7. Visceral leishmaniasis in the Grande Kabylie focus].
Dedet, J P; Addadi, K; Lannuzel, B
The authors present the results of a survey on visceral leishmaniasis in the Grande Kabylie region (Algeria). With a 2.6 human cases per 100,000 annual prevalence, and a 11.4 per cent incidence of canine leishmaniasis, the Grande Kabylie appears to be the most important focus of visceral leishmaniasis in North Africa. The endemicity ecological factors are discussed and a control program is proposed. PMID:580909
Superior mesenteric artery plasty for type A acute aortic dissection with visceral ischemia.
Kato, Wataru; Fujita, Takashi; Uchida, Kenichiro; Munakata, Hisaaki; Hibino, Makoto; Fujii, Kei; Tanaka, Keisuke; Sakai, Yoshimasa; Tajima, Kazuyoshi
Treatment of visceral ischemia complicated with acute type A aortic dissection is controversial. We had two cases of acute type A aortic dissection complicated by superior mesenteric artery (SMA) ischemia and successfully treated them with direct SMA perfusion during central aortic repair followed by SMA plasty. The presented procedures can be an option to treat visceral ischemia with a standard operative theater and equipment. PMID:25403999
Cost-Effectiveness Analysis of Combination Therapies for Visceral Leishmaniasis in the Indian Subcontinent
Filip Meheus; Manica Balasegaram; Piero Olliaro; Shyam Sundar; Suman Rijal; Marleen Boelaert
BackgroundVisceral leishmaniasis is a systemic parasitic disease that is fatal unless treated. We assessed the cost and cost-effectiveness of alternative strategies for the treatment of visceral leishmaniasis in the Indian subcontinent. In particular we examined whether combination therapies are a cost-effective alternative compared to monotherapies.Methods and FindingsWe assessed the cost-effectiveness of all possible mono- and combination therapies for the treatment
Pain Catastrophising Affects Cortical Responses to Viewing Pain in Others
Fallon, Nicholas
Pain catastrophising is an exaggerated cognitive attitude implemented during pain or when thinking about pain. Catastrophising was previously associated with increased pain severity, emotional distress and disability in chronic pain patients, and is also a contributing factor in the development of neuropathic pain. To investigate the neural basis of how pain catastrophising affects pain observed in others, we acquired EEG data in groups of participants with high (High-Cat) or low (Low-Cat) pain catastrophising scores during viewing of pain scenes and graphically matched pictures not depicting imminent pain. The High-Cat group attributed greater pain to both pain and non-pain pictures. Source dipole analysis of event-related potentials during picture viewing revealed activations in the left (PHGL) and right (PHGR) paraphippocampal gyri, rostral anterior (rACC) and posterior cingulate (PCC) cortices. The late source activity (600�1100 ms) in PHGL and PCC was augmented in High-Cat, relative to Low-Cat, participants. Conversely, greater source activity was observed in the Low-Cat group during the mid-latency window (280�450 ms) in the rACC and PCC. Low-Cat subjects demonstrated a significantly stronger correlation between source activity in PCC and pain and arousal ratings in the long latency window, relative to high pain catastrophisers. Results suggest augmented activation of limbic cortex and higher order pain processing cortical regions during the late processing period in high pain catastrophisers viewing both types of pictures. This pattern of cortical activations is consistent with the distorted and magnified cognitive appraisal of pain threats in high pain catastrophisers. In contrast, high pain catastrophising individuals exhibit a diminished response during the mid-latency period when attentional and top-down resources are ascribed to observed pain. PMID:26186545
Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency.
Wilkes, Denise
The management of chronic pain can be very challenging. Often, physicians employ intrathecal (IT) drug delivery systems as a last resort to relieve intractable pain. The system consists of an implantable pump that stores and delivers medication through a catheter to the IT space. Programmability is achieved by positioning an external devise over the implanted pump to change the mode of drug delivery. The innovations in programmable IT drug delivery systems are expanding more rapidly than ever before. Unfortunately, the rapid expansion is accompanied by a lack of prospective randomized trials examining these new options. In an effort to improve results and reduce side effects, publications by experts or expert consensus panels provide guidance for the community. The purpose of this article is to provide a summary of high interest topics in recent publications. PMID:25336986
Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency
Wilkes, Denise
The management of chronic pain can be very challenging. Often, physicians employ intrathecal (IT) drug delivery systems as a last resort to relieve intractable pain. The system consists of an implantable pump that stores and delivers medication through a catheter to the IT space. Programmability is achieved by positioning an external devise over the implanted pump to change the mode of drug delivery. The innovations in programmable IT drug delivery systems are expanding more rapidly than ever before. Unfortunately, the rapid expansion is accompanied by a lack of prospective randomized trials examining these new options. In an effort to improve results and reduce side effects, publications by experts or expert consensus panels provide guidance for the community. The purpose of this article is to provide a summary of high interest topics in recent publications. PMID:25336986
Referred Pain to the Ipsilateral Forehead and Orbit: An Unusual Phenomenon During Bronchial Artery Embolization
Ramakantan, Ravi; Ketkar, Manoj; Maddali, Krishna; Deshmukh, Hemant [Department of Radiology, King Edward Memorial Hospital, Bombay 400 012 (India)
Purpose: We report an unusual pattern of referred pain to the ipsilateral forehead and orbit observed during bronchial artery embolization (BAE) for massive hemoptysis due to pulmonary tuberculosis (TB) and postulate possible neural mechanisms for its occurrence. Methods: Seven men, from a series of 194 patients (171 men, 23 women) undergoing BAE (right bronchial artery 4, left 3) with gelatin sponge for control of massive hemoptysis due to pulmonary TB form the subject of this report. Results: Embolization was successful in achieving control of hemoptysis in these patients and there were no complications following the embolization. Transient, moderately severe, ipsilateral supraorbital and/or retroorbital pain occurred only during the injection of the gelatin sponge contrast mixture into the bronchial artery. The pain did not occur during the injection of heparinized saline or ionic contrast medium. Conclusions: Referred pain during BAE is an unusual phenomenon. Acute vessel distension triggering visceral sensations is probably the causative mechanism. Sympathetic afferents from the bronchi coursing through the posterior pulmonary plexus eventually pass to the trigeminal ganglion via the carotid sympathetic chain. The ophthalmic and maxillary divisions of the trigeminal nerve then mediate pain sensation to the ipsilateral forehead and orbit. Similarly, parasympathetic afferents from the pulmonary plexus crossing the nucleus of the spinal tract of the trigeminal nerve may be responsible for interexchange of impulses to the neurons in this nucleus. Sensory fibers of the ophthalmic and maxillary nerves relaying in this nucleus are then involved in this pain being referred to the forehead and orbit.
Visceral adiposity in young patients with coronary artery disease�a case control study
Varghese, Blessan; Swamy, Smrita; Srilakshmi, M.A.; Santhosh, M.J.; Shetty, Gurappa G.; Varghese, Kiron; Patil, Chandrakant B.; Iyengar, Shamanna S.
Aims Central obesity is associated with an increased cardiovascular risk. We carried out a hospital based case control study in young patients with coronary artery disease (CAD) to assess the importance of visceral fat Methods Coronary artery disease was established by coronary angiogram in all cases. Controls were age- and sex-matched subjects with normal coronary angiogram. Computed tomography scan performed at the level of the umbilicus to measure subcutaneous and visceral fat area (VFA). Results Cases and controls were well matched in height, weight, and body mass index (BMI). Visceral fat area was significantly higher (122.58 � 37.59 vs. 88.4 � 36.95 cm2; P=0.003) in cases whereas subcutaneous fat area was similar in cases and controls. Visceral fat area was an excellent predictor of cardiovascular risk (area under receiver operating characteristics curve 0.915 cm2). Visceral fat area correlated with BMI, waist hip ratio, blood sugar, triglycerides, and C-reactive protein significantly. Conclusion Visceral adiposity is associated with an increased risk of CAD and it correlated with anthropometric, metabolic, and inflammatory markers. PMID:22664812
Early Life Experience Shapes the Functional Organization of Stress-Responsive Visceral Circuits
Rinaman, Linda; Banihashemi, Layla; Koehnle, Thomas J.
Emotions are closely tied to changes in autonomic (i.e., visceral motor) function, and interoceptive sensory feedback from body to brain exerts powerful modulatory control over motivation, affect, and stress responsiveness. This manuscript reviews evidence that early life experience can shape the structure and function of central visceral circuits that underlie behavioral and physiological responses to emotive and stressful events. The review begins with a general discussion of descending autonomic and ascending visceral sensory pathways within the brain, and then summarizes what is known about the postnatal development of these central visceral circuits in rats. Evidence is then presented to support the view that early life experience, particularly maternal care, can modify the developmental assembly and structure of these circuits in a way that impacts later stress responsiveness and emotional behavior. The review concludes by presenting a working hypothesis that endogenous cholecystokinin signaling and subsequent recruitment of gastric vagal sensory inputs to the caudal brainstem may be an important mechanism by which maternal care influences visceral circuit development in rat pups. Early life experience may contribute to meaningful individual differences in emotionality and stress responsiveness by shaping the postnatal developmental trajectory of central visceral circuits. PMID:21497616
Goyal, Alka; Bhatnagar, Sushma
Unrelieved neuropathic pain continues to be a substantial health problem in a cancer patient arises either due to disease itself or its treatment. Review of literature showed that neuropathic pain has high prevalence rate, greater severity and analgesic requirement with worse quality of life. Underreporting by patient and under treatment by physician is an important causative factor of indefinite persistence of neuropathic pain. Careful history taking, elaborated physical examination, patient's self report and diagnostic tools with high sensitivity and specificity are needed for accurate assessment of neuropathic pain. Neuropathic cancer pain is difficult to treat and also shows poor response to opioids so in this situation alternate a treatment strategy that also includes psycosocial and spiritual counseling with yoga and meditation exercises under the palliative care framework should be practiced. To find out the burden and estimation of resource generation of this widely recognized problem, accurate establishment of incidence, prevalence, severity, and effectiveness of treatment is quite mandatory. Complex phenomenon of neuropathic pain abolishes establishment of early diagnosis and accurate etiology of this symptom, emphasizes the need of sensitive and reliable clinical grading scale, international classification system and validated diagnostic tools that correspond with clinical assessment. Multiple studies towards this direction has been culminated and some are still going on, though the data and literature is very scant and require further research for the complete evaluation of neuropathic pain. PMID:25841479
Guetti, Cristiana; Angeletti, Chiara; Paladini, Antonella; Varrassi, Giustino; Marinangeli, Franco
The treatment for pain in emergency medicine is a matter of increasing interest. Available data indicate that in both normal conditions and during major-emergencies, the majority of healthcare providers are culturally and professionally unprepared to adequately treat acute pain conditions. In case of natural disasters, opioid drugs are often unavailable. Moreover, no guidelines or validated protocols provide adequate indications for the treatment for pain in case of massive emergencies. Training of the medical and nursing staff, in both formal and continuing, or on-the-job education is needed to adequately face a devastating emergency. Unfortunately, there is an inadequate level of training among healthcare professionals, even in highly seismic areas, and the source of aid is frequently limited, especially in the immediate aftermath of a disaster to those already present at the scene. Pain inadequately treated may modify the characteristics of the pain itself. Pain is no longer considered just a symptom, but itself becomes an autonomous pathology heavily influencing the social life and psycho-social aspects of a person. In the disastrous situation following an earthquake, an inadequate treatment of pain was the major violation of the psycho-physical integrity of individuals and a severe violation of their rights, as human beings and patients. PMID:23241164
Ehrlich, George E.
Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. PMID:14710509
Autologous Tragal Perichondrium Transplantation: A Novel Approach for the Management of Painful Bullous Keratopathy
Kim, Kyoung Woo; Chun, Yeoun Sook
Purpose To introduce autologous tragal perichondrium transplantation as a novel surgical modality for the management of intractable symptomatic bullous keratopathy. Methods In three eyes of three patients with painful bullous keratopathy, autologous tragal perichondria were transplanted on the corneal surface with the human amniotic membrane transplanted above. We included an additional three eyes of three patients with painful bullous keratopathy who received amniotic membrane transplantation only to serve as controls. Clinical symptom outcomes were assessed using a visual analogue scale at postsurgical months 1, 3, 5, 7, and 9. In addition, transplanted tragal perichondrium and amniotic membrane complex tissue button obtained from one patient who underwent penetrating keratoplasty was evaluated by immunohistochemical analysis of CD34, vimentin, and alcian blue staining. Results All three patients who underwent autologous tragal perichondrium and human amniotic membrane co-transplantation showed improvements in pain and tearing. However, all three patients in the control group experienced aggravation of tearing and no further improvement of pain 3 months after surgery. In addition, one patient in the control group developed premature degradation of the amniotic membrane. Histopathologic and immunohistochemical analysis showed intact surface epithelization and positive CD34, vimentin and alcian blue staining of transplanted tragal perichondria. Conclusions The tragal perichondrium has a high mechanical structural force and high potency due to well-organized epithelization and the presence of mesenchymal stem cells. Autologous tragal perichondrium transplantation may be an effective modality for the management of painful bullous keratopathy. PMID:23730105
Pain intensity, pain interference and characteristics of spinal cord injury
Ullrich, PM; Jensen, MP; Loeser, JD; Cardenas, DD
Study Design Postal survey. Objectives To examine if the intensity of pain in persons with spinal cord injury (SCI) varied as a function of pain site, and to identify the patient and SCI characteristics associated with pain location, pain intensity and pain interference in a sample of persons with SCI. Setting Community sample, United States. Methods A postal survey including measures of pain intensity, pain interference, other pain, demographic and medical characteristics was completed by 238 adults with SCI. Results Average pain intensity was moderate and pain was common across the body. Demographic and medical variables, including SCI level, were generally not associated with pain prevalence, intensity and interference. However, persons with higher level injuries were more likely to report upper extremity pain than persons with paraplegic injuries. The lower body was the location of the highest pain ratings. Conclusion Persons with SCI tend to experience high pain intensity over multiple body locations. Lower body pain was as common as upper extremity pain, but tended to be more intense. PMID:18283293
Examining the Pain Stages of Change Questionnaire in Chronic Pain
Renee M. Williams; Eleni G. Hapidou; Chia-Yu A. Lin; Hira Abbasi
Purpose: This study examined the relationships of a readiness to adopt a self-management approach to chronic pain, measured by the Pain Stages of Change Questionnaire (PSOCQ), with other pain-related scales in patients attending a chronic pain management program and determined if these measures changed from admission to discharge. The PSOCQ consists of four stages: Pre- contemplation, Contemplation, Action and Maintenance.
Over-the-counter pain relievers
... Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine - over-the-counter; Pain medicine - OTC ... Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain ...
Moradi, Ali; Ebrahimzadeh, Mohammad H; Ring, David
Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness. PMID:25207288
Warming Moxibustion Relieves Chronic Visceral Hyperalgesia in Rats: Relations to Spinal Dynorphin and Orphanin-FQ System
Qi, Li; Liu, Hui-Rong; Yi, Tao; Wu, Lu-Yi; Liu, Xi-Ru; Zhao, Chen; Shi, Yin; Ma, Xiao-Peng; Wu, Huan-Gan
As a twin therapy of acupuncture in traditional Chinese medicine, moxibustion has shown its effects in relieving abdominal pain in irritable bowel syndrome (IBS) patients and IBS rat models, but its mechanisms are largely unknown. In this paper, we determined the role of spinal dynorphin and orphanin-FQ system in analgesic effect of warming moxibustion (WM) on chronic visceral hyperalgesia (CVH) in IBS-like rat model. Here, we show that (1) repeated WM at bilateral ST25 and ST37 acupoints markedly attenuated the abdominal withdrawal reflex scores in CVH rats; (2) intrathecal administration of ? receptor antagonist prior to WM significantly attenuated the WM analgesia and dynorphinA (1-17) enhanced the WM analgesia. WM significantly reinforced the upregulation of spinal dynorphin mRNA/protein and ? receptor mRNA levels in CVH rats; (3) intrathecal administration of orphanin-FQ receptor antagonist prior to WM significantly attenuated the WM analgesia and orphanin-FQ enhanced the WM analgesia. WM reinforced the upregulation of spinal orphanin-FQ mRNA/protein and orphanin-FQ receptor mRNA levels in CVH rats. These results suggest that moxibustion may relieve CVH at least in part by activating spinal dynorphin and orphanin-FQ system. PMID:23573158
Warming Moxibustion Relieves Chronic Visceral Hyperalgesia in Rats: Relations to Spinal Dynorphin and Orphanin-FQ System.
Qi, Li; Liu, Hui-Rong; Yi, Tao; Wu, Lu-Yi; Liu, Xi-Ru; Zhao, Chen; Shi, Yin; Ma, Xiao-Peng; Wu, Huan-Gan
As a twin therapy of acupuncture in traditional Chinese medicine, moxibustion has shown its effects in relieving abdominal pain in irritable bowel syndrome (IBS) patients and IBS rat models, but its mechanisms are largely unknown. In this paper, we determined the role of spinal dynorphin and orphanin-FQ system in analgesic effect of warming moxibustion (WM) on chronic visceral hyperalgesia (CVH) in IBS-like rat model. Here, we show that (1) repeated WM at bilateral ST25 and ST37 acupoints markedly attenuated the abdominal withdrawal reflex scores in CVH rats; (2) intrathecal administration of ? receptor antagonist prior to WM significantly attenuated the WM analgesia and dynorphinA (1-17) enhanced the WM analgesia. WM significantly reinforced the upregulation of spinal dynorphin mRNA/protein and ? receptor mRNA levels in CVH rats; (3) intrathecal administration of orphanin-FQ receptor antagonist prior to WM significantly attenuated the WM analgesia and orphanin-FQ enhanced the WM analgesia. WM reinforced the upregulation of spinal orphanin-FQ mRNA/protein and orphanin-FQ receptor mRNA levels in CVH rats. These results suggest that moxibustion may relieve CVH at least in part by activating spinal dynorphin and orphanin-FQ system. PMID:23573158
A versatile cryo-focussing flow switching gas chromatography inlet for trace analysis of intractable compounds.
Apps, Peter; Mmualefe, Lesego
A wide variety of samples that can be analysed by gas chromatography do not lend themselves to the usual preparation of solvent extracts for split-splitless injections, and are best handled by purge and trap or equilibrium headspace sampling. A cryo-focussing, flow switching gas chromatography inlet system that handles different types of sample without the need for hardware changes has been prototyped. It provides excellent repeatability and linearity with liquid injections, purge and trap, and equilibrium headspace samples, in both split and splitless modes. The performance of the system was tested with sub-nanogram quantities of challenging analytes such as free carboxylic acids, alcohols, diols, phenols and aldehydes, and volatiles purged from contaminated soil, mammal faeces, a pesticide formulation, and a spice. Repeatability RSDs for peak areas were consistently below 11% and repeatabilities of retention times below 0.05%, independently of sample type (liquid or gas phase) and nature or quantity of compound. Regression coefficients of peak areas vs. quantity were typically ? 0.999 over two orders of magnitude ranges extending down to below 0.01 ng, also independently of sample and analyte. Limits of quantitation were robustly below 0.1-0.2 ng. Peak shapes and resolution are the same with use of the cryo-trap and flow switch as they are with conventional injections. Performance is robust to flow rate and, for most compounds, to trapping and desorption temperature. The cryo-trapping flow switching inlet's performance parameters match those of other sample introduction systems, and are achieved with sub-nanogram quantities of intractable analytes. PMID:22920301
[Reduction cranioplasty for a case of intractable chronic subdural hematoma in infancy].
Tsutsumi, K; Asano, T; Shigeno, T; Matsui, T; Ito, S; Nakaguti, H
Although almost all infants suffering chronic subdural hematomas (CSDH) are successfully treated by established methods such as a subdural puncture, burr holes and shunting procedures, infantile CSDH with progressive craniocerebral disproportion requires a special therapeutical regimen. Clinical efforts such as reduction cranioplasty have been made as a treatment for these cases. This is a case report of a 9-month-old male infant with an intractable CSDH, bilateral and large, and subsequent brain atrophy caused by traumatic head injury. Excellent results were obtained by a modified reduction cranioplasty. In brief, the patient was supine-positioned with a 20-degree flexion of the head in an attempt to obtain a large operative field. Bicoronal skin incision was combined with an additional linear one on the midline (T-shaped incision). Bilateral frontoparietal craniotomy with periosteum was made to keep the midline bony bridge overlying the superior sagittal sinus (SSS). The resulting extensive dural opening allowed complete evacuation of the subdural hematoma. Thereafter, the anterior part, ca. 4cm in width, of the bony bridge was removed in order to make the remaining bone able to be manipulated and connected to the frontal bone. Prior to this stage, SSS close to the crista galli was ligated and cut with the falx to avoid postoperative kinking. The dura mater was sutured so as not to leave an excessive subdural space. The bone flaps were trimmed to complete a good-shaped reconstruction. Finally, the excessive scalp was removed because the original scalp was too large for the reconstructed skull.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8295704
Growth failure in children with intractable epilepsy is not due to increased resting energy expenditure.
Bergqvist, A G Christina; Trabulsi, Jillian; Schall, Joan I; Stallings, Virginia A
The aim of this study was to evaluate the resting energy expenditure (REE) of children with intractable epilepsy (IE) compared with healthy children, and to determine factors that contribute to the pattern of REE. REE, growth status, and body composition were assessed in 25 prepubertal children with IE (15 males, 10 females; mean age 5y 5mo [SD 2y 2mo] range 2-9y) with and without cerebral palsy (CP) and compared with those in 75 healthy children of similar age, sex, and fat free mass (FFM; 43 males, 32 females; mean age 6y 4mo [SD 1y 8mo], range 2-9y). Of the 25 children with IE, 12 had generalized and 13 partial seizures; 10 children had CP (four hemiplegia, one diplegia, and five tetraplegia); 18 were ambulators. REE (kcal/d), determined by indirect calorimetry, was expressed as a percentage of that predicted using Schofield equations. Energy intake from 3-day weighed food records was assessed for children with IE only and expressed as a percentage of estimated energy requirement. Compared with healthy children, children with IE had significantly lower percentage (Student's t-test, p<0.05) of predicted REE (111 [SD 13] vs 104 [SD 4]), weight z-score, body mass index z-score, and FFM. Using multiple regression, REE adjusted for FFM, fat mass, and sex were significantly lower in children with IE and CP (-110 kcal/d, 95% confidence interval -199 to -21, p=0.016). In children with IE, energy intake was also a statistically significant predictor of REE. CP largely explained the suboptimal growth status and lower REE of children with IE compared with healthy children. PMID:18422677
Postamputation pain: studies on mechanisms.
Nikolajsen, Lone
Amputation is followed by both painful and non-painful phantom phenomena in a large number of amputees. Non-painful phantom sensations rarely pose any clinical problem, but 60-80% of all amputees also experience painful sensations (i.e. phantom pain) located to the missing limb. The severity of phantom pain usually decreases with time, but severe pain persists in 5-10% of patients. Pain in the residual limb (i.e. stump pain) is another consequence of amputation. Both stump and phantom pain can be very difficult to treat. Treatment guidelines used for other neuropathic pain conditions are probably the best approximation, especially for the treatment of stump pain. The aim of the present doctoral thesis was to explore some of the mechanisms underlying pain after amputation. Ten studies were carried out (I-X). My PhD thesis from 1998 dealt with pain before the amputation and showed that preamputation pain increases the risk of phantom pain after amputation (I). A perioperative epidural blockade, however, did not reduce the incidence of pain or abnormal sensory phenomena after amputation (II, III). The importance of sensitization before amputation for the subsequent development of pain is supported by study IV, in which pressure pain thresholds obtained at the limb before amputation were inversely related to stump and phantom pain after 1 week. Afferent input from the periphery is likely to contribute to postamputation pain as sodium channels were upregulated in human neuromas (VI), although neuroma removal did not always alleviate phantom pain (V). Sensitization of neurons in the spinal cord also seems to be involved in pain after amputation as phantom pain was reduced by ketamine, an NMDA-receptor antagonist. Another NMDA-receptor antagonist, memantine, and gabapentin, a drug working by binding to the ?2?-subunit of voltage-gated calcium channels, had no effect on phantom pain (VII-IX). Supraspinal factors are also important for pain after amputation as catastrophizing was associated with phantom pain (X). In conclusion, the present doctoral thesis confirmed and expanded the findings by others that several mechanisms are involved in the development and maintenance of phantom pain. A better understanding of the underlying mechanisms will hopefully lead to improved treatment of pain after amputation in the future. PMID:23158899
Pain Assessment for Older Adults
Ellen Flaherty
WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%-50% of community dwelling older people have persistent pain. Additionally, 45-80% of nursing home residents report pain that is often left untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and increased healthcare utilization and costs. Older
Chronic Pain in College Students
Thomas, Michael; Roy, Ranjan; Cook, Andrew; Marykuca, Steve
A survey of university students confirms earlier studies that found chronic pain fairly common among young adults. Students with chronic pain were similar demographically and psychologically to students with pain of less than 3 months' duration, but were much more likely to use analgesics and alcohol and to report that pain interfered with school work. Treatment implications are discussed. PMID:21221345
Chronic pain in elderly people
Lucy Gagliese; Ronald Melzack
Chronic pain in elderly people has only recently begun to receive serious empirical consideration. There is compelling evidence that a significant majority of the elderly experience pain which may interfere with normal functioning. Nonetheless, a significant proportion of these individuals do not receive adequate pain management. Three significant factors which may contribute to this are (1) lack of proper pain
Intractable Occipital Neuralgia Caused by an Entrapment in the Semispinalis Capitis
Kim, Deok-ryeong; Lee, Sang-won
Occipital neuralgia is a rare pain syndrome characterized by periodic lancinating pain involving the occipital nerve complex. We present a unique case of entrapment of the greater occipital nerve (GON) within the semispinalis capitis, which was thought to be the cause of occipital neuralgia. A 66-year-old woman with refractory left occipital neuralgia revealed an abnormally low-loop of the left posterior inferior cerebellar artery on the magnetic resonance imaging, suggesting possible vascular compression of the upper cervical roots. During exploration, however, the GON was found to be entrapped at the perforation site of the semispinalis capitis. There was no other compression of the GON or of C1 and C2 dorsal roots in their intracranial course. Postoperatively, the patient experienced almost complete relief of typical neuralgic pain. Although occipital neuralgia has been reported to occur by stretching of the GON by inferior oblique muscle or C1-C2 arthrosis, peripheral compression in the transmuscular course of the GON in the semispinalis capitis as a cause of refractory occipital neuralgia has not been reported and this should be considered when assessing surgical options for refractory occipital neuralgia. PMID:24278663
Complex Regional Pain Syndrome
... injury. Your doctor may also call this condition reflex sympathetic dystrophy or causalgia. The cause of the ... specifically at dealing with chronic pain. Other Organizations Reflex Sympathetic Dystrophy Syndrome Association of America Questions to ...
Complex regional pain syndrome
... plays an important role in the pain. Another theory is that CRPS is caused by a triggering ... early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent ...
... as running, jumping or twisting, skiing, or playing soccer) You have flat feet Anterior knee pain is ... to the kneecap Runners, jumpers, skiers, bicyclists, and soccer players who exercise often Teenagers and healthy young ...
Characterisation of the role of Vrp1 in cell fusion during the development of visceral muscle of Drosophila melanogaster
Background In Drosophila muscle cell fusion takes place both during the formation of the somatic mesoderm and the visceral mesoderm, giving rise to the skeletal muscles and the gut musculature respectively. The core process of myoblast fusion is believed to be similar for both organs. The actin cytoskeleton regulator Verprolin acts by binding to WASP, which in turn binds to the Arp2/3 complex and thus activates actin polymerization. While Verprolin has been shown to be important for somatic muscle cell fusion, the function of this protein in visceral muscle fusion has not been determined. Results Verprolin is specifically expressed in the fusion competent myoblasts of the visceral mesoderm, suggesting a role in visceral mesoderm fusion. We here describe a novel Verprolin mutant allele which displays subtle visceral mesoderm fusion defects in the form of mislocalization of the immunoglobulin superfamily molecule Duf/Kirre, which is required on the myoblast cell surface to facilitate attachment between cells that are about to fuse, indicating a function for Verprolin in visceral mesoderm fusion. We further show that Verprolin mutant cells are capable of both migrating and fusing and that the WASP-binding domain of Verprolin is required for rescue of the Verprolin mutant phenotype. Conclusions Verprolin is expressed in the visceral mesoderm and plays a role in visceral muscle fusion as shown by mislocalization of Duf/Kirre in the Verprolin mutant, however it is not absolutely required for myoblast fusion in either the visceral or the somatic mesoderm. PMID:20701765
Sodium channelopathies and pain
Angelika Lampert; Andrias O. O�Reilly; Peter Reeh; Andreas Leffler
Chronic pain often represents a severe, debilitating condition. Up to 10% of the worldwide population are affected, and many\\u000a patients are poorly responsive to current treatment strategies. Nociceptors detect noxious conditions to produce the sensation\\u000a of pain, and this signal is conveyed to the CNS by means of action potentials. The fast upstroke of action potentials is mediated\\u000a by voltage-gated
Reuler, James B.
Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949
Tissue granuloma structure-function in experimental visceral leishmaniasis
In experimental visceral leishmaniasis in normal mice (BALB/c, C57BL/6) acquired resistance to Leishmania donovani, a protozoan which targets tissue macrophages, depends upon T cells, Th1 cell-type cytokine generation and activated mononuclear phagocytes. In the intact host, initial control and eventual resolution of L. donovani hepatic infection in normal mice is expressed by and accomplished within well-formed, mature tissue granulomas. In the liver, these immunologically active, inflammatory structures are assembled around a core of fused, parasitized resident macrophages (Kupffer cells) which come to be encircled by both cytokine-secreting T cells and influxing leishmanicidal blood monocytes. This pro-host defense granuloma structure-function relationship, in which histologically mature granulomas provide the microenvironment for intracellular L. donovani killing, however, is only one of seven which have been identified through experimental modifications in this model. This report reviews these structure-function relationships and illustrates the broad spectrum of additional possible responses. These responses range from structurally intact granulomas which provide no antileishmanial function (the �ineffective� granuloma), to enlarged granulomas which show enhanced parasite killing (the �hypertrophied� granuloma), to effective antileishmanial activity in the absence of any tissue reaction (the �invisible� granuloma). PMID:11703536
Is the IL-10 -819 polymorphism associated with visceral leishmaniasis?
Hajilooi, Mehrdad; Sardarian, Kosro; Dadmanesh, Maryam; Matini, Mohamad; Lotfi, Pegah; Bazmani, Ahad; Tabatabaiefar, Mohammad Amin; Arababadi, Mohammad Kazemi; Momeni, Mohammad
Previous investigations demonstrated that immune responses play critical roles in the defense against visceral leishmaniasis (VL). A key regulator of immune responses is the cytokine, IL-10 and polymorphisms within its promoter which could alter its expression. Thus, the aim of this study was to examine the correlation between polymorphism at the -819 position of the IL-10 gene and VL in a selected Iranian population. This cross-sectional study was performed on 100 patients with clinical presentation of VL and seropositive for the leishmania (group 1), 62 patients without clinical presentation but seropositive (group 2), and 128 healthy controls (group 3). The IL-10 -819 polymorphism was evaluated using the PCR-RFLP technique. The anti-leishmania antibody titration was assessed using an immunofluorescence assay. Our results showed that the polymorphism at IL-10 -819 (C/T) position was significantly associated with VL, and C/T genotype was significantly higher in VL patients when compared to groups 2 and 3 (p < 0.001). However, the results demonstrated that the C and T alleles were not associated with VL (p = 0.855). The data presented here confirm the results of previous reports that polymorphisms at the -819 position of the IL-10 gene can influence susceptibility to VL suggesting that the C/T genotype may be considered as a risk factor for the disease. PMID:23912644
Delayed dynamic abdominal wall closure following multi-visceral transplantation
Iype, Satheesh; Butler, Andrew; Jamieson, Neville; Middleton, Stephen; Jah, Asif
INTRODUCTION Primary closure of the abdominal wall following intestinal transplantation or multivisceral transplantation could become a challenging problem in a significant number of patients. PRESENTATION OF CASE A 38-year-old woman with familial adenomatous polyposis (FAP) underwent a multi-visceral transplantation for short gut syndrome. She subsequently developed acute graft rejection that proved resistant to conventional treatment. She was relisted and underwent re-transplantation along with kidney transplantation. Abdominal wall closure could not be achieved because of the large size of the graft and bowel oedema. The wound was initially managed with laparostomy followed by insertion of the delayed dynamic abdominal closure (DDAC) device (Abdominal Retraction Anchor � ABRA� system). Continuous dynamic traction to the wound edges resulted in gradual approximation and complete closure of the abdominal wound was achieved within 3 weeks. DISCUSSION Successful abdominal closure after multivisceral transplantation or isolated intestinal transplantation often requires biological mesh, vascularised flaps or abdominal wall transplantation. DDAC eliminated the need for a prosthetic mesh or skin graft and provided an excellent cosmetic result. Adjustment of the dynamic traction at the bedside minimised the need for multiple returns to the operating theatre. It resulted in a well-healed linear scar without a hernia. CONCLUSION Dynamic traction allows delayed closure of laparotomy resulting in strong and cosmetically sound wound healing with native tissue. PMID:25460454
The pathology associated with visceral toxicosis of catfish.
Khoo, Lester H; Goodwin, Andrew E; Wise, David J; Holmes, William E; Hanson, Larry A; Steadman, James M; McIntyre, Larry M; Gaunt, Patricia S
Visceral toxicosis of catfish (VTC) syndrome was recognized in the late 1990 s and recently has been associated with exposure to Clostridium botulinum type E neurotoxin. Tentative diagnosis is based on clinical presentation and gross findings, and is confirmed by bioassay. In April 2009, channel catfish (Ictalurus punctatus) from 2 different farms presented with abnormal swimming behavior and mortalities. Nine fish were submitted to the Aquatic Research and Diagnostic Laboratory (Stoneville, Mississippi) for evaluation. Bacterial cultures from these fish were negative. Necropsy findings included intestinal intussusceptions, ascites, pale proximal intestines with engorged serosal blood vessels, splenic congestion, and a reticular pattern to the liver. Significant histopathologic findings were limited to cerebral, splenic, and hepatic congestion, splenic lymphoid depletion and perivascular edema, vascular dilation and edema of the gastrointestinal tract, and perivascular edema in the anterior and posterior kidneys. Intoxication from C. botulinum type E neurotoxin was suspected based on the clinical signs and lack of gross and microbiological evidence of an infectious disease process. The toxicosis was confirmed with a positive bioassay using serum collected from the submitted fish. PMID:22362805
Hexadecylphosphocholine: oral treatment of visceral leishmaniasis in mice.
Kuhlencord, A; Maniera, T; Eibl, H; Unger, C
Hexadecylphosphocholine (He-PC), a novel phospholipid derivative, was tested against Leishmania donovani and Leishmania infantum, the causative agents of visceral leishmaniasis. In vitro, promastigotes were highly susceptible to He-PC; the 50% inhibitory concentrations were between 0.89 and 2.25 micrograms/ml for the different leishmanial strains. In vivo, a marked antileishmanial activity in infected BALB/c mice could be demonstrated after oral administration of He-PC. Whereas parasite suppression and killing in the liver were comparable after 5 days of treatment with He-PC (10 or 20 mg/kg of body weight per day administered orally) and sodium stibogluconate (120 mg of pentavalent antimonal agent per kg/day administered subcutaneously), a superior reduction in the parasite load in the spleen and bone marrow was observed after oral treatment with He-PC. After a 4-week treatment period, parasite suppression in the spleen was better than that observed with standard sodium stibogluconate therapy by a factor of more than 600. PMID:1329624
Visceral Adiposity Index: An Indicator of Adipose Tissue Dysfunction
The Visceral Adiposity Index (VAI) has recently proven to be an indicator of adipose distribution and function that indirectly expresses cardiometabolic risk. In addition, VAI has been proposed as a useful tool for early detection of a condition of cardiometabolic risk before it develops into an overt metabolic syndrome. The application of the VAI in particular populations of patients (women with polycystic ovary syndrome, patients with acromegaly, patients with NAFLD/NASH, patients with HCV hepatitis, patients with type 2 diabetes, and general population) has produced interesting results, which have led to the hypothesis that the VAI could be considered a marker of adipose tissue dysfunction. Unfortunately, in some cases, on the same patient population, there is conflicting evidence. We think that this could be mainly due to a lack of knowledge of the application limits of the index, on the part of various authors, and to having applied the VAI in non-Caucasian populations. Future prospective studies could certainly better define the possible usefulness of the VAI as a predictor of cardiometabolic risk. PMID:24829577
Live Vaccination Tactics: Possible Approaches for Controlling Visceral Leishmaniasis
Saljoughian, Noushin; Taheri, Tahareh; Rafati, Sima
Vaccination with durable immunity is the main goal and fundamental to control leishmaniasis. To stimulate the immune response, small numbers of parasites are necessary to be presented in the mammalian host. Similar to natural course of infection, strategy using live vaccine is more attractive when compared to other approaches. Live vaccines present the whole spectrum of antigens to the host immune system in the absence of any adjuvant. Leishmanization was the first effort for live vaccination and currently used in a few countries against cutaneous leishmaniasis, in spite of their obstacle and safety. Then, live attenuated vaccines developed with similar promotion of creating long-term immunity in the host with lower side effect. Different examples of attenuated strains are generated through long-term in vitro culturing, culturing under drug pressure, temperature sensitivity, and chemical mutagenesis, but none is safe enough and their revision to virulent form is possible. Attenuation through genetic manipulation and disruption of virulence factors or essential enzymes for intracellular survival are among other approaches that are intensively under study. Other designs to develop live vaccines for visceral form of leishmaniasis are utilization of live avirulent microorganisms such as Lactococcus lactis, Salmonella enterica, and Leishmania tarentolae called as vectored vaccine. Apparently, these vaccines are intrinsically safer and can harbor the candidate antigens in their genome through different genetic manipulation and create more potential to control Leishmania parasite as an intracellular pathogen. PMID:24744757
Live vaccination tactics: possible approaches for controlling visceral leishmaniasis.
Saljoughian, Noushin; Taheri, Tahareh; Rafati, Sima
Vaccination with durable immunity is the main goal and fundamental to control leishmaniasis. To stimulate the immune response, small numbers of parasites are necessary to be presented in the mammalian host. Similar to natural course of infection, strategy using live vaccine is more attractive when compared to other approaches. Live vaccines present the whole spectrum of antigens to the host immune system in the absence of any adjuvant. Leishmanization was the first effort for live vaccination and currently used in a few countries against cutaneous leishmaniasis, in spite of their obstacle and safety. Then, live attenuated vaccines developed with similar promotion of creating long-term immunity in the host with lower side effect. Different examples of attenuated strains are generated through long-term in vitro culturing, culturing under drug pressure, temperature sensitivity, and chemical mutagenesis, but none is safe enough and their revision to virulent form is possible. Attenuation through genetic manipulation and disruption of virulence factors or essential enzymes for intracellular survival are among other approaches that are intensively under study. Other designs to develop live vaccines for visceral form of leishmaniasis are utilization of live avirulent microorganisms such as Lactococcus lactis, Salmonella enterica, and Leishmania tarentolae called as vectored vaccine. Apparently, these vaccines are intrinsically safer and can harbor the candidate antigens in their genome through different genetic manipulation and create more potential to control Leishmania parasite as an intracellular pathogen. PMID:24744757
Visceral leishmaniasis mimicking as second line anti retroviral therapy failure.
Yanamandra, Uday; Jairam, Anantaram; Shankar, Subramanian; Negi, Rakhi; Guleria, Bupesh; Nair, Velu
Visceral leishmaniasis (VL) has increased as a complicating infection in subjects with human immunodeficiency virus (HIV) in developing countries. Both infections tend to lower the cell-mediated immunity resulting in poor drug response. In HIV-positive subjects the clinical course as well as organ involvement of VL simulates tuberculosis, another very common tropical infection. We present a case of VL/HIV co-infection where the individual failed to respond to first and second line antiretroviral therapy with persistently low CD4 counts. This patient was also subjected empirically to antitubercular therapy with no clinical improvement; he was finally diagnosed as a case of VL in HIV upon revelation of amastigotes in bone marrow despite the initial negative serology on two occasions. He showed dramatic improvement in CD4 counts and clinical status on Amphotericin B therapy. In endemic areas and in HIV positive subjects a systemic and careful parasitology follow-up is necessary to ensure that no clinical form of leishmaniasis is overlooked. PMID:22082903
Reduced cortical thickness associated with visceral fat and BMI
Veit, Ralf; Kullmann, Stephanie; Heni, Martin; Machann, J�rgen; H�ring, Hans-Ulrich; Fritsche, Andreas; Preissl, Hubert
Structural brain imaging studies have shown that obesity is associated with widespread reductions in gray matter (GM) volume. Although the body mass index (BMI) is an easily accessible anthropometric measure, substantial health problems are more related to specific body fat compartments, like visceral adipose tissue (VAT). We investigated cortical thickness measures in a group of 72 healthy subjects (BMI range 20�35�kg/m2, age range 19�50�years). Multiple regression analyses were performed using VAT and BMI as predictors and age, gender, total surface area and education as confounds. BMI and VAT were independently associated with reductions in cortical thickness in clusters comprising the left lateral occipital area, the left inferior temporal cortex, and the left precentral and inferior parietal area, while the right insula, the left fusiform gyrus and the right inferior temporal area showed a negative correlation with VAT only. In addition, we could show significant reductions in cortical thickness with increasing VAT adjusted for BMI in the left temporal cortex. We were able to detect widespread cortical thinning in a young to middle-aged population related to BMI and VAT; these findings show close resemblance to studies focusing on GM volume differences in diabetic patients. This may point to the influence of VAT related adverse effects, like low-grade inflammation, as a potentially harmful factor on brain integrity already in individuals at risk of developing diabetes, metabolic syndromes and arteriosclerosis. PMID:25379443
Fern�ndez-de-Las-Pe�as, C�sar
Muscle nociception is mainly characterized by local tenderness and referred pain. The neurophysiological basis of muscle pain supports a role of sensitization mechanisms. From a clinical viewpoint, muscle pain is represented by the presence of myofascial trigger points (TrPs). Evidence suggests that TrPs are able to start a peripheral nociceptive mechanism and hence contributing to changes in the central nervous system. Several studies demonstrated that the referred pain elicited by TrPs reproduces the headache pattern in patients with tension-type headache (TTH), migraine, cervicogenic headache and, in some individuals, with cluster headache. In fact, sensitization of nociceptive pain pathways in the central nervous system due to prolonged nociceptive stimuli from TrPs seems to be responsible for the conversion of episodic to chronic TTH. In other headaches, TrPs may be able to stimulate the trigeminal nucleus caudalis and hence triggering a migraine or cluster headache attack. Proper treatment directed towards TrP inactivation has documented positive effects in individuals with these headaches; however, longitudinal studies are needed to further determine the role of TrPs in head pain. PMID:26049772
Regulation of Folate Receptor 1 Gene Expression in the Visceral Endoderm
Salbaum, J. Michael; Finnell, Richard H.; Kappen, Claudia
BACKGROUND Nutrient supply to the developing mammalian embryo is a fundamental requirement. Before completion of the chorioallantoic placenta, the visceral endoderm plays a crucial role in nurturing the embryo. We have found that visceral endoderm cells express folate receptor 1, a high-affinity receptor for the essential micronutrient folic acid, suggesting that the visceral endoderm has an important function for folate transport to the embryo. The mechanisms that direct expression of FOLR1 in the visceral endoderm are unknown. METHODS Sequences were tested for transcriptional activation capabilities in the visceral endoderm utilizing reporter gene assays in a cell model for extraembryonic endoderm in vitro, and in transgenic mice in vivo. RESULTS With F9 embryo carcinoma cells as a model for extraembryonic endoderm, we demonstrate that the P4 promoter of the human FOLR1 gene is active during differentiation of the cells towards visceral endoderm. However, transgenic mouse experiments show that promoter sequences alone are insufficient to elicit reporter gene transcription in vivo. Using sequence conservation as guide to choose genomic sequences from the human FOLR1 gene locus, we demonstrate that the sequence termed F1CE2 exhibits specific enhancer activity in F9 cells in vitro, in the visceral endoderm, and later the yolk sac in transgenic mouse embryos in vivo. We further show that the transcription factor HNF4-alpha can activate this enhancer sequence. CONCLUSIONS We have identified a transcriptional enhancer sequence from the FOLR1 locus with specific activity in vitro and in vivo, and suggest that FOLR1 is a target for regulation by HNF4-alpha. PMID:19180647
Factors contributing to pain chronicity
Charlie K. Wang; Jennifer Myunghae Hah; Ian Carroll
The chronicity of pain is the feature of pain that is least understood and most directly linked with our inability to effectively\\u000a manage pain. Acute pain is relatively responsive to our current pharmacologic and interventional armamentarium. However, as\\u000a pain persists, our ability to treat effectively diminishes and the patient�s frustration and resource utilization increases.\\u000a This article explores our current understanding
Multiple pain complaints in amputees.
Lindesay, J E
A group of amputees complaining of longstanding phantom pain was compared with another comparable group of non-complainers. It was found that those with phantom pain made significantly more complaints of other painful conditions, both related and unrelated to the amputation; they were also more depressed. It is suggested that this association is due to a lowered pain tolerance in the group with phantom pain complaints, and that depression is one factor contributing to this lowered tolerance. PMID:3999080
Pain as social glue: shared pain increases cooperation.
Bastian, Brock; Jetten, Jolanda; Ferris, Laura J
Even though painful experiences are employed within social rituals across the world, little is known about the social effects of pain. We examined the possibility that painful experiences can promote cooperation within social groups. In Experiments 1 and 2, we induced pain by asking some participants to insert their hands in ice water and to perform leg squats. In Experiment 3, we induced pain by asking some participants to eat a hot chili pepper. Participants performed these tasks in small groups. We found evidence for a causal link: Sharing painful experiences with other people, compared with a no-pain control treatment, promoted trusting interpersonal relationships by increasing perceived bonding among strangers (Experiment 1) and increased cooperation in an economic game (Experiments 2 and 3). Our findings shed light on the social effects of pain, demonstrating that shared pain may be an important trigger for group formation. PMID:25193943
Measurement properties of painDETECT by average pain severity
Cappelleri, Joseph C; Bienen, E Jay; Koduru, Vijaya; Sadosky, Alesia
Background Since the burden of neuropathic pain (NeP) increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. This study evaluated whether painDETECT, a screening questionnaire to identify patients with NeP, can distinguish pain severity. Materials and methods Subjects (n=614, 55.4% male, 71.8% white, mean age 55.5 years) with confirmed NeP were identified during office visits to US community-based physicians. The Brief Pain Inventory � Short Form stratified subjects by mild (score 0�3, n=110), moderate (score 4�6, n=297), and severe (score 7�10, n=207) average pain. Scores on the nine-item painDETECT (seven pain-symptom items, one pain-course item, one pain-irradiation item) range from ?1 to 38 (worst NeP); the seven-item painDETECT scores (only pain symptoms) range from 0 to 35. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory � Short Form (0�10 scale), was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted (age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities) mean painDETECT scores. Cumulative distribution functions on painDETECT scores by average pain severity were compared (Kolmogorov�Smirnov test). Cronbach�s alpha assessed internal consistency reliability. Results Unadjusted mean scores were 15.2 for mild, 19.8 for moderate, and 24.0 for severe pain for the nine items, and 14.3, 18.6, and 22.7, respectively, for the seven items. Adjusted nine-item mean scores for mild, moderate, and severe pain were 17.3, 21.3, and 25.3, respectively; adjusted seven-item mean scores were 16.4, 20.1, and 24.0, respectively. All pair-wise comparisons of scores between pain-severity groups showed sizable and statistically significant differences (P<0.0001). Cumulative distribution functions showed distinct separation between severity (P<0.0001). Cronbach�s alphas were 0.76 and 0.80 for the nine- and seven-item scales, respectively. Conclusion This study provides strong psychometric evidence on the validity and reliability of painDETECT for distinguishing average pain severity in patients with NeP. PMID:25395867
Management of Persistent Pain in the Older Patient A Clinical Review
Makris, Una E.; Abrams, Robert C.; Gurland, Barry; Reid, M. Carrington
Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended�emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy. PMID:25157726
The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control
Marlene Z. Cohen; Catherine F. Musgrave; Deborah B. McGuire; Neville E. Strumpf; Mark F. Munsell; Tito R. Mendoza; Maya Gips
Goals: Little is known about Israeli elders' cancer pain ex- perience. The purpose of this study was to explore the cancer pain expe- rience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control. Patients and methods: Descriptive cross-sectional methods were used to obtain data with four instruments. The patients were
Heart Rate Variability in Overweight Health Care Students: Correlation with Visceral Fat
Krishna, Bandi Hari; N, Mallikarjuna Reddy
Background and Objectives: Increased sympathetic activity, decreased parasympathetic activity and sympathovagal imbalance (SVI) has been reported in obese individuals. However, the SVI and its association with visceral fat in overweight health care students have not been explored. Therefore, in the present study, we have assessed heart rate variability (HRV) and its association with visceral fat in overweight health care students. Materials and Methods: Frequency domain parameters of HRV, body fat distribution and baseline anthropometric parameters were recorded in the control (n=40) and overweight (n=40) individuals. Further, the association of visceral fat with HRV was analysed. Results: There was no significant difference in age and height of overweight group and control group (p = 0.732). The baseline heart rate and blood pressure (p<0.001) were higher in the overweight group. Total body fat, subcutaneous fat and visceral fat were higher in the overweight group (p<0.001). Among frequency domain parameter of HRV, LFnu and LF: HF were more in the overweight group (p<0.001). Further, HFnu was less in the overweight group (p<0.001). Conclusion: Sympathovagal imbalance due to increased sympathetic activity and its association with visceral fat was observed in overweight individuals. PMID:25737980
Development of a Portable Training Tool for Simulating Visceral Angiographic Procedures for Beginners
Yamagami, Takuji [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Osuga, Keigo, E-mail: email@example.com [Osaka University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology (Japan); Yoshimatsu, Rika; Matsumoto, Tomohiro; Miura, Hiroshi; Terayama, Koshi [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Anai, Hiroshi [Nara Medical University, Department of Radiology (Japan); Takahashi, Masahide [National Cancer Center Hospital, Division of Diagnostic Radiology (Japan); Hasebe, Terumitsu [Toho University Sakura Medical Center, Department of Radiology (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan)
The purpose of this study was to evaluate the usefulness of a tool that we developed to simulate performance of visceral angiography to train beginners in the field of splanchnic angiography. Seven residents and two fellows who were rotating within the Division of Interventional Radiology at our institution between June and August 2008 participated in the evaluation of this tool. They had no experience in performing visceral angiography as an operator. Time for selection of arterial branches arising from the celiac axis on the model was measured before and after training. After such training, the participants performed actual visceral angiography as an operator with instructors beside them. Success of the trainees in selecting visceral arterial branches was evaluated in these real-life cases. In the first test using the model, seven of nine trainees (77.8%) succeeded in selecting all required arteries, while the remaining two failed to select all required arteries. After training using the model, all trainees succeeded in selecting all required arteries just before the actual angiographic study. In the actual angiography, the catheter was successfully inserted from the femoral artery and advanced to the superior mesenteric, celiac, splenic, common hepatic, gastroduodenal, and right and left hepatic arteries by all trainees with only two exceptions. In conclusion, this tool is helpful for training beginners in visceral angiographic procedures.
Intercellular communication in sensory ganglia by purinergic receptors and gap junctions: implications for chronic pain.
Hanani, Menachem
Peripheral injury can cause abnormal activity in sensory neurons, which is a major factor in chronic pain. Recent work has shown that injury induces major changes not only in sensory neurons but also in the main type of glial cells in sensory ganglia-satellite glial cells (SGCs), and that interactions between sensory neurons and SGCs contribute to neuronal activity in pain models. The main functional changes observed in SGCs after injury are an increased gap junction-mediated coupling among these cells, and augmented sensitivity to ATP. There is evidence that the augmented gap junctions contribute to neuronal hyperexcitability in pain models, but the mechanism underlying this effect is not known. The changes in SGCs described above have been found following a wide range of injuries (both axotomy and inflammation) in somatic, orofacial and visceral regions, and therefore appear to be a general feature in chronic pain. We have found that in cultures of sensory ganglia calcium signals can spread from an SGC to neighboring cells by calcium waves, which are mediated by gap junctions and ATP acting on purinergic P2 receptors. A model is proposed to explain how augmented gap junctions and greater sensitivity to ATP can combine to produce enhanced calcium waves, which can lead to neuronal excitation. Thus this simple scheme can account for several major changes in sensory ganglia that are common to a great variety of pain models. PMID:22771859
De novo mutations of voltage-gated sodium channel ?II gene SCN2A in intractable epilepsies
Ogiwara, I; Ito, K; Sawaishi, Y; Osaka, H; Mazaki, E; Inoue, I; Montal, M; Hashikawa, T; Shike, T; Fujiwara, T; Inoue, Y; Kaneda, M; Yamakawa, K
Background: Mutations of voltage-gated sodium channel ?II gene, SCN2A, have been described in a wide spectrum of epilepsies. While inherited SCN2A mutations have been identified in multiple mild epilepsy cases, a de novo SCN2A-R102X mutation, which we previously reported in a patient with sporadic intractable childhood localization-related epilepsy, remains unique. To validate the involvement of de novo SCN2A mutations in the etiology of intractable epilepsies, we sought to identify additional instances. Methods: We performed mutational analyses on SCN2A in 116 patients with severe myoclonic epilepsy in infancy, infantile spasms, and other types of intractable childhood partial and generalized epilepsies and did whole-cell patch-clamp recordings on Nav1.2 channels containing identified mutations. Results: We discovered 2 additional de novo SCN2A mutations. One mutation, SCN2A-E1211K, was identified in a patient with sporadic infantile spasms. SCN2A-E1211K produced channels with altered electrophysiologic properties compatible with both augmented (a ?18-mV hyperpolarizing shift in the voltage dependence of activation) and reduced (a ?22-mV hyperpolarizing shift in the voltage dependence of steady-state inactivation and a slowed recovery from inactivation) channel activities. The other de novo mutation, SCN2A-I1473M, was identified in a patient with sporadic neonatal epileptic encephalopathy. SCN2A-I1473M caused a ?14-mV hyperpolarizing shift in the voltage dependence of activation. Conclusions: The identified de novo mutations SCN2A-E1211K, -I1473M, and -R102X indicate that SCN2A is an etiologic candidate underlying a variety of intractable childhood epilepsies. The phenotypic variations among patients might be due to the different electrophysiologic properties of mutant channels. GLOSSARY BFNIS = benign familial neonatal-infantile seizures; EMA = epilepsy with myoclonic absence; FLE = frontal lobe epilepsy; GEFS+ = generalized epilepsy with febrile seizures plus; IS = infantile spasms; OLE = occipital lobe epilepsy; PE = partial epilepsy; SMEB = borderline severe myoclonic epilepsy in infancy; SMEI = severe myoclonic epilepsy in infancy; VGSC = voltage-gated sodium channel; WT = wild-type. PMID:19786696
Alleviation of chronic pain following rat spinal cord compression injury with multimodal actions of huperzine A
Yu, Dou; Thakor, Devang K.; Han, Inbo; Ropper, Alexander E.; Haragopal, Hariprakash; Sidman, Richard L.; Zafonte, Ross; Schachter, Steven C.; Teng, Yang D.
Diverse mechanisms including activation of NMDA receptors, microglial activation, reactive astrogliosis, loss of descending inhibition, and spasticity are responsible for ?40% of cases of intractable neuropathic pain after spinal cord injury (SCI). Because conventional treatments blocking individual mechanisms elicit only short-term effectiveness, a multimodal approach with simultaneous actions against major pain-related pathways may have value for clinical management of chronic pain. We hypothesize that [-]-huperzine A (HUP-A), an alkaloid isolated from the club moss Huperzia serrata, that is a potent reversible inhibitor of acetylcholinesterase and NMDA receptors, could mitigate pain without invoking drug tolerance or dependence by stimulating cholinergic interneurons to impede pain signaling, inhibiting inflammation via microglial cholinergic activation, and blocking NMDA-mediated central hypersensitization. We tested our hypothesis by administering HUP-A i.p. or intrathecally to female Sprague�Dawley rats (200�235 g body weight) after moderate static compression (35 g for 5 min) of T10 spinal cord. Compared with controls, HUP-A treatment demonstrates significant analgesic effects in both regimens. SCI rats manifested no drug tolerance following repeated bolus i.p. or chronic intrathecal HUP-A dosing. The pain-ameliorating effect of HUP-A is cholinergic dependent. Relative to vehicle treatment, HUP-A administration also reduced neural inflammation, retained higher numbers of calcium-impermeable GluR2-containing AMPA receptors, and prevented Homer1a up-regulation in dorsal horn sensory neurons. Therefore, HUP-A may provide safe and effective management for chronic postneurotrauma pain by reestablishing homeostasis of sensory circuits. PMID:23386718
Visceral Leishmaniasis as a Possible Reason for Pancytopenia
Koster, Kira-Lee; Laws, Hans-J�rgen; Troeger, Anja; Meisel, Roland; Borkhardt, Arndt; Oommen, Prasad Thomas
Leishmaniasis is caused by different species of the protozoa, Leishmania, and frequently found in South-Western Asia, Eastern Africa, Brazil, and Mediterranean countries. Leishmania are transmitted to humans by the bite of sandflies. After weeks to months, unspecific symptoms may occur, accompanied by more specific findings like pancytopenia and organomegaly. We report two children with pancytopenia and hepato-/splenomegaly: a 1-year-old boy was first diagnosed with an Adenovirus-infection, accompanied by fever, pancytopenia, and hepatosplenomegaly who had spent his summer vacation in Spain and a 3-year-old boy of Macedonian origin who was first diagnosed with a Parvovirus B19-infection again accompanied by splenomegaly and pancytopenia. In both children, leukemia was excluded by an initial bone marrow puncture. As fever was still persistent weeks after the children�s first hospital stay, both children received antibiotics empirically without sustainable effect. While different autoantibodies were present in both children, an immunosuppressive therapy was initiated in the younger boy without therapeutic success. A second bone marrow puncture was performed and Leishmania were finally detected morphologically and proven serologically. After weight-adjusted treatment with liposomal Amphotericin B for 10?days, both children recovered completely without relapse. Aim of this report is to broaden the spectrum of differential diagnoses in children with pancytopenia, splenomegaly, and fever to visceral leishmaniasis particularly when travel history is positive for the Mediterranean area. The infection may mimic more common diseases, such as leukemia, viral infections, or autoimmune diseases, because polyclonal B cell activation and other mechanisms may lead to multiple positive serologic tests. Both cases illustrate typical pitfalls and shall encourage taking Leishmaniasis into diagnostic consideration. PMID:26176005
[Visceral leishmaniasis as a threat for non-endemic countries].
G�rski, Stanis?aw; Wierci?ska-Drapa?o, Alicja
Global warming, globalisation, and constantly increasing number of people involved in long-distance tourism and travel to exotic destinations are likely to increase the number of cases of exotic diseases "imported" to nonendemic countries. One of the often forgotten and neglected diseases has been visceral leishmaniasis (VL or kala-azar). The disease is endemic to 62 countries, with India and Sudan accounting for the majority of the cases. It is typically fatal if left untreated. Each year about 500 000 new cases are reported worldwide, and 50 000 die as a result of the disease. Kala-azar is present in the Mediterranean Europe and 70% of cases are imported to non-endemic countries of European Union from that area. Immunocompromised status of patients, like HIV carriers are the principal prospective target for kala-azar. HIV/VL-coinfected patients have significantly higher relapse rates and decreased life expectancy. There is no formal system of reporting imported cases in Europe, except from Germany. In non-endemic countries, including Poland, there is usually the substantial delay between the onset of symptoms and the final diagnosis, with an average exceeding 3 months. This fact suggests that physicians are not familiar with leishmania infections. Despite progress in vaccine development, the only way to prevent the infection is avoiding sandfly bites. Mosquito nets, wearing appropriate clothes and repellents containing DEET (diethyl toluamide) can reduce number of bites and protect also from the other vector-borne diseases like malaria or dengue. Education concerning kala-azar risk and ways of the disease prevention is a needed for tourists and the other travelers. PMID:19856834
Convergence of cranial visceral afferents within the solitary tract nucleus
McDougall, Stuart J.; Peters, James H.; Andresen, Michael C.
Primary afferent axons within the solitary tract (ST) relay homeostatic information via glutamatergic synapses directly to 2nd order neurons within the nucleus of the solitary tract (NTS). These primary afferents arise from multiple organ systems and relay multiple sensory modalities. How this compact network organizes the flow of primary afferent information will shape central homeostatic control. To assess afferent convergence and divergence, we recorded ST-evoked synaptic responses in pairs of medial NTS neurons in horizontal brainstem slices. ST shocks activated EPSCs along monosynaptic or polysynaptic pathways. Gradations in shock intensity discriminated multiple inputs and stimulus recruitment profiles indicated that each EPSC was unitary. In 24 pairs, 75% were 2nd order neurons with 64% receiving one direct ST input with the remainder receiving additional convergent ST afferent inputs (22% two; 14% three monosynaptic ST-EPSCs). Some (34%) 2nd order neurons received polysynaptic EPSCs. Neurons receiving only higher order inputs were uncommon (13%). Most ST-EPSCs were completely independent, but four EPSCs of a total of 81 had equal thresholds, highly correlated latencies and synchronized synaptic failures consistent with divergence from a single source ST axon or from a common interneuron producing a pair of polysynaptic EPSCs. We conclude that ST afferent inputs are remarkably independent with little evidence of substantial shared information. Individual cells receive highly focused information from the viscera. Thus, afferent excitation of 2nd order NTS neurons is generally dominated by single visceral afferents and therefore focused on a single afferent modality and/or organ region. PMID:19828803
Epidemiological Feature of Visceral Leishmaniasis in China, 2004-2012
ZHAO, Shuqing; LI, Zhongjie; ZHOU, Sheng; ZHENG, Canjun; MA, Huilai
Abstract Background Visceral leishmaniasis (VL) remains an important public health problem in China. It is essential to elucidate the current epidemiological characteristics of VL for designing control policy. Methods The data were obtained from China Disease Prevention and Control Information System from 2004 to 2012. Characteristics by major variables, such as age, gender, season and geography were analyzed using SPSS13.0. Results The incidence of VL in China remained at a lower level in recent years. The outbreak appeared in xinjiang kashgar region in 2008. A total of 3337 VL cases were reported in China from 2004 to 2012, 97.03% of cases were concentrated in Xinjiang, Gansu and Sichuan provinces. The cases under 5 year-old accounted for 59.21%. concentrated in 3 ~ 5 months each year and annual December to January of next year The ratio of males to females was 1.67:1(2088:1249). The lag time between symptom onset and diagnosis of VL appeared a marked decrease after 2008, and were shorter in endemic provinces of Xinjiang, Gansu and Sichuan than non-endemic provinces. The case fatality rate was 2.99% (10/3337) during the study period. Conclusion The reported cases of VL were concentrated in Xinjiang, Gansu, Sichuan provinces in China, 2004-2012. The onset was given priority to children. The lag time between symptom onset and diagnosis of VL were difference among years and provinces. Therefore, prevention and control measures should be focused on improving awareness and capacities of diagnosis and treatment, targeting high-risk people in high-risk areas.
Positive Traits Linked to Less Pain through Lower Pain Catastrophizing
Hood, Anna; Pulvers, Kim; Carrillo, Janet; Merchant, Gina; Thomas, Marie
The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0� Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = ?.41, p < .01) and MPQ-SF scores (r = ?.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = ?.44, p < .01) and MPQ-SF scores (r = ?.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing. PMID:22199416
[Nursing aspects in pain treatment].
Sundqvist, A
Pain, the concept of pain and how pain is connected with culture are discussed in this article. The experience of pain in individual. It can not be questioned. The primary task of nursing is to help and support a patient to cope with pain in spite of the fact whether there is a cause for pain or not. Besides pharmacotherapy there are other possibilities to help a patient, e.g. by taking care of the surroundings, offering interesting subjects to think about, using imagination, relaxation, cognitive behavioral therapy, massage, therapeutic touch and thermat and cryotherapy. PMID:8054647
Observation of Pain-Sensitive Points along the Meridians in Patients with Gastric Ulcer or Gastritis
Ben, Hui; Li, Liang; Rong, Pei-Jing; Jin, Zhi-Gao; Zhang, Jian-Liang; Li, Yan-Hua; Li, Xia
This study aims to investigate the sensitization of human skin points along certain meridians related to visceral disease by using the pressure-pain threshold (PPT) as an indicator. We detected and compared the PPTs of people with and without gastric ulcer or gastritis on the related acupoints, abdomen area, and back area with von Frey detector and observed the similarities and differences under their respective physiological and pathological states. The results showed that (1) the PPTs of patients with gastric ulcer on related acupoints decreased significantly compared with the control group; (2) there was no significant difference in PPT between the chosen points of the measured meridian and the adjacent nonacupoints; (3) there was an apparent distribution of tender points on the relevant abdomen and back regions of patients with gastric ulcer or gastritis, but none was found on the control group; (4) the pain-sensitive points of gastric ulcer and gastritis patients were BURONG (ST19), LIANGMEN (ST21), and HUAROUMEN (ST24) of the stomach meridian on the abdominal region and PISHU (BL20), WEISHU (BL21), and WEICANG (BL50) on the back, among others The results suggest that the practical significance of acupoints may lie in its role as a relatively sensitive functional area. In a pathological state, the reflex points on the skin which are related to certain visceral organs become sensitive and functionally intensify. PMID:23227096
Indoleamine 2,3-dioxygenase activity as a potential biomarker of immune suppression during visceral leishmaniasis.
Gangneux, Jean-Pierre; Poinsignon, Yves; Donaghy, Ludovic; Amiot, Laurence; Tarte, Karin; Mary, Charles; Robert-Gangneux, Florence
Leishmania parasites induce an immunomodulation by subverting the host immune response towards a CD4(+) Th2 lymphocytic cell response that favors parasite persistence. Here, we report that after successful treatment of visceral leishmaniasis due to Leishmania infantum, an immune reconstitution syndrome revealing hip septic arthritis was associated with a switch from Th2 towards a Th1 cytokine profile, and a decrease in the level of immunomodulating factors, such as soluble HLA-G and indoleamine 2,3-dioxygenase (IDO) activity. We then measured IDO activity in a cohort of 39 patients and uninfected control subjects. Results showed significantly enhanced IDO activity in patients with visceral Leishmania infection, compared with uninfected control subjects (P?0.001), but also compared with treated patients (P?0.05). A decrease in IDO activity could constitute a relevant biomarker for the restoration of the immune response during visceral leishmaniasis. PMID:23413147
Attenuation of nerve growth factor-induced visceral hyperalgesia via cannabinoid CB 1 and CB 2-like receptors
W. Paul Farquhar-Smith; Sian I Jaggar; Andrew S. C Rice
Cannabinoids have previously been shown to possess analgesic properties in a model of visceral hyperalgesia in which the neurotrophin, nerve growth factor (NGF), plays a pivotal role. The purpose of this study was to investigate the antihyperalgesic effects of two cannabinoids in NGF-evoked visceral hyperalgesia in order to test the hypothesis that endocannabinoids may modulate the NGF-driven elements of inflammatory
Multiple relapses of visceral leishmaniasis in an adolescent with idiopathic CD4+ lymphocytopenia associated with novel immunophenotypic and molecular features.
Prigione, Ignazia; Castagnola, Elio; Imberti, Luisa; Gambini, Claudio; Gradoni, Luigi; Dianzani, Umberto; Ramenghi, Ugo; Giacopelli, Francesca; Moretta, Alessandro; Moretta, Lorenzo; Plebani, Alessandro; Fischer, Alain; Pistoia, Vito
An adolescent with idiopathic CD4 lymphocytopenia suffered from 4 visceral leishmaniasis relapses despite appropriate treatment. CD8 lymphocytopenia and abnormal expansion of TCRalphabeta, CD4, CD8 cells were consistently detected together with reduced export of mature T cells from thymus. This novel form of idiopathic CD4 lymphocytopenia may predispose to multiple visceral leishmaniasis relapses. PMID:19106781
Identification of a novel peptide ligand targeting visceral adipose tissue via transdermal route by in vivo phage display.
Lee, Nam Kyung; Kim, Hong Shin; Kim, Kyung Hyun; Kim, Eun-Bae; Cho, Chong Su; Kang, Sang Kee; Choi, Yun Jaie
To find novel peptide ligands targeting visceral adipose tissue (visceral fat) via transdermal route, in vivo phage display screening was conducted by dermal administration of a phage-peptide library to rats and a peptide sequence, CGLHPAFQC (designated as TDA1), was identified as a targeting ligand to visceral adipose tissue through the consecutive transdermal biopannings. Adipocyte-specific affinity and transdermal activity of the TDA1 were validated in vitro and targeting ability of the dermally administered TDA1 to visceral adipose tissue was also confirmed in vivo. TDA1 was effectively translocated into systemic circulation after dermal administration and selectively targeted visceral adipose tissue without any preference to other organs tested. Fluorescent microscopic analysis revealed that the TDA1 could be specifically localized in the hair follicles of the skin, as well as in the visceral adipose tissue. Thus, we inferred that dermally administered TDA1 would first access systemic circulation via hair follicles as its transdermal route and then could target visceral fat effectively. The overall results suggest that the TDA1 peptide could be potentially applied as a homing moiety for delivery of anti-obesity therapeutics to visceral fat through the convenient transdermal pathway. PMID:21999821
[Pain and Christianity. A symbol for overcoming pain?].
Markschies, C
Pain and Christianity appear to belong together: Christ's pain stands at the centre of God's healing; his pain leads to the salvation of mankind. We can learn from Jesus' example how to bear suffering and pain. In early Christian times, the belief that Jesus Christ suffered pain on the cross was usually not accepted. In line with the "apathy axiom", freedom from emotion was something to strive for at that time. Only after the acceptance of Christianity as the state religion of the Roman Empire in 380 AD did the pain of Christ again stand in the centre of the Christian doctrine of salvation. The memory of the fact that Jesus himself had to undergo the worst pain can still help people to overcome their pain and comfort them. PMID:17674055
Complex regional pain syndrome in a young athlete with von Willebrand disease.
Khadavi, Michael J; Alm, John C; Emerson, Jane-Anne
A 17-year-old female with type 1 Von Willebrand Disease (vWD) developed left medial calf pain while running track. Over the next 6 months, orthopedic surgery, sports medicine, vascular surgery, and neurology treated her under various working diagnoses; however, the pain, allodynia, coldness, and pale skin color worsened. She was admitted to a tertiary pediatric hospital for intractable pain where PM&R diagnosed her with complex regional pain syndrome (CRPS) type 1, began gabapentin, and initiated an aggressive inpatient rehabilitation program. During her 3 weeks of inpatient rehabilitation, passive range of motion of knee extension improved from 40� from extension to full extension, and ankle dorsiflexion improved from 15� from neutral to a consistent range of motion beyond neutral. Additional outcome measures were distance of ambulation and assistive device usage; from admission to inpatient rehabilitation to 2 months postdischarge, her weight-bearing tolerance progressed from nonweight-bearing to partial weight-bearing, and ambulation improved from 20 feet with a three-point crutch gait to unlimited distances with a four-point crutch gait. This is the first known case of a bleeding disorder as the likely underlying microvascular pathology associated with CRPS, a theory exposed in 2010. PMID:24666636
Accepting pain management or seeking pain cure: an exploration of patients' attitudes to chronic pain.
Clarke, Kathryn A; Iphofen, Ron
This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible. PMID:17544130
Mailis-Gagnon, Angela; Lakha, S. Fatima; Ou, Ting; Louffat, Ada; Yegneswaran, Balaji; Umana, Margarita; Cohodarevic, Tea; Nicholson, Keith; Deshpande, Amol
Abstract Objective To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic. Design Cross-sectional, descriptive study. Setting A tertiary care, hospital-based pain clinic in Toronto, Ont. Participants A total of 455 consecutive patients newly referred to the pain clinic by community physicians. Main outcome measures Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg. Results In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores. Conclusion Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population. PMID:21402957
[Greater trochanteric pain syndrome].
Nissen, M J; Genevay, S
Trochanteric bursitis, also known as "greater trochanter pain syndrome", is a frequent and often under-diagnosed cause of pain in the lateral hip region. The diagnosis is essentially based on the clinical examination; however various forms of imaging may be useful to confirm the diagnosis and particularly to ex- clude other aetiologies. The different therapeutic options include non-steroidal anti-inflammatories, physiotherapy, local injections of cortisone and local anaesthetic, and extra-corporeal shock wave therapy. Surgical intervention is only indicated in rare cases. PMID:25946869
Discogenic pain in acute nonspecific low-back pain
Hironori Hyodo; Tetsuro Sato; Hirotoshi Sasaki; Yasuhisa Tanaka
Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral
Low Back Pain: Where Does the Pain Come From?
Helena Brisby
\\u000a The pain mechanisms in patients with low back pain are unclear. Different theories exist about the mechanisms behind the experienced\\u000a pain, and different originating tissues are suggested to be of importance. The mechanisms in acute low back pain with recovery\\u000a within a few days are believed to be totally different compared to those in more long-standing (usually referred to as
New advances in musculoskeletal pain
Bove, Susan E.; Flatters, Sarah J.L.; Inglis, Julia J.; Mantyh, Patrick W.
Non-malignant musculoskeletal pain is the most common clinical symptom that causes patients to seek medical attention and is a major cause of disability in the world. Musculoskeletal pain can arise from a variety of common conditions including osteoarthritis, rheumatoid arthritis, osteoporosis, surgery, low back pain and bone fracture. A major problem in designing new therapies to treat musculoskeletal pain is that the underlying mechanisms driving musculoskeletal pain are not well understood. This lack of knowledge is largely due to the scarcity of animal models that closely mirror the human condition which would allow the development of a mechanistic understanding and novel therapies to treat this pain. To begin to develop a mechanism-based understanding of the factors involved in generating musculoskeletal pain, in this review we present recent advances in preclinical models of osteoarthritis, post-surgical pain and bone fracture pain. The models discussed appear to offer an attractive platform for understanding the factors that drive this pain and the preclinical screening of novel therapies to treat musculoskeletal pain. Developing both an understanding of the mechanisms that drive persistent musculoskeletal pain and novel mechanism-based therapies to treat these unique pain states would address a major unmet clinical need and have significant clinical, economic and societal benefits. PMID:19166876
Long-term outcome in patients with intractable epilepsy showing bilateral diffuse cortical glucose hypometabolism pattern on PET
Shandal, Varun; Veenstra, Amy L.; Behen, Michael; Sundaram, Senthil; Chugani, Harry
The objective of this study is to determine the long-term outcome of children with intractable epilepsy who have diffuse cortical hypometabolism on 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography (FDG-PET) scans. Seventeen children with intractable epilepsy showing bilateral, diffuse cortical hypometabolism on FDG-PET were followed up through telephone interview from 1 year 4 months to 11 years 4 months (mean: 5 years 7 months + 2 years 1 month) after their PET scans. One child succumbed to Sanfilippo disease at age 20 years. Only 2 children were seizure free. Fifty percent had walking difficulties, 56.25% were not toilet trained, all had speech difficulties, 43.75% had behavioral problems, 37.5% had poor eye contact, 75% had socialization difficulties, and 87.5% attended special schools. Three children were found to have genetic causes, including a 4-MB deletion of the mitochondrial genome, MECP2 duplication, and Lafora disease. In conclusion, the long-term outcome in this patient population is poor, and they tend to suffer from genetic/neurodegenerative diseases. PMID:21940690
Atypical language laterality is associated with large-scale disruption of network integration in children with intractable focal epilepsy.
Ibrahim, George M; Morgan, Benjamin R; Doesburg, Sam M; Taylor, Margot J; Pang, Elizabeth W; Donner, Elizabeth; Go, Cristina Y; Rutka, James T; Snead, O Carter
Epilepsy is associated with disruption of integration in distributed networks, together with altered localization for functions such as expressive language. The relation between atypical network connectivity and altered localization is unknown. In the current study we tested whether atypical expressive language laterality was associated with the alteration of large-scale network integration in children with medically-intractable localization-related epilepsy (LRE). Twenty-three right-handed children (age range 8-17) with medically-intractable LRE performed a verb generation task in fMRI. Language network activation was identified and the Laterality index (LI) was calculated within the pars triangularis and pars opercularis. Resting-state data from the same cohort were subjected to independent component analysis. Dual regression was used to identify associations between resting-state integration and LI values. Higher positive values of the LI, indicating typical language localization were associated with stronger functional integration of various networks including the default mode network (DMN). The normally symmetric resting-state networks showed a pattern of lateralized connectivity mirroring that of language function. The association between atypical language localization and network integration implies a widespread disruption of neural network development. These findings may inform the interpretation of localization studies by providing novel insights into reorganization of neural networks in epilepsy. PMID:25681650
Long Term Results (>5 Years) in Patients With Peritoneovenous Shunting for Intractable Ascites: Liver Function and Cancer Mortality
Meakins, Jonathan L.; Wu, Andrew; Smadja, Claude; Bonnet, Patrick; Gouffier, Etienne; Campillo, Bernard
This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients. In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted. PMID:2487384
Neuroimaging and electroencephalographic changes after vagus nerve stimulation in a boy with medically intractable myoclonic astatic epilepsy.
Fan, Pi-Chuan; Peng, Steven Shinn-Forng; Yen, Ruoh-Fang; Shieh, Jeng-Yi; Kuo, Meng-Fai
Myoclonic astatic epilepsy (MAE) is characterized by multiple seizure types, which are often refractory. Although vagus nerve stimulation (VNS) is an alternative treatment for medically intractable seizures, its exact mechanism of action remains unclear. Herein, we report the case of a 4-year-old boy with intractable MAE who has been in a seizure-free status for 2 years and 3 months since 6 months after the implantation of a vagus nerve stimulator (Model 103, Cyberonics, Inc., Houston, TX). Various test results 6 months after VNS were compared with those before VNS. Results of an electroencephalograph revealed disappearance of epileptiform discharges and an increased beta-gamma spectrum rhythm. The brain diffusion-tensor imaging showed an increased ratio of fraction anisotropy in the right fimbria-fornix, indicating improved diffusion of the white matter tract, and (18)F-fluorodeoxyglucose positron emission tomography revealed globally improved cerebral glucose metabolism. His cognitive and social-emotional performances also improved at 2 years after VNS. To the best of our knowledge, this is the first report to describe the effects of VNS on fimbria-fornix and glucose metabolism in MAE. PMID:23643463
Expressing pain: The communication and interpretation of facial pain signals
Kenneth M. Prkachin; Kenneth D. Craig
This article reviews recent theory and research on the origins, nature, and meaning of facial expressions of pain. A general model of pain expression, distinguishing experiential, encoding, and decoding processes involved in pain episodes, is proposed. Variables which are known to or may affect these processes are reviewed. Relationships between elements of the model and clinical phenomena of interest to
Pain perception in major depression depends on pain modality
Karl-J�rgen B�r; Stanislaw Brehm; Michael Karl Boettger; Silke Boettger; Gerd Wagner; Heinrich Sauer
One frequently described feature of depression is an increased vulnerability to pain complaints, and chronic pain is frequently accompanied by symptoms of depression. In contrast to this, a decreased sensitivity to experimental pain has been described in major depression. The physiological basis of this phenomenon is yet elusive. We investigated 30 patients suffering from a major depressive disorder and matched
Pain perception model of human skin using multiple pain sensors
Aydin Tarik Zengin; Nobutomo Matsunaga; Hiroshi Okajima; Shigeyasu Kawaji
In the coexistence circumstance with human and robot, sensory and emotional feelings of human should be considered in case of interaction. A typical unpleasant feeling influenced by this interaction is pain. In order to keep this interaction safe between human and robot, the pain sensing will be an important ability for the robot. In this paper, we provide a pain
Pain Response and Pain Control in Burn Patients
Castana, O.; Anagiotos, G.; Rempelos, G.; Adalopoulou, A.; Kokkinakis, C.; Giannakidou, M.; Diplas, D.B.; Alexakis, D.
Summary Burn injury is totally correlated to pain, which depends on burn depth and extent, cause, age and the patient's general condition, and on the local therapy of the burn wound. In hospitalized patients adjectival and numerical scales have been used to measure pain. The management of pain is challenging to the therapist and extremely important for the patient. PMID:21991161
The new JCAHO pain standards: Implications for pain management nurses
Patricia H Berry; June L Dahl
The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management. Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at
Greek Brief Pain Inventory: Validation and Utility in Cancer Pain
Kyriaki Mystakidou; Tito Mendoza; Eleni Tsilika; Sofia Befon; Efi Parpa; George Bellos; Lambros Vlahos; Charles Cleeland
Objective: The Brief Pain Inventory (BPI) is a pain assessment tool. It has been translated into and validated in several languages. The purpose of this study was the translation into and validation of the BPI in Greek. Moreover, we wanted to detect cultural and social differences, if any, of pain interference in patients� lives. Methods: The translation and validation of
... PAGE Knee Pain K nees are complex, weight-bearing joints (junctions between 2 bones) that provide your ... and pain. WHEN TO SEEK MEDICAL ADVICE � Difficulty bearing weight on the knee � Swelling of the knee � ...
Acute pain medicine in anesthesiology
Munro, Anastacia P.; Tighe, Patrick J.
The American Academy of Pain Medicine and the American Society for Regional Anesthesia have recently focused on the evolving practice of acute pain medicine. There is increasing recognition that the scope and practice of acute pain therapies must extend beyond the subacute pain phase to include pre-pain and pre-intervention risk stratification, resident and fellow education in regional anesthesia and multimodal analgesia, as well as a deeper understanding of the pathophysiologic mechanisms that are integral to the variability observed among individual responses to nociception. Acute pain medicine is also being established as a vital component of successful systems-level acute pain management programs, inpatient cost containment, and patient satisfaction scores. In this review, we discuss the evolution and practice of acute pain medicine and we aim to facilitate further discussion on the evolution and advancement of this field as a subspecialty of anesthesiology. PMID:24381730
Spinal cord plasticity in peripheral inflammatory pain�
Dickie, Allen Charles
Inflammatory pain is a debilitating condition that can occur following tissue injury or inflammation and results in touch evoked pain (allodynia), exaggerated pain (hyperalgesia) and spontaneous pain, yet the neural ...
Pain Management Following Spinal Cord Injury
... Center Spinal Cord Injury InfoSheet 10 Level - Consumer Pain Management following Spinal Cord Injury coming from somewhere other ... pain is described as burning, cramping and constant. PAIN MANAGEMENT Pain management usually includes treatment with medications, modified ...
Pharmacologic treatment of neuropathic pain
Mark S. Wallace
Neuropathic pain, or pain after nervous system injury, can be very refractory to pharmacologic interventions. Through a better\\u000a understanding of the pathophysiology of neuropathic pain, it has been suggested that nonopioid agents, such as antidepressants\\u000a and anticonvulsants, may be more efficacious in the treatment of neuropathic pain than common analgesics, such as opioids\\u000a or nonsteroidal anti-inflammatory drugs. However, this has
Knowledge Translation and Pain Management
Shannon Scott-Findlay; Carole A. Estabrooks
Over the last few decades, there has been substantial growth in pediatric pain research, yet children continue to endure pain\\u000a despite this well-established body of evidence. Assessing, treating, and managing pain in children is complex because of the\\u000a developmental issues involved in assessing and understanding the child�s pain, the nature and the structure of health care\\u000a professionals� work, the immense
Substance Abuse in Cancer Pain
Tatiana D. Starr; Lauren J. Rogak; Steven D. Passik
In the oncology community, opioids recently have become the cornerstone of cancer pain management. This has led to a rapid\\u000a increase in opioid prescribing in an effort to address the growing public health problem of chronic pain. A new paradigm in\\u000a noncancer pain management has emerged, that of risk assessment and stratification in opioid therapy. Techniques foreign to\\u000a cancer pain
Interventional Strategies for Pain Management
Kulbir S. Walia; Frederick W. Luthardt; Maneesh C. Sharma; Peter S. Staats
\\u000a The International Association for the Study of Pain (IASP) defines pain as �an unpleasant sensory and emotional experience\\u000a associated with actual or potential tissue damage, or described in terms of such damage.� While pain is traditionally thought\\u000a of as a part of the body�s defense system, triggering a reflex reaction to retract or withdraw from a painful stimulus, in\\u000a certain
Orofacial pain: diagnosis and treatment.
Manusov, E G; Johnson, R
Orofacial pain can have an inflammatory, neurologic or musculoskeletal cause. Inflammatory diseases include dental abscess, sinusitis, temporal arteritis, sialolithiasis and infections of the parotid gland. Common neurologic diseases that cause facial pain are trigeminal neuralgia, glossopharyngeal neuralgia, paratrigeminal neuralgia and cluster headaches. Musculoskeletal causes include temporomandibular joint syndrome and myofascial pain dysfunction syndrome. A clear understanding of pertinent anatomy and an organized approach to diagnosis will facilitate the evaluation of patients with orofacial pain. PMID:1739060
Glycosylation of Erythrocyte Spectrin and Its Modification in Visceral Leishmaniasis
Samanta, Sajal; Dutta, Devawati; Ghoshal, Angana; Mukhopadhyay, Sumi; Saha, Bibhuti; Sundar, Shyam; Jarmalavicius, Saulius; Forgber, Michael; Mandal, Chhabinath; Walden, Peter; Mandal, Chitra
Using a lectin, Achatinin-H, having preferential specificity for glycoproteins with terminal 9-O-acetyl sialic acid derivatives linked in ?2-6 linkages to subterminal N-acetylgalactosamine, eight distinct disease-associated 9-O-acetylated sialoglycoproteins was purified from erythrocytes of visceral leishmaniaisis (VL) patients (RBCVL). Analyses of tryptic fragments by mass spectrometry led to the identification of two high-molecular weight 9-O-acetylated sialoglycoproteins as human erythrocytic ?- and ?-spectrin. Total spectrin purified from erythrocytes of VL patients (spectrinVL) was reactive with Achatinin-H. Interestingly, along with two high molecular weight bands corresponding to ?- and ?-spectrin another low molecular weight 60 kDa band was observed. Total spectrin was also purified from normal human erythrocytes (spectrinN) and insignificant binding with Achatinin-H was demonstrated. Additionally, this 60 kDa fragment was totally absent in spectrinN. Although the presence of both N- and O-glycosylations was found both in spectrinN and spectrinVL, enhanced sialylation was predominantly induced in spectrinVL. Sialic acids accounted for approximately 1.25 kDa mass of the 60 kDa polypeptide. The demonstration of a few identified sialylated tryptic fragments of ?- and ?-spectrinVL confirmed the presence of terminal sialic acids. Molecular modelling studies of spectrin suggest that a sugar moiety can fit into the potential glycosylation sites. Interestingly, highly sialylated spectrinVL showed decreased binding with spectrin-depleted inside-out membrane vesicles of normal erythrocytes compared to spectrinN suggesting functional abnormality. Taken together this is the first report of glycosylated eythrocytic spectrin in normal erythrocytes and its enhanced sialylation in RBCVL. The enhanced sialylation of this cytoskeleton protein is possibly related to the fragmentation of spectrinVL as evidenced by the presence of an additional 60 kDa fragment, absent in spectrinN which possibly affects the biology of RBCVL linked to both severe distortion of erythrocyte development and impairment of erythrocyte membrane integrity and may provide an explanation for their sensitivity to hemolysis and anemia in VL patients. PMID:22164239
Visceral Leishmaniasis and HIV Coinfection in Latin America
Lindoso, Jos� Angelo; Cota, Gl�ucia Fernandes; da Cruz, Alda Maria; Goto, Hiro; Maia-Elkhoury, Ana Nilce Silveira; Romero, Gustavo Adolfo Sierra; de Sousa-Gomes, M�rcia Leite; Santos-Oliveira, Joanna Reis; Rabello, Ana
Visceral leishmaniasis (VL) is an endemic zoonotic disease in Latin America caused by Leishmania (Leishmania) infantum, which is transmitted by sand flies from the genus Lutzomyia. VL occurs in 12 countries of Latin America, with 96% of cases reported in Brazil. Recently, an increase in VL, primarily affecting children and young adults, has been observed in urban areas of Latin America. The area in which this spread of VL is occurring overlaps regions with individuals living with HIV, the number of whom is estimated to be 1.4 million people by the World Health Organization. This overlap is suggested to be a leading cause of the increased number of reported VL-HIV coinfections. The clinical progression of HIV and L. infantum infections are both highly dependent on the specific immune response of an individual. Furthermore, the impact on the immune system caused by either pathogen and by VL-HIV coinfection can contribute to an accelerated progression of the diseases. Clinical presentation of VL in HIV positive patients is similar to patients without HIV, with symptoms characterized by fever, splenomegaly, and hepatomegaly, but diarrhea appears to be more common in coinfected patients. In addition, VL relapses are higher in coinfected patients, affecting 10% to 56.5% of cases and with a lethality ranging from 8.7% to 23.5% in Latin America, depending on the study. With regards to the diagnosis of VL, parasitological tests of bone marrow aspirates have proven to be the most sensitive test in HIV-infected patients. Serologic tests have demonstrated a variable sensitivity according to the method and antigens used, with the standard tests used for diagnosing VL in Latin America displaying lower sensitivity. For this review, few articles were identified that related to VL-HIV coinfections and originated from Latin America, highlighting the need for improving research within the regions most greatly affected. We strongly support the formation of a Latin American network for coinfections of Leishmania and HIV to improve the consistency of research on the current situation of VL-HIV coinfections. Such a network would improve the collection of vital data and samples for better understanding of the clinical manifestations and immunopathogenic aspects of VL in immunosuppressed patients. Ultimately, a concerted effort would improve trials for new diagnostic methodologies and therapeutics, which could accelerate the implementation of more specific and effective diagnosis as well as public policies for treatments to reduce the impact of VL-HIV coinfections on the Latin American population. PMID:25233461
Ryszard Przew?ocki; Barbara Przew?ocka
The advance in our understanding of the biogenesis of various endogenous opioid peptides, their anatomical distribution, and the characteristics of the multiple receptors with which they interact open a new avenue for understanding the role of opioid peptide systems in chronic pain. The main groups of opioid peptides: enkephalins, dynorphins and ?-endorphin derive from proenkephalin, prodynorphin and proopiomelanocortin, respectively. Recently,
Bioterrorism, stress, and pain
Peter B. Polatin; Mark Young; Maile Mayer; Robert Gatchel
This article reviews the accumulating scientific evidence demonstrating the negative impact caused by a cataclysmic event, such as bioterrorism, on the mental health of a community. Moreover, the potential mental health problems created by the continuing threat of possible future events are discussed. This close link among disaster events, stress, pain, and psychopathology is presented from a biopsychosocial perspective. Although
Shriver, Adam Joseph
The experience of pain is something that most people are extremely familiar with. However, once we begin to examine the subject from an ethical point of view, and particularly when we examine so-called marginal cases such as nonhuman animals, we...
Peltier, Amanda; Goutman, Stephen A; Callaghan, Brian C
Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease [corrected]. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined. PMID:24803311
Dyspareunia: Painful Sex for Women
MENU Return to Web version Dyspareunia Overview What is dyspareunia? Dyspareunia (say: "dis-par-oon-ya") is painful sexual intercourse for women. The pain can be in the genital area or deep inside the pelvis. The pain is often described as sharp, burning or similar to menstrual cramps. It can have ...
Spiritual Coping with Chronic Pain�
Henderson, Kevin
and Pain interference (PI) (p?.05). Despite SP correlating well with R/S coping, neither the positive nor negative R/S coping subscales accounted for any of the variance in pain outcomes. Three of the CSQ coping subscales correlated with pain outcomes...
Scrotal pain: Evaluation and management
Gordhan, Chirag G
Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID:25598931
Scrotal pain: evaluation and management.
Gordhan, Chirag G; Sadeghi-Nejad, Hossein
Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID:25598931
Educational programs and cancer pain
Adriana Janzantte Ducci
Cognitive aspects are involved in cancer pain experience and management. Establishing and testing cognitive interventions, like educational programs, can improve pain control. The purpose of this investigation was to analyze studies about educational programs for cancer pain patients and their caregivers, and describe nurses' role in these programs. A literature review was made from MedLine data base, accessed through PubMed,
Pain, Transportation Issues and Whiplash
Michele Sterling
The development of pain following a motor vehicle crash (MVC) is a common occurrence. The most frequently reported and investigated pain condition following such trauma is neck pain or whiplash associated disorders (WAD), which are usually associated with rear-end collision. However, WAD can also be caused by any event that results in the hyperextension and flexion of the cervical spine
Ethical dilemmas in pain management
Betty R. Ferrell; Diane Novy; Mark D. Sullivan; John Banja; Michel Y. Dubois; Melvin C. Gitlin; Daniel Hamaty; Allen Lebovits; Arthur G. Lipman; Philipp M. Lippe; Jeffrey Livovich
The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that
Relieving visceral hyperalgesia effect of Kangtai capsule and its potential mechanisms via modulating the 5-HT and NO level in vivo.
Chen, Yun-Long; Huang, Xiao-Qi; Xu, Shi-Jie; Liao, Jin-Bin; Wang, Ru-Jun; Lu, Xiao-Feng; Xie, You-Liang; Zhou, Fu-Sheng; Su, Zi-Ren; Lai, Xiao-Ping
Kangtai capsule (KT) is one type of traditional Chinese medicine preparation derived from the proved recipe, which was frequently applied as an effective clinical treatment of IBS. However, there still lack the reasonable and all-round analytical approach and the scientific studies on its underlying mechanisms. Therefore, our study aimed to develop the novel method for evaluating its quality as well as to interpret the potential mechanisms. In our study, high performance liquid chromatography (HPLC) fingerprint was applied to provide a chemical profile of KT. The neonatal maternal separation (NMS) on Sprague-Dawley pups was employed to evaluate the therapeutic effect of KT by virtue of various parameters including visceral hyperalgesia, serum nitric oxide (NO) level, and tissue 5-hydroxytryptamine (5-HT) level. Consequently, a chromatographic condition, which was carried at 30�C with a flow rate of 0.5 ml/min on AQUA 3? C18 column with mobile phase of acetonitrile and water-phosphoric acid (100:0.1, v/v), was established to give a common fingerprint chromatography under 254 nm with a similarity index of 0.963 within ten batches of KT samples. On the NMS model, KT markedly elevated the pain threshold of NMS rats. Furthermore, KT at three doses significantly decreased 5-HT content from distal colon of visceral hyperalgesia rats induced by NMS, while the significant decrease of 5-HT content in serum was only observed in the group with KT at high dose. However, compared with that in NMS rats without KT, there was no apparent difference of 5-HT level from brain issue in the rats with various doses. Besides, KT could substantially elevate the concentration of NO in the serum. The results showed our study developed the simple, rapid, accurate, reproducible qualitative and quantitative analysis by HPLC fingerprint for the quality control for KT. Data from the pharmacological investigation suggested that the curative effect of KT to the visceral hypersensitivity may be concerned with the level of 5-HT and NO in vivo, promising its potential in irritable bowel syndrome treatment. PMID:23141427