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Sample records for bone pain secondary

  1. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-01-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  2. Recurrent Upper Quadrant Pain: A Fish Bone Secondary to Gastric Perforation and Liver Abscess

    Directory of Open Access Journals (Sweden)

    Hui Liang

    2011-12-01

    Full Text Available A 60-year-old male patient was admitted to our hospital for recurrent upper quadrant pain for 1 month. He had a past history of coronary artery disease. After admission, he repeatedly suffered from high-grade fever, chills and upper quadrant pain. Computed tomography (CT showed a round hypodense mass in the left lobe of the liver, approximately 2.7 × 2.2 cm in size, and a fish bone was confirmed by surgery in the left lobe of liver. The patient was cured completely after surgical removal of the fish bone and liver abscess. CT scan 1 month after discharge showed that the liver abscess had disappeared completely.

  3. Bone pain palliation: Philippines setting

    International Nuclear Information System (INIS)

    Pagsisihan, J.R.; Barrenechea, E.; San Luis, T.O.L.

    2008-01-01

    Metastatic bone disease is a major sequela of several solid cancers; the breast, prostate, lung, kidney and thyroid etc. Bone pain is a common symptom in advancing malignancy and often determines the quality of life in the later stages of disease. Management of bone pain remains palliative at present. With the improved cancer survival resulting from advances in cancer management, the population of patients seeking relief of bone pain has increased. Radiopharmaceutical therapy offers potential pain relief with minimal adverse effects. The purpose of this study was to assess the current status of radiopharmaceutical therapy for bone pain palliation in the Philippines. To date, no study has been done on bone pain palliation therapy. The study population included all cancer patients with bone metastasis presenting with chronic bone pain who were subjected to radiopharmaceutical therapy for bone pain palliation in the different medical centers and hospitals in the Philippines. The clinical histories of the patients were reviewed. The specific radiopharmaceutical and corresponding doses used for the said therapies were also noted. The respondents were inquired of the effectiveness of the therapy in relieving bone pain and duration of the response to the therapy. The complete blood count, before and after the therapy, were retrieved. The approximate cost of the therapy was also inquired and was then compared with the cost of different treatment modalities. Over the years only six radiopharmaceutical therapies have been performed in the Philippines (three male patients with prostate cancer, two female patients with breast cancer and one female patient with renal cancer). All had multiple bone metastases on bone scintigraphy and presented with chronic bone pain, which were not adequately controlled by other treatment modalities such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and radiation therapy. Four subjects were subjected to Strontium-89 chloride (Sr

  4. Stress fractures and bone pain

    International Nuclear Information System (INIS)

    Groshar, D.; Even-Sapir, E.; Lam, M.; Israel, O.; Front, D.

    1984-01-01

    Stress fractures result from an unusual repetitive physical activity causing absorption of bone in excess of repair and bone formation. This leads to the weakening of the bone and subsequently to a fracture. It is a benign condition that if recognized in time does not need any treatment besides rest. However, if diagnosis is not made and physical activity continues it may result in severe injury to the bone and a frank fracture may result. Pain is the typical clinical feature and bone scintigraphy, being more sensitive than radiography, is done to establish early diagnosis. The presence of asymptomatic sites of abnormal bone uptake typical of stress fracture in which pain appeared only about 2 weeks after scintigraphy, drew the authors' attention to the question of how close is the relationship between stress fractures and bone pain. Sixty-four military recruits diagnosed as suffering from stress fracture were investigated in order to correlate sites with abnormal uptake of Tc-99m MDP on bone scintigraphy with sites of local pain. In 37 (58%) subjects multiple sites of abnormal uptake were recognised. Of 123 sites of abnormal uptake, 31 (25%) were asymptomatic. In three patients bone pain appeared at the site of the abnormal uptake two weeks after scintigraphy. Bone scintigraphy appears to be more sensitive than bone pain in the diagnosis of stress fractures. The osteoblastic activity which manifests itself by abnormal uptake appears in some cases earlier than the pain caused by the fracture. Present findings may suggest that under certain circumstances, in a population prone to stress fracture, bone scan should be considered as a screening method

  5. Radioisotopes for metastatic bone pain.

    Science.gov (United States)

    Roqué I Figuls, Marta; Martinez-Zapata, Maria José; Scott-Brown, Martin; Alonso-Coello, Pablo

    2011-07-06

    This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates. To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival. We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010. Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope. We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis. This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to

  6. Vitamin D - Prevalence, mortality and bone pain

    DEFF Research Database (Denmark)

    Durup, Darshana Tiffany; Schwarz, Peter

    2013-01-01

    without hyperparathyroidism had decreased mortality compared to subjects suffering from hypovitaminosis D and raised serum PTH. Among 21.195 patients who had serum parathyroid hormone and serum calcium measured besides 25-hydroxyvitamin D, 10.5% of suffered from hyperparathyroidism secondary to vitamin D...... includes 12 women in the age 18-50 years, premenopausal and all suffering from bone pain, vitamin D deficiency and hyperparathyroidism. The recruitment is done through Copenhagen General Practitioners' Laboratory, which analyzes vitamin D samples daily. The study comprise of 6 visits; screening and 5...... of pain questionnaires and quantified by the use of pressure algometry. The pain will decrease by normalization of vitamin D. To invent an animal model for clinical osteomalacic bone pain, fifty seven-month-old, female Spraque-Dawley rats were maintained four months on synthetic diets containing...

  7. Vitamin D - Prevalence, mortality and bone pain

    DEFF Research Database (Denmark)

    Durup, Darshana Tiffany; Schwarz, Peter

    2013-01-01

    of the pain syndrome in patients with vitamin D deficiency and bone pain. Furtherme, development of a non-cancer animal model of bone pain, was carried out, to enable investigations of bone pain threshold, bone microenvironment and endocrinology parameters involved in this debilitating disease. A unique...... deficiency. These subjects might be prone to bone pain. Characterization and quantification of bone pain in patients suffering from vitamin D deficiency is being investigated and might provide clues to the nature of bone pain and assist in evaluating the results from the animal model. So far the study...... of pain questionnaires and quantified by the use of pressure algometry. The pain will decrease by normalization of vitamin D. To invent an animal model for clinical osteomalacic bone pain, fifty seven-month-old, female Spraque-Dawley rats were maintained four months on synthetic diets containing...

  8. Vitamin D -prevalence, mortality and bone pain

    DEFF Research Database (Denmark)

    Durup, Darshana Tiffany

    2013-01-01

    without hyperparathyroidism had decreased mortality compared to subjects suffering from hypovitaminosis D and raised serum PTH. Among 21.195 patients who had serum parathyroid hormone and serum calcium measured besides 25-hydroxyvitamin D, 10.5% of suffered from hyperparathyroidism secondary to vitamin D...... vitamin D level and mortality was reverse J-shaped. In the same population, prevalence of vitamin D insufficiency and hyperparathyroidism secondary to vitamin D deficiency was 54.4% and 10.5%, respectively. These patients have potentially risked of suffering from or getting osteomalacia accompanying bone...... includes 12 women in the age 18-50 years, premenopausal and all suffering from bone pain, vitamin D deficiency and hyperparathyroidism. The recruitment is done through Copenhagen General Practitioners' Laboratory, which analyzes vitamin D samples daily. The study comprise of 6 visits; screening and 5...

  9. Bone scintigraphy in patients with pain

    OpenAIRE

    Shin, Seung Hyeon; Kim, Seong Jang

    2017-01-01

    Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disor...

  10. Multiple spontaneous bone infarcts secondary to alcohol abuse

    International Nuclear Information System (INIS)

    Wadhwa, S.S.; Mansberg, R.

    1999-01-01

    Alcohol induced spontaneous osteonecrosis is part of the differential diagnosis in patients with history of alcohol abuse and diffuse bone pain. Usually patients have a longer than 10 year history of alcohol abuse prior to the development of osteonecrosis. The femoral head is the commonest site involved, however, involvement of the long bones is also seen. Facial involvement is rarely seen. Fat embolism secondary to coexisting hyperlipidemia has been postulated as a possible cause of osteonecrosis in alcoholics. A case of multifocal spontaneous bone infarction with facial bone involvement in a 34 year old female alcoholic is described. Copyright (1999) The Australian and New Zealand Society of Nuclear Medicine Inc

  11. Bone scintigraphy in painful os peroneum syndrome

    DEFF Research Database (Denmark)

    Jeppesen, Johanne B; Jensen, Frank K; Falborg, Bettina

    2011-01-01

    Lateral foot pain may be caused by various entities including the painful os peroneum syndrome. A case of a 68-year-old man is presented, who experienced a trauma with distortion of the right foot. Nine months later, he still had pain in the lateral part of the right foot. Bone scintigraphy showed...

  12. Bone-scintigraphy in painful bipartite patella

    Energy Technology Data Exchange (ETDEWEB)

    Iossifidis, A. [Orthopaedic Academic Unit, St. Thomas` Hospital, London (United Kingdom); Brueton, R.N. [Orthopaedic Academic Unit, St. Thomas` Hospital, London (United Kingdom); Nunan, T.O. [Dept. of Nuclear Medicine, St. Thomas` Hospital, London (United Kingdom)

    1995-10-01

    Although, the use of technetium scintigraphy in the assessment of anterior knee pain has been described, no reference has been made to the scintigraphic appearances of painful bipartite patella. We report the scintigraphic-appearances of painful bipartite patella in 25-year-old man a 2 1/2 years history of unexplained patellar pain. Painful bipartite patella is a rare cause of chronic post-traumatic patellar pain. Bone scintigraphy, by demonstrating increased uptake by the painful accessory bipartite fragment, appears to be an imaging method of choice in the diagnosis of this condition. (orig./MG)

  13. WITHDRAWN: Radioisotopes for metastatic bone pain.

    Science.gov (United States)

    Roqué I Figuls, Marta; Martinez-Zapata, Maria José; Scott-Brown, Martin; Alonso-Coello, Pablo

    2017-03-23

    This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates. To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival. We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010. Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope. We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis. This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to

  14. Radiotherapy for pain management of bone metastases

    International Nuclear Information System (INIS)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano

    2011-01-01

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  15. Radiotherapy for pain management of bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano, E-mail: rezende.med@terra.com.br [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)

    2011-07-01

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  16. Acupuncture for Cancer-Induced Bone Pain?

    Directory of Open Access Journals (Sweden)

    Carole A. Paley

    2011-01-01

    Full Text Available Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may represent a potentially valuable adjunct to existing strategies for pain relief and it is known to be relatively free of harmful side-effects. Although acupuncture is used in palliative care settings for all types of cancer pain the evidence-base is sparse and inconclusive and there is very little evidence to show its effectiveness in relieving cancer-induced bone pain (CIBP. The aim of this critical review is to consider the known physiological effects of acupuncture and discuss these in the context of the pathophysiology of malignant bone pain. The aim of future research should be to produce an effective protocol for treating CIBP with acupuncture based on a sound, evidence-based rationale. The physiological mechanisms presented in this review suggest that this is a realistic objective.

  17. Radiopharmaceutical therapy for bone pain palliation: Philippine setting

    International Nuclear Information System (INIS)

    Jefferson, P.; Barrenechea, E.

    2007-01-01

    Full text: Bone metastases are often multiple, presenting with multifocal bone pain. Bone pain is a common symptom in advancing malignancy and often determines the quality of life in the later stages of disease. Management of bone pain remains palliative at present. Systemic targeted treatment of metastatic sites using radiopharmaceuticals offers potential pain relief with minimal adverse effects. Acting systemically, targeted therapy using bone seeking radiopharmaceuticals are well suited to the management of disseminated cancer when repeated local treatment becomes impractical. Radiopharmaceuticals developed for treating painful bone metastases use the following radionuclides: 32 P, 89 Sr, 186 Re, 188 Re, 153 Sm, 117mSn, 177 Lu and 223 Ra. Nuclear medicine started in the Philippines in the year 1969. Majority of the procedures are mostly diagnostic. With the improved cancer survival resulting from advances in cancer management, the population of patients seeking relief of bone pain has increased. The purpose of this study is to assess the current status of radiopharmaceutical therapy for bone pain palliation in the Philippines. It also aims to determine which radiopharmaceuticals are being used for therapy and to evaluate the acceptability, efficacy, accessibility, and cost effectiveness of the therapy in the country. To date, no local study has been done on bone pain palliation therapy. This pioneer study can serve as a baseline study for future researches on the therapy. This can also promote the therapy as an effective treatment modality in the management of bone pain secondary to bone metastases. Methods: The study population included all cancer patients with bone metastasis presenting with chronic bone pain who were subjected to radiopharmaceutical therapy for bone pain palliation in the different medical centers and hospitals in the Philippines. The clinical histories of the patients were reviewed. The specific radiopharmaceutical and corresponding doses

  18. Radiopharmaceuticals for the therapy of metastatic bone pain

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol [Kyungpook National University Medicine School, Daegu (Korea, Republic of)

    2006-04-15

    Bone metastasis is a common sequelae of solid malignant tumors such as prostate, breast, lung, and renal cancers, which can lead to various complications, including fractures, hypercalcemia, and bone pain, as well as reduced performance status and quality of life. It occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. Several sequelae occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. A multidisciplinary approach is usually required not only to address the etiology of the pain and is complicating factors but also to treat the patient appropriately. Pharmaceutical therapy of bone pain, includes non-steroidal analgesics, opiates, steroids, hormones, bisphosphonates, and chemotherapy. While external beam radiation therapy remains the mainstay of pain palliation of a solitary lesions, bone seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesion. {sup 32}P, {sup 89}SrCl, {sup 153}Sm-EDTMP, {sup 188}Re/{sup 186}Re-HEDP, and {sup 177}Lu-EDTMP can be used to treat painful osseous metastases. These various radiopharmaceuticals have shown good efficacy in relieving bone pain secondary to bone metastasis. This systemic from of metabolic radiotherapy is simple to administer and complements other treatment options. This has been associated with improved mobility in many patients, reduced dependence on narcotic and non-narcotic analgesics, improved performance status and quality of life, and in some studies, improved survival. All of these agents, although comprising different physical and chemical characteristics, offer certain advantages in that they are simple to administer, are well tolerated by the patient if used appropriately, and can be used alone or in combination with the other forms of treatment. This article

  19. Bone and bone marrow scintigraphy in a patient with sickle cell-thalassemia and recurrent pain attacks

    International Nuclear Information System (INIS)

    Mikosch, P.; Gallowitsch, H.-J.; Lind, P.; Jauk, B.; Kaulfersch, W.

    2003-01-01

    The case of an eight years old African boy who suffers from sickle cell-thalassemia is presented. In the course of the disease frequent pain attacks occurred within the abdomen and extremities, recently also within the trunk. Local pain, at some occasions in combination with local swelling and always positive laboratory parameters for inflammation, hindered a solely clinical differentiation between bone infarcts and osteomyelitis. Bone scintigraphy, eventually in combination with bone marrow scintigraphy, can assist the clinician in the differentiation of aseptic bone infarcts versus secondary osteomyelitis. Based on the presented case scintigraphic results for bone infarcts, osteomyelitis and special scintigraphic pattern seen in sickle cell disease are presented. Furthermore, problems regarding the interpretation of the scintigraphies in relation to the delayed time after the beginning of pain attacks are discussed. (author)

  20. Severe pegfilgrastim-induced bone pain completely alleviated with loratadine: A case report.

    Science.gov (United States)

    Romeo, Cristina; Li, Quan; Copeland, Larry

    2015-08-01

    Febrile neutropenia is an oncologic emergency that can result in serious consequences. Granulocyte colony stimulating factors (G-CSFs) are often used as prophylaxis for febrile neutropenia. Bone pain is the most notorious adverse effect caused by G-CSFs. Specifically, with pegfilgrastim (Neulasta(®)), the incidence of bone pain is higher in practice than was observed during clinical trials. Traditional analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, can be ineffective in severe pegfilgrastim-induced bone pain. With the high frequency of this adverse effect, it is clear that health practitioners need additional treatment options for patients who experience severe pegfilgrastim-induced bone pain. The mechanisms of bone pain secondary to G-CSFs are not fully known, but research has shown that histamine release is involved in the inflammatory process. There is scant previous clinical data on antihistamine use in the management of G-CSF-induced pain. We present the first case report in which loratadine prophylaxis completely alleviated NSAID-resistant severe pain secondary to pegfilgrastim. The result showed that loratadine may be a promising option for severe, resistant pegfilgrastim-induced bone pain. Further clinical studies are warranted and ongoing. © The Author(s) 2014.

  1. Bone pain palliation with strontium-89 in breast cancer patients with bone metastases and refractory bone pain

    International Nuclear Information System (INIS)

    Berna, L.; Carrio, I.; Alonso, C.; Ferre, J.; Estorch, M.; Torres, G.

    1995-01-01

    Fifteen patients with breast cancer and skeletal metastases who had bone pain refractory to opioid analgesics and who were not eligible for or had not responded to local field radiotherapy, were treated with strontium-89. All patients had received previous treatment with chemotherapy and radiotherapy for bone metastases. Severity of bone pain, sleeping pattern, mobility and dependency on analgesics were evaluated before and 4, 8 and 12 weeks after 89 Sr administration. Patients received 2 MBq/kg (118-148 MBq) of 89 Sr by i.v. injection. Pain relief and a reduction in analgesic requirements were observed in 7 of the 15 (47%) patients, with a reduction in the severity score from 34% to 71%. Duration of the response varied from 3 to 7 months. A decrease in peripheral blood cell count was observed in 11 patients: a 15%-66% reduction in white cell count and a 14%-75% reduction in platelet count were detected at 12 weeks after treatment in these patients. We conclude that 89 Sr is effective (47% response rate) for bone pain palliation in patients with bone metastases from breast cancer. Dependency on opioid analgesics may be reduced in patients with refractory bone pain. (orig.)

  2. Targeting glia for bone cancer pain.

    Science.gov (United States)

    Zhou, Ya-Qun; Liu, Zheng; Liu, Hui-Quan; Liu, Dai-Qiang; Chen, Shu-Ping; Ye, Da-Wei; Tian, Yu-Ke

    2016-11-01

    Bone cancer pain (BCP) remains to be a clinical challenge with limited pharmaceutical interventions. Therefore, novel therapeutic targets for the management of BCP are in desperate need. Recently, a growing body of evidence has suggested that glial cells may play a pivotal role in the pathogenesis of BCP. Areas covered: This review summarizes the recent progress in the understanding of glia in BCP and reveals the potential therapeutic targets in glia for BCP treatment. Expert opinion: Pharmacological interventions inhibiting the activation of glial cells, suppressing glia-derived proinflammatory cytokines, cell surface receptors, and the intracellular signaling pathways may be beneficial for the pain management of advanced cancer patients. However, these pharmacological interventions should not disrupt the normal function of glia cells since they play a vital supportive and protective role in the central nervous system.

  3. Molecular Mechanisms That Contribute to Bone Marrow Pain

    Directory of Open Access Journals (Sweden)

    Jason J. Ivanusic

    2017-09-01

    Full Text Available Pain associated a bony pathology puts a significant burden on individuals, society, and the health-care systems worldwide. Pathology that involves the bone marrow activates sensory nerve terminal endings of peripheral bone marrow nociceptors, and is the likely trigger for pain. This review presents our current understanding of how bone marrow nociceptors are influenced by noxious stimuli presented in pathology associated with bone marrow. A number of ion channels and receptors are emerging as important modulators of the activity of peripheral bone marrow nociceptors. Nerve growth factor (NGF sequestration has been trialed for the management of inflammatory bone pain (osteoarthritis, and there is significant evidence for interaction of NGF with bone marrow nociceptors. Activation of transient receptor potential cation channel subfamily V member 1 sensitizes bone marrow nociceptors and could contribute to increased sensitivity of patients to noxious stimuli in various bony pathologies. Acid-sensing ion channels sense changes to tissue pH in the bone marrow microenvironment and could be targeted to treat pathology that involves acidosis of the bone marrow. Piezo2 is a mechanically gated ion channel that has recently been reported to be expressed by most myelinated bone marrow nociceptors and might be a target for treatments directed against mechanically induced bone pain. These ion channels and receptors could be useful targets for the development of peripherally acting drugs to treat pain of bony origin.

  4. Pathogenesis and pharmacological treatment of bone pain in skeletal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Ripamonti, C. [National Cancer Institute, Rehabilitation, Pain Therapy and Palliative Care Division, Milan (Italy); Fulfaro, F. [Societa' per l' Assistenza al Malato Oncologico Terminale, Palermo (Italy)

    2001-03-01

    Sixty-five percent of patients with advanced cancer present bone metastases and most of them present a rather slow clinical course characterized by pain, mobility deficiencies and skeletal complications such as fractures and spinal cord compression. Metastatic involvement of the bone is one of the most frequent causes of pain in cancer patients and represents one of the firs signs of widespread neoplastic disease. The pain may originate directly from the plastic disease. The pain may originate directly from the bone, from nerve root compression or from muscle spasms in the area of the lesions. The mechanism of metastatic bone pain is mainly somatic (nociceptive) even though, in some cases, neuropathic and visceral stimulations may overlap. The conventional symptomatic treatment of metastatic bone pain requires the use of multidisciplinary therapies such as radiotherapy in association with systemic treatment (hormonotherapy, chemotherapy, radioisotopes) with the support of analgesic therapy. Recently, studies have indicated the use of bisphosphonates in the treatment of pain and in the prevention of skeletal complications in patients with metastatic bone disease. In some patients pharmacological treatment, radiotherapy, radioisotopes administered alone or in association are not able to manage pain adequately. The role of neuroinvasive techniques in treating metastatic bone pain is debated. The clinical conditions of the patient, his life expectancy and quality of life must guide the physician in the choice of the best possible therapy.

  5. Pathogenesis and pharmacological treatment of bone pain in skeletal metastases

    International Nuclear Information System (INIS)

    Ripamonti, C.; Fulfaro, F.

    2001-01-01

    Sixty-five percent of patients with advanced cancer present bone metastases and most of them present a rather slow clinical course characterized by pain, mobility deficiencies and skeletal complications such as fractures and spinal cord compression. Metastatic involvement of the bone is one of the most frequent causes of pain in cancer patients and represents one of the firs signs of widespread neoplastic disease. The pain may originate directly from the plastic disease. The pain may originate directly from the bone, from nerve root compression or from muscle spasms in the area of the lesions. The mechanism of metastatic bone pain is mainly somatic (nociceptive) even though, in some cases, neuropathic and visceral stimulations may overlap. The conventional symptomatic treatment of metastatic bone pain requires the use of multidisciplinary therapies such as radiotherapy in association with systemic treatment (hormonotherapy, chemotherapy, radioisotopes) with the support of analgesic therapy. Recently, studies have indicated the use of bisphosphonates in the treatment of pain and in the prevention of skeletal complications in patients with metastatic bone disease. In some patients pharmacological treatment, radiotherapy, radioisotopes administered alone or in association are not able to manage pain adequately. The role of neuroinvasive techniques in treating metastatic bone pain is debated. The clinical conditions of the patient, his life expectancy and quality of life must guide the physician in the choice of the best possible therapy

  6. The use of radioisotopes for palliation of metastatic bone pain.

    Science.gov (United States)

    Gkialas, I; Iordanidou, L; Galanakis, I; Giannopoulos, S

    2008-01-01

    Bone pain associated with advanced prostate and other cancers is a frequent and significant complication. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the armamentarium for the treatment of multiple osseous metastases. The 3 radioisotopes currently approved for treatment of pain (strontium-89/(89)Sr, samarium-153/(153)Sm and rhenium-186/(186)Re) are discussed in this review including the approved dose, method of administration and indications for use.

  7. Reversible bone pain and symmetric bone scan uptake in a dialysis patient treated with cinacalcet: a case report

    Directory of Open Access Journals (Sweden)

    Bottino Carla

    2010-06-01

    Full Text Available Abstract Introduction The medical management of secondary hyperparathyroidism in patients with end-stage renal disease involves a combination of dietary restrictions, phosphate binders, active vitamin D analogs, and calcimimetics. Case presentation We report the case of a 36-year-old Hispanic dialysis patient, originally from Cuba and now residing in the USA, who developed severe bone pain and muscle twitching after starting low dose cinacalcet, despite normal pre-dialysis ionized calcium and elevated parathyroid hormone. The clinical symptoms correlated with increased symmetrical uptake on bone scan that resolved rapidly upon discontinuation of cinacalcet. Conclusion Cinacalcet may induce severe bone pain and a unique bone scan uptake pattern in hemodialysis patients.

  8. Painful os styloideum: bone scintigraphy in carpe bossu disease

    International Nuclear Information System (INIS)

    Apple, J.S.; Martinez, S.; Nunley, J.A.

    1984-01-01

    The os styloideum (ninth carpal bone) is an anatomic variant that may occur as an accessory ossicle located dorsally between the capitate and trapezoid, and the bases of the second and third metacarpals. The association of dorsal wrist pain or fatigability with an os styloideum is known as carpe bossu disease. The authors describe a woman with dorsal wrist pain in whom the diagnosis of painful os styloideum (carpe bossu disease) was made using plain radiography, bone scintigraphy and tomography

  9. Chronic pain in hemodialysis patients: Role of bone mineral ...

    African Journals Online (AJOL)

    ... lower calcium, lower 25(OH) D3 levels, higher parathyroid hormone (PTH) levels and experienced chronic pain (p< 0.001). Conclusion: Chronic pain is highly experienced in long-term hemodialysis patients. Malnutrition, high CRP and disturbed bone mineral metabolism are highly correlated with the incident of this pain.

  10. Secondary aneurysmal bone cyst following chondroblastoma of the patella

    Directory of Open Access Journals (Sweden)

    Tomoyuki Kato

    2013-09-01

    Full Text Available Aneurysmal bone cyst (ABC is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature.

  11. Human brain activity associated with painful mechanical stimulation to muscle and bone.

    Science.gov (United States)

    Maeda, Lynn; Ono, Mayu; Koyama, Tetsuo; Oshiro, Yoshitetsu; Sumitani, Masahiko; Mashimo, Takashi; Shibata, Masahiko

    2011-08-01

    The purpose of this study was to elucidate the central processing of painful mechanical stimulation to muscle and bone by measuring blood oxygen level-dependent signal changes using functional magnetic resonance imaging (fMRI). Twelve healthy volunteers were enrolled. Mechanical pressure on muscle and bone were applied at the right lower leg by an algometer. Intensities were adjusted to cause weak and strong pain sensation at either target site in preliminary testing. Brain activation in response to mechanical nociceptive stimulation targeting muscle and bone were measured by fMRI and analyzed. Painful mechanical stimulation targeting muscle and bone activated the common areas including bilateral insula, anterior cingulate cortex, posterior cingulate cortex, secondary somatosensory cortex (S2), inferior parietal lobe, and basal ganglia. The contralateral S2 was more activated by strong stimulation than by weak stimulation. Some areas in the basal ganglia (bilateral putamen and caudate nucleus) were more activated by muscle stimulation than by bone stimulation. The putamen and caudate nucleus may have a more significant role in brain processing of muscle pain compared with bone pain.

  12. Bone pain induced by metastatic cancer: pathophysiology and treatment

    International Nuclear Information System (INIS)

    Salas-Herrera, Isaias; Huertas-Gabert, Luis Carlos

    2004-01-01

    Cancer patients who develop bone metastases are an estimated 60 to 84% . Of these 79% experienced pain syndromes are difficult to manage, of which 50% die without adequate pain relief and with a poor quality of life. Therefore, it is necessary to have accessible and effective medications for the management of this condition. The pathophysiology of pain in bone is reviewed and the drugs used most frequently in the management of this type of cancer pain are described. Furthermore an algorithm of 6 steps is presented and can guide the physician when making a therapeutic decision. (author) [es

  13. Secondary infertility caused by the retention of fetal bones after an abortion: a case report

    Directory of Open Access Journals (Sweden)

    Kramer Hannah MC

    2008-06-01

    Full Text Available Abstract Introduction Unwanted contraception through prolonged retention of fetal bone is a rare cause of secondary infertility. It is usually associated with a history of abortion, either spontaneous or induced. Case presentation We describe a case of intrauterine retention of fetal bone diagnosed 8 years after the termination of a pregnancy. The patient had no complaints of pain, irregular vaginal bleeding or discharge. A hysteroscopy was performed and irregular structures were removed. These fragments were fetal bones, which probably functioned as an intrauterine contraceptive device. After removal of the fetal bone fragments the patient conceived spontaneously within 6 months. Conclusion This case report stresses the importance of taking a thorough history and evaluation of the endometrium by transvaginal ultrasound or hysteroscopy in women with secondary infertility.

  14. Bone scintigraphy in children with obscure skeletal pain

    International Nuclear Information System (INIS)

    Majd, Massoud

    1979-01-01

    In a group of 82 children with focal or generalized skeletal pain of obscure etiology, the radionuclide skeletal scintigraphy was the only, or the most informative, clue to the diagnosis of a variety of benign and malignant conditions. It is strongly recommended that any unexplained bone or joint pain in children be evaluated by this non-invasive technique [fr

  15. Managing metastatic bone pain: New perspectives, different solutions.

    Science.gov (United States)

    Zaporowska-Stachowiak, Iwona; Łuczak, Jacek; Hoffmann, Karolina; Stachowiak, Katarzyna; Bryl, Wiesław; Sopata, Maciej

    2017-09-01

    Bone metastases are the most frequent cause of cancer-induced bone pain (CIBP). Although palliative radiotherapy and pharmacotherapy conducted according to World Health Organization (WHO) analgesic ladder are the treatment of choice for CIBP reduction, these methods are not always successful, especially with regard to alleviation of incidental pain. Antiresorptive drugs (bisphosphonates) are able to inhibit bone destruction (loss), proliferation of cancer cells and angiogenesis, but their prolonged use may lead to a spectrum of adverse effects. In this paper, types of bone metastases, their complications, as well as diagnostic and therapeutic implications are presented. Moreover, the paper discusses presently used CIBP treatment methods and research directions for future methods, with special focus on bone metastases. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Pain of osteoarthritis and bone uptake - is there a correlation

    International Nuclear Information System (INIS)

    Wadhwa, S.S.; Carollan, M.; Abbati, D.; Chan, W.-L.; Bui, C.

    2003-01-01

    Full text: In patients with osteoarthritis bone scintigraphy is consistently reported as demonstrating mild, moderate or severe arthritis, particularly for the medial compartment of the knee, depending on the degree of uptake. Numerous studies however have not demonstrated a correlation between severity of bone scan findings and severity of osteoarthritis (OA) demonstrated at surgery or arthroscopy. In fact, most studies have not demonstrated any correlation between OA as assessed with imaging and subsequent surgical findings. The only positive correlation for outcome of OA of the knee appears to be the severity of pain. In this pilot study we investigate if there is correlation between pain and scintigraphic findings in medial compartment OA. 69 patients (18 - 87 years) without history of recent knee trauma or previous surgery for insertion of knee prosthesis who presented for a bone scan for any reasons were studied. All patients were asked to quantify any knee pain on a simple 4 point score i.e. no pain, non limiting pain, pain limiting daily activity and rest pain. Uptake in the medial compartment of the knee was quantified by measuring the count ratio between the medial compartment and the corresponding distal femur. 45 patients reported no pain, 20 reported non-limiting pain while 4 reported limiting pain. No patient reported pain at rest. In general pain was bilateral with no major differences. The mean knee/femur ratio for patients with no pain was 1.46 +/- 0.95 (N=90). Knee/femur ratio for patients with non-limiting pain was 1.77 +/- 0.57 (N=40) and for those with limiting pain it was 2.36 +/- 1.82 (N=8). Although the results were not statistically significant there was a clear trend towards a rising knee/femur ratio with increasing pain. The number of patients with knee pain was small and further study concentrating on this group would be required to assess the significance of the trend findings. Further study particularly in patients with significant

  17. Bone Marrow Failure Secondary to Cytokinesis Failure

    Science.gov (United States)

    2015-12-01

    SUPPLEMENTARY NOTES 14. ABSTRACT Fanconi anemia (FA) is a human genetic disease characterized by a progressive bone marrow failure and heightened...L. Tian, M. Kahkonen, J. Schwartzentruber, M. Kircher, G. University of Washington Centre for Mendelian , F.C. Consortium, J. Majewski, D.A. Dyment

  18. The physiology of bone pain. How much do we really know?

    Directory of Open Access Journals (Sweden)

    Sara eNencini

    2016-04-01

    Full Text Available Pain is associated with most bony pathologies. Clinical and experimental observations suggest that bone pain can be derived from noxious stimulation of the periosteum or bone marrow. Sensory neurons are known to innervate the periosteum and marrow cavity, and most of these have a morphology and molecular phenotype consistent with a role in nociception. However, little is known about the physiology of these neurons, and therefore information about mechanisms that generate and maintain bone pain is lacking. The periosteum has received greater attention relative to the bone marrow, reflecting the easier access of the periosteum for experimental assessment. With the electrophysiological preparations used, investigators have been able to record from single periosteal units in isolation, and there is a lot of information available about how they respond to different stimuli, including those that are noxious. In contrast, preparations used to study sensory neurons that innervate the bone marrow have been limited to recording multi-unit activity in whole nerves, and whilst they clearly report responses to noxious stimulation, it is not possible to define responses for single sensory neurons that innervate the bone marrow. There is only limited evidence that peripheral sensory neurons that innervate bone can be sensitized or that they can be activated by multiple stimulus types, and at present this only exists in part for periosteal units. In the central nervous system, it is clear that spinal dorsal horn neurons can be activated by noxious stimuli applied to bone. Some can be sensitized under pathological conditions and may contribute in part to secondary or refered pain associated with bony pathology. Activity related to stimulation of sensory nerves that innervate bone has also been reported in neurons of the spinoparabrachial pathway and the somatosensory cortices, both known for roles in coding information about pain. Whilst these provide some clues

  19. Re-evaluation of bone pain in patients with type 1 Gaucher disease suggests that bone crises occur in small bones as well as long bones.

    Science.gov (United States)

    Baris, Hagit N; Weisz Hubshman, Monika; Bar-Sever, Zvi; Kornreich, Liora; Shkalim Zemer, Vered; Cohen, Ian J

    2016-09-01

    Bone crises in type 1 Gaucher disease are reported in long bones and occasionally in weight bearing bones and other bones, but rarely in small bones of the hands and feet. We retrospectively examined the incidence of bone pain in patients followed at the Rabin Medical Center, Israel, before and following the initiation of enzyme replacement therapy (ERT) and evaluated them for bone crises. Of 100 type I Gaucher disease patients, 30 (30%) experienced one or more bone crises. Small bone crises represented 31.5% of all bone crises and were always preceded by crises in other bones. While the incidence of long bone crises reduced after the initiation of ERT, small bone crises increased. Almost 60% of patients with bone crises were of the N370S/84GG genotype suggesting a greater susceptibility of N370S/84GG patients to severe bone complications. These patients also underwent the greatest number of splenectomies (70.6% of splenectomised patients). Splenectomised patients showed a trend towards increased long and small bone crises after surgery. Active investigation of acute pain in the hands and feet in patients in our cohort has revealed a high incidence of small bone crises. Physicians should consider imaging studies to investigate unexplained pain in these areas. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Utility of bone SPECT in temporomandibular joint pain

    International Nuclear Information System (INIS)

    Yang, Dong Hunn; Sung, Mi Sook; Lee, Jung Whee; Chung, Soo Kyo; Shinn, Kyung Sub

    1997-01-01

    Temporomandibular (TM) joint pain results from many etiologic factors. The aim of this study was to evaluate the utility of Bone SPECT in patients with TM joint pain. The subjects were 34 patients with TM joint pain. All patients underwent plain radiography, planar bone scan, and Bone SPECT. The intensity of radioisotope uptake at TM joint was graded into three; no increased uptake above the background activity as grade 0, uptake similar to occipital bone as grade I, and uptake similar to maxillary sinus as grade II. Clinical findings and therapeutic methods were reviewed. Twenty-seven patients (80%) out of 34 patients with TM joint pain had increased uptake in bone SPECT. Twenty-one (78%) out of 27 patients had increased uptake in the mandibular condyle and remaining six patients (22%) had uptake in the mandibular and maxillary arch, which proved to be dental problem. Seven patients (21%) out of 34 were grade as 0, four (12%) were grade I, 23 (68%) were grade. II. Four patients with grade I had clicking sound and symptoms which were subsided with medication in all cases. Among 23 patients with grade II, 7 patients had clicking sound and 14 patients underwent medication and decompression therapy. With Planar bone scan, 11 cases (32%) had increased uptake in TM joint area. Plain radiography revealed narrowing, distension, erosion and limitation of TM joint in 16 cases (47%). Bone SPECT can be valuable for screening and managing the patients with TM joint pain. Patients with grade II needed intensive treatment such as joint aspiration. However degree of the radioisotope uptake did not well correlated with clinical symptoms

  1. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma

    Science.gov (United States)

    Doval, Dinesh Chandra; Bhatia, Komal; Vaid, Ashok Kumar; Pavithran, Keechelat; Sharma, Jai Bhagwan; Hazarika, Digant; Jena, Amarnath

    2006-01-01

    Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC. PMID:16937544

  2. The Src family kinase inhibitor dasatinib delays pain-related behaviour and conserves bone in a rat model of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Appel, Camilla Kristine; Gallego-Pedersen, Simone; Andersen, Line

    2017-01-01

    -induced bone pain, including cancer growth, osteoclastic bone degradation and nociceptive signalling. Here we investigate the role of dasatinib, an oral Src kinase family and Bcr-Abl tyrosine kinase inhibitor, in an animal model of cancer-induced bone pain. Daily administration of dasatinib (15 mg/kg, p...

  3. External Beam Radiotherapy in Metastatic Bone Pain from Solid ...

    African Journals Online (AJOL)

    The vertebral column was the commonest site of metastatic deposits (Table2). Table 2: Distribution of Bone ... Dorsal spine. Lumbar spine. Pelvis/femur. Shoulder/hume rus. Ribs. Others. 0. 20. 40. 60. 80. 100. % OF PATIENTS. 1. 2. 3. WEEKS. ONSET OF PAIN RELIEF. Nigerian Journal of Surgery • July 2011 • Vol 17 • No 1 ...

  4. Reactor-produced radioisotopes from ORNL for bone pain palliation.

    Science.gov (United States)

    Knapp, F F; Mirzadeh, S; Beets, A L; O'Doherty, M; Blower, P J; Verdera, E S; Gaudiano, J S; Kropp, J; Guhlke, J; Palmedo, H; Biersack, H J

    1998-04-01

    The treatment of painful skeletal metastases is a common clinical problem, and the use of therapeutic radionuclides which localize at metastatic sites has been found to be an effective method for treatment of pain, especially for multiple sites for which the use of external beam irradiation is impractical. There are currently several metastatic-targeted agents radiolabeled with various therapeutic radionuclides which are in various stages of clinical investigation. Since neutron-rich radionuclides are produced in research reactors and often decay by emission of beta- particles, most radionuclides used for bone pain palliation are reactor-produced. Key examples of radionuclides produced by single neutron capture of enriched targets include rhenium-186 and samarium-153. In addition, generator systems are also of interest which provide therapeutic daughter radionuclides from the decay of reactor-produced parent radionuclides. One important example is rhenium-188, available from generators via decay of reactor-produced tungsten-188. Tin-117m is an example of a reactor-produced radionuclide which decays with the emission of low-energy conversion electrons rather than by beta- decay. Each of these agents and/or radionuclides has specific advantages and disadvantages, however, the ideal agent for bone pain palliation has not yet been identified. The goal of this paper is to briefly review the production and use of several reactor-produced radionuclides for bone pain palliation, and to discuss the role of the ORNL High Flux Isotope Reactor (HFIR) for the production of many of these radionuclides.

  5. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes)

    DEFF Research Database (Denmark)

    Albert, H. B.; Sørensen, Joan S.; Berit Schiott, Christensen

    2013-01-01

    PURPOSE: Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35-40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6...... in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment (Bioclavid) or placebo and were blindly evaluated at baseline, end of treatment and at 1-year follow-up. OUTCOME MEASURES: Primary outcome, disease-specific disability, lumbar pain. Secondary...... outcome leg pain, number of hours with pain last 4 weeks, global perceived health, EQ-5D thermometer, days with sick leave, bothersomeness, constant pain, magnetic resonance image (MRI). RESULTS: 144 of the 162 original patients were evaluated at 1-year follow-up. The two groups were similar at baseline...

  6. Cementoplasty for managing painful bone metastases outside the spine

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Gang; Jin, Peng; Liu, Xun-wei; Li, Min; Li, Li [Jinan Military General Hospital, Department of Medical Imaging, Jinan, Shandong Province (China)

    2014-03-15

    To illustrate the effect of treatment with cementoplasty in patients with painful bone metastases in the extraspinal region. A retrospective study was conducted to review 51 consecutive patients who underwent cementoplasty under CT or fluoroscopic guidance, a total of 65 lesions involving the ilium, ischium, pubis, acetabulum, humeral, femur and tibia. In 5 patients with a high risk of impending fracture in long bones based on Mirels' scoring system, an innovative technique using a cement-filled catheter was applied. The clinical effects were evaluated using the visual analogue scale (VAS) preoperatively and postoperatively. All patients were treated successfully with a satisfying resolution of painful symptoms at 3 months' follow-up. Cement leakage was found in 8 lesions without any symptoms. VAS scores decreased from 8.19 ± 1.1 preoperatively to 4.94 ± 1.6 at 3 days, 3.41 ± 2.1 at 1 month and 3.02 ± 1.9 at 3 months postoperatively. There was a significant difference between the mean preoperative baseline score and the mean score at all of the postoperative follow-up points (P < 0.01). Cementoplasty is an effective technique for treating painful bone metastases in extraspinal regions, which is a valuable, minimally invasive, method that allows reduction of pain and improvement of patients' quality of life. (orig.)

  7. Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate

    NARCIS (Netherlands)

    Guo, J.; Li, C.; Zhang, Q.; Wu, G.; Deacon, S.A.; Chen, J.; Hu, H.; Zou, S.; Ye, Q.

    2011-01-01

    BACKGROUND: Secondary alveolar bone grafting has been widely used to reconstruct alveolar cleft. However, there is still some controversy. OBJECTIVES: To compare the effectiveness and safety of different secondary bone grafting methods. SEARCH STRATEGY: The final electronic and handsearches were

  8. Paracetamol overdose secondary to dental pain: a case series.

    Science.gov (United States)

    Siddique, I; Mahmood, H; Mohammed-Ali, R

    2015-09-25

    There have been documented cases of serious and life-threatening health effects due to patients taking unintentional analgesia overdose secondary to dental pain. We aimed to determine firstly what proportion of unintentional paracetamol overdose cases admitted to an acute medical assessment unit (MAU) were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally what clinical burden such cases placed on the hospital services. The clinical coding department provided information to allow appropriate identification and data collection from patient discharge summaries and case notes of all unintentional paracetamol overdose cases secondary to dental pain over a 24 month period (1 March 2012 to 28 February 2014). One hundred and sixteen admissions were identified specifically for unintentional paracetamol overdose. Dental pain accounted for 48 (41%) of all cases. Females (67%) were twice as likely to be admitted, compared to males (33%), with a mean age of 36 years and four months. Thirty-two (63%) non-dentally registered and all nine (100%) registered patients were unable to access timely emergency dental care before their admission. Forty cases (83%) were referred to the hospital oral and maxillofacial services (OMFS). Thirty-seven (93%) patients underwent elective outpatient dental extractions and the remaining three (7%) patients were admitted for intravenous antibiotics, incision and drainage and dental extractions. All patients were treated under local anaesthetic. Dental pain is the single most common cause of acute medical admission secondary to unintentional paracetamol overdose. Patients registered with a general dental practitioner (GDP), as well as those not registered with a GDP, had difficulty accessing timely emergency primary dental care.

  9. Diphosphonic Acid (HEDP) Complex As A, Bone Pain Palliative Agent

    International Nuclear Information System (INIS)

    H G, Adang; Mutalib, A; Bagiawati, Sri; S, Evi; Aguawarini, Sri; Abidin

    2003-01-01

    Bone pain is a common complication for patient with bone metastases from prostate, breasts, lung and renal cancers. The systemic treatment of metastatic bone cancers can be done by using analgesic drug therapy, hormonal therapy, chemotherapy, narcotic (morphine) and radiopharmaceuticals. Samarium-153 EDTMP is one of the most widely used radiopharmaceutical for the treatment of metallics bone pain. Preparation and quality control of 186 Re-HEDP have been carried out. Radiochemical purity was analysed using paper chromatography and resulted in maximum yields more than 90 % . Complexes quite were stable for 3 days when stored at 4 o C. Rhenium-186 HEDP complex contents in the blood reach optimum activity after 5 minutes and decrease drastically at 24 hours post injection. The complex showed major renal clearance up to 41 % as perrhenate ion within 24 hours after injection, Biodistribution pattern of the injected complex in mice indicates that the accumulated optimum activity in the bone was obtained between 2 - 24 hours post injection, Sterility and pyrogenicity test indicated that the complex were sterile and pyrogen free

  10. Grid-climbing Behaviour as a Pain Measure for Cancer-induced Bone Pain and Neuropathic Pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Gallego-Pedersen, Simone; Petersen, Nicolas Caesar

    2017-01-01

    Despite affecting millions of people, chronic pain is generally treated insufficiently. A major point of focus has been the lack of translation from preclinical data to clinical results, with the predictive value of chronic pain models being a major concern. In contrast to current focus on stimulus......-based nociceptive responses in preclinical research, development of behavioural tests designed to quantify suspension of normal behaviour is likely a more equivalent readout for human pain-assessment tests. In this study, we quantified grid-climbing behaviour as a non-stimulus-evoked behavioural test for potential...... use as a measure of neuropathic and cancer-induced bone pain in mice. In both models, the grid-climbing test demonstrated pain-related sparing of the affected leg during climbing. In both models, the behaviour was reversed by administration of morphine, suggesting that the observed behaviour was pain-specific....

  11. Effect of Bisphosphonates, Denosumab, and Radioisotopes on Bone Pain and Quality of Life in Patients with Non-Small Cell Lung Cancer and Bone Metastases: A Systematic Review.

    Science.gov (United States)

    Hendriks, Lizza E L; Hermans, Bregtje C M; van den Beuken-van Everdingen, Marieke H J; Hochstenbag, Monique M H; Dingemans, Anne-Marie C

    2016-02-01

    Bone metastases are common in patients with non-small cell lung cancer (NSCLC), often causing pain and a decrease in quality of life (QoL). The effect of bone-targeted agents is evaluated by reduction in skeletal-related events in which neither pain nor QoL are included. Radioisotopes can be administered for more diffuse bone pain that is not eligible for palliative radiotherapy. The evidence that bone-targeted agents relieve pain or improve QoL is not solid. We performed a systematic review of the effect of bone-targeted agents on pain and QoL in patients with NSCLC. Our systematic literature search included original articles or abstracts reporting on bisphosphonates, denosumab, or radioisotopes or combinations thereof in patients with bone metastases (≥5 patients with NSCLC), with pain, QoL, or both serving as the primary or secondary end point. Of the twenty-five eligible studies, 13 examined bisphosphonates (one also examined denosumab) and 12 dealt with radioisotopes. None of the randomized studies on bisphosphonates or denosumab evaluated pain and QoL as the primary end point. In the single-arm studies of bisphosphonates a decrease in pain or analgesic consumption was found for 38% to 77% of patients. QoL was included in five of 13 studies, but improvement was found in only two. No high-level evidence that bisphosphonates or denosumab reduce pain or improve QoL was found. Although the data are limited, radioisotopes seem to reduce pain with a rapid onset of action and duration of response of 1 to 3 months. The evidence that bisphosphonates or denosumab reduce or prevent pain in patients with NSCLC and bone metastases or that they have an influence on QoL is very weak. Radioisotopes can be used to reduce diffuse pain, although there is no high-level evidence supporting such use. Copyright © 2015 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  12. [Effectiveness of conventional diagnostic radiology and nuclear medicine in the treatment of pain from bone metastases].

    Science.gov (United States)

    Genovese, Eugenio Annibale; Mallardo, Vania; Vaccaro, Andrea; Santagata, Mario; Raucci, Antonio; D'Agosto, Gianfranco; Fontanarosa, Antonio; Schillirò, Francesco

    2013-01-01

    Bone is one of the most common metastasis sites from solid tumors. Bone pain due to metastatic neoplastic growth is due to tumor infiltration and expansion of bone membranes. Treatment of acute and chronic pain represents one of the greatest problems in clinical oncology, requiring a multidisciplinary approach. This review focuses on the effectiveness of conventional diagnostic radiology and nuclear medicine for the detection, management and treatment of pain from bone metastasis.

  13. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  14. Dexamethasone for the prevention of a pain flare after palliative radiotherapy for painful bone metastases: a multicenter double-blind placebo-controlled randomized trial

    International Nuclear Information System (INIS)

    Westhoff, Paulien G; Graeff, Alexander de; Geerling, Jenske I; Reyners, Anna KL; Linden, Yvette M van der

    2014-01-01

    Radiotherapy has a good effect in palliation of painful bone metastases, with a pain response rate of more than 60%. However, shortly after treatment, in approximately 40% of patients a temporary pain flare occurs, which is defined as a two-point increase of the worst pain score on an 11-point rating scale compared to baseline, without a decrease in analgesic intake, or a 25% increase in analgesic intake without a decrease in worst pain score, compared to baseline. A pain flare has a negative impact on daily functioning and mood of patients. It is thought to be caused by periostial edema after radiotherapy. Dexamethasone might diminish this edema and thereby reduce the incidence of pain flare. Two non-randomized studies suggest that dexamethasone reduces the incidence of a pain flare by 50%. The aim of this trial is to study the effectiveness of dexamethasone to prevent a pain flare after palliative radiotherapy for painful bone metastases and to determine the optimal dose schedule. This study is a three-armed, double-blind, placebo-controlled multicenter trial. We aim to include 411 patients with uncomplicated painful bone metastases from any type of primary solid tumor who receive short schedule radiotherapy (all conventional treatment schedules from one to six fractions). Arm 1 consists of daily placebo for four days, arm 2 starts with 8 mg dexamethasone before the (first) radiotherapy and three days placebo thereafter. Arm 3 consists of four days 8 mg dexamethasone. The primary endpoint is the occurrence of a pain flare. Secondary endpoints are pain, quality of life and side-effects of dexamethasone versus placebo. Patients complete a questionnaire (Brief Pain Inventory with two added questions about side-effects of medication, the EORTC QLQ-C15-PAL and QLQ-BM22 for quality of life) at baseline, daily for two weeks and lastly at four weeks. This study will show whether dexamethasone is effective in preventing a pain flare after palliative radiotherapy for

  15. Single-dose radiotherapy for painful bone metastases

    International Nuclear Information System (INIS)

    Kal, H.B.

    1999-01-01

    Background: External beam radiotherapy is frequently applied for palliative treatment of painful bone lesions with a variety of fractionation schemes. There is a continuous interest to administer only 1 or a few dose fractions for inducing pain relief. Methods: A review of the literature was made with the aim to determine whether a treatment can be deduced that is simple and effective. The linear-quadratic (L-Q) concept was applied to compare reported therapy schemes which each other for the iso-effect pain relief. Results: Single-dose and fractionated radiotherapy resulted in partial or complete pain relief in about 80% of the patients. Complete responses have been observed in about 43% of the patients. For patients responding to treatment, the duration of pain relief is at least 3 to 4 months with reported duration of up to 1 year or even longer. Conclusion: Based on this review of literature data concerning randomized trials a treatment with a single dose of 8 Gy is effective for inducing pain relief. (orig.) [de

  16. Magnification bone scan of knees for knee pain evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myoung Hoon; Park, Chan H.; Yoon, Seok Nam; Hwang, Kyung Hoon [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    2001-07-01

    Knee pain is one of the common complaints of patients seen in our orthopedic clinic. Routine anterior and posterior views of whole body bone scan (WBBS) is often not sufficient in the evaluation of these patients. An ideal bone scan using pinhole collimator or single photon emission tomography (SPECT), however, is impractical and time consuming in busy nuclear medicine department with limited resources. Therefore, the aim of the study is to assess limited bone scan of knees with magnification (LNSKM) for knee pain evaluation. Technical aspect of LBSKM and diagnostic efficacy are discussed on this poster. Adult patients with knee pain were reffered for LBSKM from an orthopedic surgen specializing knees. Four hundred fifteen LBSKMs were performed since 1999. patients were given 740 MBq (20mCi) Tc-99m MDP intravenously and 3 hours later LBSKM was performed using a low energy high resolution parallel hole collimator and Siemens Orbitor camera. (Simens medical systems. Inc., Hoffman Estates, III., USA). Anterior view of the knees was taken for 5 min, without magnification and both lateral views of symptomatic knees were obtained with electronic magnification (1.25, upto 2.0) for 8 min each. Disease processes such as DJD, traumatic arthritis, P-F tendonitis, SONK, meniscus tear are detected and illustrated along with normal knee scan finding. We believe LBSKM may not be as good as SPECT or pinhole imaging of the knees in the evaluation of knee pain but superior to routine WBBS in the nuclear medicine department with limited resources of instrumentation and manpower.

  17. Bone mineral density and secondary hyperparathyroidism in pulmonary hypertension.

    Science.gov (United States)

    Ulrich, Silvia; Hersberger, Martin; Fischler, Manuel; Huber, Lars C; Senn, Oliver; Treder, Ursula; Speich, Rudolf; Schmid, Christoph

    2009-04-14

    Low bone mineral density (BMD) is common in chronic lung diseases and associated with reduced quality of life. Little is known about BMD in pulmonary hypertension (PH). Steroid-naïve patients with PH (n=34; 19 idiopathic, 15 chronic thromboembolic) had BMD measured by DXA at the time of diagnostic right heart catheterization. Exercise capacity, quality of life and various parameters related to PH severity and bone metabolism were also assessed. 24 patients with left heart failure (LHF) were similarly assessed as controls. The prevalence of osteopenia was high both in PH (80%) and in controls with LHF (75%). Low BMD was associated with lean body mass, age, lower BMI, impaired exercise capacity and in PH with higher pulmonary vascular resistance. Serum parathyroid hormone (PTH) was elevated and considerably higher in PH than in LHF (above normal, in 55 vs 29%). Secondary hyperparathyroidism was not related to impaired renal function but possibly to low vitamin D status. Osteopenia is common in PH and in chronically ill patients with LHF. Osteopenia is associated with known risk factors but in PH also with disease severity. Preventive measures in an increasingly chronic ill PH population should be considered. Secondary hyperparathyroidism is highly prevalent in PH and might contribute to bone and possibly pulmonary vascular disease. Whether adequate vitamin D substitution could prevent low BMD in PH remains to be determined.

  18. Do Laying Hens with Keel Bone Fractures Experience Pain?

    Science.gov (United States)

    Nasr, Mohammed A. F.; Nicol, Christine J.; Murrell, Joanna C.

    2012-01-01

    The European ban on battery cages has forced a change towards the use of non-cage or furnished cage systems, but unexpectedly this has been associated with an increased prevalence of keel bone fractures in laying hens. Bone fractures are acutely painful in mammals, but the effect of fractures on bird welfare is unclear. We recently reported that keel bone fractures have an effect on bird mobility. One possible explanation for this is that flying becomes mechanically impaired. However it is also possible that if birds have a capacity to feel pain, then ongoing pain resulting from the fracture could contribute to decreased mobility. The aim was to provide proof of concept that administration of appropriate analgesic drugs improves mobility in birds with keel fracture; thereby contributing to the debate about the capacity of birds to experience pain and whether fractures are associated with pain in laying hens. In hens with keel fractures, butorphanol decreased the latency to land from perches compared with latencies recorded for these hens following saline (mean (SEM) landing time (seconds) birds with keel fractures treated with butorphanol and saline from the 50, 100 and 150 cm perch heights respectively 1.7 (0.3), 2.2 (0.3), p = 0.05, 50 cm; 12.5 (6.6), 16.9 (6.7), p = 0.03, 100 cm; 20.6 (7.4), 26.3 (7.6), p = 0.02 150 cm). Mobility indices were largely unchanged in birds without keel fractures following butorphanol. Critically, butorphanol can be considered analgesic in our study because it improved the ability of birds to perform a complex behaviour that requires both motivation and higher cognitive processing. This is the first study to provide a solid evidential base that birds with keel fractures experience pain, a finding that has significant implications for the welfare of laying hens that are housed in non-cage or furnished caged systems. PMID:22927930

  19. Do laying hens with keel bone fractures experience pain?

    Directory of Open Access Journals (Sweden)

    Mohammed A F Nasr

    Full Text Available The European ban on battery cages has forced a change towards the use of non-cage or furnished cage systems, but unexpectedly this has been associated with an increased prevalence of keel bone fractures in laying hens. Bone fractures are acutely painful in mammals, but the effect of fractures on bird welfare is unclear. We recently reported that keel bone fractures have an effect on bird mobility. One possible explanation for this is that flying becomes mechanically impaired. However it is also possible that if birds have a capacity to feel pain, then ongoing pain resulting from the fracture could contribute to decreased mobility. The aim was to provide proof of concept that administration of appropriate analgesic drugs improves mobility in birds with keel fracture; thereby contributing to the debate about the capacity of birds to experience pain and whether fractures are associated with pain in laying hens. In hens with keel fractures, butorphanol decreased the latency to land from perches compared with latencies recorded for these hens following saline (mean (SEM landing time (seconds birds with keel fractures treated with butorphanol and saline from the 50, 100 and 150 cm perch heights respectively 1.7 (0.3, 2.2 (0.3, p = 0.05, 50 cm; 12.5 (6.6, 16.9 (6.7, p = 0.03, 100 cm; 20.6 (7.4, 26.3 (7.6, p = 0.02 150 cm. Mobility indices were largely unchanged in birds without keel fractures following butorphanol. Critically, butorphanol can be considered analgesic in our study because it improved the ability of birds to perform a complex behaviour that requires both motivation and higher cognitive processing. This is the first study to provide a solid evidential base that birds with keel fractures experience pain, a finding that has significant implications for the welfare of laying hens that are housed in non-cage or furnished caged systems.

  20. Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

    International Nuclear Information System (INIS)

    Chow, Edward; Ling, Alison; Davis, Lori; Panzarella, Tony; Danjoux, Cyril

    2005-01-01

    Background and purpose: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials

  1. Pheochromocytoma presenting as musculoskeletal pain from bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Lynn, M.D.; Braunstein, E.M.; Shapiro, B.

    1987-10-01

    Six patients presented with musculoskeletal pain resulting from destructive bone lesions. These patients were ultimately shown to have metastatic pheochromocytoma. None of the cases exhibited typical symptoms of metastatic pheochromocytoma, nor was it suspected at the time of presentation. In three patients, hypertension caused pheochromocytoma to be considered as a diagnosis. The three remaining patients, all of whom had documented hypertension in the past, underwent bone biopsy. Two of these patients became markedly hypertensive in the postoperative period. Malignant pheochromocytoma may present with metastatic skeletal disease in some patients in whom the presence of hypertension as well as a carefully elicited history may suggest the diagnosis. In such patients, the possibility of pheochromocytoma should be taken into account, as biopsy may trigger a hypertensive crisis in patients not under adrenergic blockade.

  2. Scaling of Haversian canal surface area to secondary osteon bone volume in ribs and limb bones.

    Science.gov (United States)

    Skedros, John G; Knight, Alex N; Clark, Gunnar C; Crowder, Christian M; Dominguez, Victoria M; Qiu, Shijing; Mulhern, Dawn M; Donahue, Seth W; Busse, Björn; Hulsey, Brannon I; Zedda, Marco; Sorenson, Scott M

    2013-06-01

    Studies of secondary osteons in ribs have provided a great deal of what is known about remodeling dynamics. Compared with limb bones, ribs are metabolically more active and sensitive to hormonal changes, and receive frequent low-strain loading. Optimization for calcium exchange in rib osteons might be achieved without incurring a significant reduction in safety factor by disproportionally increasing central canal size with increased osteon size (positive allometry). By contrast, greater mechanical loads on limb bones might favor reducing deleterious consequences of intracortical porosity by decreasing osteon canal size with increased osteon size (negative allometry). Evidence of this metabolic/mechanical dichotomy between ribs and limb bones was sought by examining relationships between Haversian canal surface area (BS, osteon Haversian canal perimeter, HC.Pm) and bone volume (BV, osteonal wall area, B.Ar) in a broad size range of mature (quiescent) osteons from adult human limb bones and ribs (modern and medieval) and various adult and subadult non-human limb bones and ribs. Reduced major axis (RMA) and least-squares (LS) regressions of HC.Pm/B.Ar data show that rib and limb osteons cannot be distinguished by dimensional allometry of these parameters. Although four of the five rib groups showed positive allometry in terms of the RMA slopes, nearly 50% of the adult limb bone groups also showed positive allometry when negative allometry was expected. Consequently, our results fail to provide clear evidence that BS/BV scaling reflects a rib versus limb bone dichotomy whereby calcium exchange might be preferentially enhanced in rib osteons. Copyright © 2013 Wiley Periodicals, Inc.

  3. Chodroblastoma with secondary aneurysmal bone cyst in the sphenoid sinus: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sung Hwan; Yu, In Kyu; Kim, Seong Min; Kim, Ju Heon; Lee, Seung Yeon [Eulji University Hospital, Eulji University School of Medicine, Daejeon (Korea, Republic of)

    2017-01-15

    Chondroblastomas are rare benign cartilaginous neoplasms found in young patients. These tumors typically arise in the epiphysis or apophysis of a long bone. Chondroblastomas arising in the skull and facial bones are extremely rare. We describe a rare case of a patient presenting with chondroblastoma with secondary aneurysmal bone cyst in the sphenoid sinus that mimicked invasive sinusitis or malignant bone tumor.

  4. A Simple and Effective Daily Pain Management Method for Patients Receiving Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry L.

    2010-01-01

    Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

  5. The Role of Purinergic Receptors in Cancer-Induced Bone Pain

    Directory of Open Access Journals (Sweden)

    Sarah Falk

    2012-01-01

    Full Text Available Cancer-induced bone pain severely compromises the quality of life of many patients suffering from bone metastasis, as current therapies leave some patients with inadequate pain relief. The recent development of specific animal models has increased the understanding of the molecular and cellular mechanisms underlying cancer-induced bone pain including the involvement of ATP and the purinergic receptors in the progression of the pain state. In nociception, ATP acts as an extracellular messenger to transmit sensory information both at the peripheral site of tissue damage and in the spinal cord. Several of the purinergic receptors have been shown to be important for the development and maintenance of neuropathic and inflammatory pain, and studies have demonstrated the importance of both peripheral and central mechanisms. We here provide an overview of the current literature on the role of purinergic receptors in cancer-induced bone pain with emphasis on some of the difficulties related to studying this complex pain state.

  6. Pain and quality of life following palliative radiotherapy of bone metastases

    International Nuclear Information System (INIS)

    Sauer, N.; Wild, B.; Henningsen, P.; Jakobsen, T.; Leising, D.; Treiber, M.

    2006-01-01

    Pain and quality of life following palliative radiotherapy of bone metastases Background and purpose: palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases. Patients and methods: 263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data. Results: radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably. Conclusion: Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects. (orig.)

  7. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Carrafiello, Gianpaolo; Lagana, Domenico; Ianniello, Andrea; Nicotera, Paolo; Fontana, Federico; Dizonno, Massimiliano; Cuffari, Salvatore; Fugazzola, Carlo

    2009-01-01

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  8. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carrafiello, Gianpaolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: gcarraf@tin.it; Lagana, Domenico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: donlaga@gmail.com; Ianniello, Andrea [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: ianand@libero.it; Nicotera, Paolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: paolonicotera@virgilio.it; Fontana, Federico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: fede.fontana@libero.it; Dizonno, Massimiliano [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: massimilianodizonno@libero.it; Cuffari, Salvatore [Service of Anaesthesiology and Palliative Care, University of Insubria, 21100 Varese (Italy)], E-mail: salvatore.cuffari@libero.it; Fugazzola, Carlo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: carlo.fugazzola@ospedale.varese.it

    2009-08-15

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  9. Survey of bone pain in patients of infectious section of Labafinejad hospital using radioisotope scanning

    International Nuclear Information System (INIS)

    Ibrahimie, Farhad

    1996-01-01

    Skeletal scintigraphy is the first or second most frequently performed imaging procedure in most nuclear medicine departments. The uses of bone scan in orthopedic practice are multiple. Bone scans are often used to localize disease, to identify areas of focal increased physiological activity, and to evaluate pain. Bone scans are particularly useful in depicting and localizing small tumors. Bone scans may clarify the significance of radiographic abnormalities. When pain is poorly localized, a bone scan helps focus attention, particularly when it precisely corresponds to the questionable radiographic lesion. In order to do a survey about role of bone scan for the detection and localizing bone pain, a retrospective study was done about 37 patient who from 1373 to 1374 were admitted to the infectious department of Martyr Labafinejad having bone pain. The results of our studies showed that most common case of bone pain of this patients was due to brucellosis (brucella arthritis) with 19%, and other causes were cellulits with 13.15% osteomyelitis and D.J.D with 11%, septic arthritis, bone metastasis, bone abscesses, discopathy, infectious spondylitis, lymphoma, D.V.T. and reactive traumatic arthritis with 2.7%

  10. Pain in castration-resistant prostate cancer with bone metastases: a qualitative study

    Directory of Open Access Journals (Sweden)

    Gater Adam

    2011-10-01

    Full Text Available Abstract Background Bone metastases are a common painful and debilitating consequence of castration-resistant prostate cancer (CPRC. Bone pain may predict patients' prognosis and there is a need to further explore CRPC patients' experiences of bone pain in the overall context of disease pathology. Due to the subjective nature of pain, assessments of pain severity, onset and progression are reliant on patient assessment. Patient reported outcome (PRO measures, therefore, are commonly used as key endpoints for evaluating the efficacy of CRPC treatments. Evidence of the content validity of leading PRO measures of pain severity used in CRPC clinical trials is, however, limited. Methods To document patients' experience of CRPC symptoms including pain, and their impact on health-related quality of life (HRQL, semi-structured in-depth qualitative interviews were conducted with 17 patients with CRPC and bone metastases. The content validity of the Present Pain Intensity (PPI scale from the McGill Pain Questionnaire (MPQ, and the 'Average Pain' and 'Worst Pain' items of the Brief Pain Inventory Short-Form (BPI-SF was also assessed. Results Patients with CRPC and bone metastases present with a constellation of symptoms that can have a profound effect on HRQL. For patients in this study, bone pain was the most prominent and debilitating symptom associated with their condition. Bone pain was chronic and, despite being generally well-managed by analgesic medication, instances of breakthrough cancer pain (BTcP were common. Cognitive debriefing of the selected PRO measures of pain severity highlighted difficulties among patients in understanding the verbal response scale (VRS of the MPQ PPI scale. There were also some inconsistencies in the way in which the BPI-SF 'Average Pain' item was interpreted by patients. In contrast, the BPI-SF 'Worst Pain' item was well understood and interpreted consistently among patients. Conclusions Study findings support the

  11. Palliation of bone cancer pain by antagonists of platelet-activating factor receptors.

    Directory of Open Access Journals (Sweden)

    Katsuya Morita

    Full Text Available Bone cancer pain is the most severe among cancer pain and is often resistant to current analgesics. Thus, the development of novel analgesics effective at treating bone cancer pain are desired. Platelet-activating factor (PAF receptor antagonists were recently demonstrated to have effective pain relieving effects on neuropathic pain in several animal models. The present study examined the pain relieving effect of PAF receptor antagonists on bone cancer pain using the femur bone cancer (FBC model in mice. Animals were injected with osteolytic NCTC2472 cells into the tibia, and subsequently the effects of PAF receptor antagonists on pain behaviors were evaluated. Chemical structurally different type of antagonists, TCV-309, BN 50739 and WEB 2086 ameliorated the allodynia and improved pain behaviors such as guarding behavior and limb-use abnormalities in FBC model mice. The pain relieving effects of these antagonists were achieved with low doses and were long lasting. Blockade of spinal PAF receptors by intrathecal injection of TCV-309 and WEB 2086 or knockdown of the expression of spinal PAF receptor protein by intrathecal transfer of PAF receptor siRNA also produced a pain relieving effect. The amount of an inducible PAF synthesis enzyme, lysophosphatidylcholine acyltransferase 2 (LPCAT2 protein significantly increased in the spinal cord after transplantation of NCTC 2472 tumor cells into mouse tibia. The combination of morphine with PAF receptor antagonists develops marked enhancement of the analgesic effect against bone cancer pain without affecting morphine-induced constipation. Repeated administration of TCV-309 suppressed the appearance of pain behaviors and prolonged survival of FBC mice. The present results suggest that PAF receptor antagonists in combination with, or without, opioids may represent a new strategy for the treatment of persistent bone cancer pain and improve the quality of life of patients.

  12. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, Rikke Rie; Nielsen, Christian K.; Nasser, Arafat

    2011-01-01

    The purinergic P2X7 receptor is implicated in both neuropathic and inflammatory pain, and has been suggested as a possible target in pain treatment. However, the specific role of the P2X7 receptor in bone cancer pain is unknown. We demonstrated that BALB/cJ P2X7 receptor knockout (P2X7R KO) mice...... were susceptible to bone cancer pain and moreover had an earlier onset of pain-related behaviours compared with cancer-bearing, wild-type mice. Furthermore, acute treatment with the selective P2X7 receptor antagonist, A-438079, failed to alleviate pain-related behaviours in models of bone cancer pain...... with and without astrocyte activation (BALB/cJ or C3H mice inoculated with 4T1 mammary cancer cells or NCTC 2472 osteosarcoma cells, respectively), suggesting that astrocytic P2X7 receptors play a negligible role in bone cancer pain. The results support the hypothesis that bone cancer pain is a separate pain state...

  13. Characteristics of bone biochemical indices in predicting secondary osteoporotic fracture after intertrochanteric fracture in elderly women

    Directory of Open Access Journals (Sweden)

    Shaofeng Yang

    2018-01-01

    The Translational Potential of this Article: Besides BMD, bone microstructure and remodeling levels can be accurately measured by bone biochemical indices. The main objective of this research is to explore the change of BMD and the serum level of bone biochemical indices of elderly women who suffered unilateral intertrochanteric fracture within 12 months. Simultaneously, with aim to better obtain bone remodeling level and predict more accurately the risk of a secondary osteoporotic fracture, bone biochemical indices of these patients, who undergo secondary osteoporotic fracture or not, are collected during follow-up and compared respectively.

  14. Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer

    Directory of Open Access Journals (Sweden)

    Santanu Pal

    2014-01-01

    Full Text Available Background: The primary aim of this prospective non-randomized study was to evaluate the effect of hemi-body irradiation (HBI on pain and quality of life in cancer patients with extensive bone metastases. The secondary aim was to evaluate side-effects and cost-effectiveness of the treatment. Materials and Methods: Between March 2008 and December 2010, a total of 23 (male = 14, female = 9, median age = 60 years diagnosed cases of metastatic cancer patients (prostate = 11, breast = 6, and lung = 6 received HBI, which was delivered as lower (n = 7 (dose = 8 Gy, upper (n = 8 (dose = 6 Gy, or sequential HBI (n = 8 with a Telecobalt unit (Theratron 780C. Among them, one lung cancer patient died at 2 months and one prostate cancer patient defaulted after the second follow-up. Thus, 21 patients (male = 13, female = 8, median age = 65 years (prostatic cancer = 10, breast cancer = 6, and lung cancer = 5 were followed up for a minimum of 6 months. Evaluations were performed before and at 2, 4, 8, 16, and 24 weeks after treatment. Pain evaluation was done by Visual Analogue Scale (VAS, Verbal Rating Scale (VRS, Percentage of Pain Relief (PRR, and Global Pain Score (GPS. Toxicity was assessed by CTC v-3 toxicity scores in the medical record. Assessment of oral morphine consumption was done before and after radiation using paired t-test, and correlation analysis was also done with decrease of morphine consumption and reduction of pain score using statistical analysis. Results: Response (control of pain was partial (PR in 67% and complete (CR in 22% of patients. For most patients, the pain control lasted throughout the follow-up period (6 months. From 66.66% patients requiring 13 or more Morphine (10 mg tablets per day prior to HBI, none of the patients required to consume 13 or more Morphine (10 mg tablets per day following HBI, which was correlated with significant reduction in various pain scores (P < 0.05. One way ANOVA with Dunnett′s Multiple Comparison

  15. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    International Nuclear Information System (INIS)

    Nakamura, Naoki; Shikama, Naoto; Wada, Hitoshi; Harada, Hideyuki; Nozaki, Miwako; Nagakura, Hisayasu; Tago, Masao; Oguchi, Masahiko; Uchida, Nobue

    2012-01-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: “time until first increase in pain” (85%), “incidence of spinal cord compression” (50%), and “incidence of pathologic fractures” (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  16. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, RR; Nielsen, CK; Nasser, A

    2011-01-01

    The purinergic P2X7 receptor is implicated in both neuropathic and inflammatory pain, and has been suggested as a possible target in pain treatment. However, the specific role of the P2X7 receptor in bone cancer pain is unknown. We demonstrated that BALB/cJ P2X7 receptor knockout (P2X7R KO) mice...... of the P2X7R KO mouse. Further experiments are needed to elucidate the exact role of the P2X7 receptors in bone cancer pain. Pain-related behaviours had an earlier onset in bone cancer-bearing, P2X7 receptor-deficient mice, and treatment with A-438079 failed to alleviate pain-related behaviours....

  17. The role of conventional bone scintigraphy in evaluation of the patients with back pain

    International Nuclear Information System (INIS)

    Khancherly, A.

    2002-01-01

    The aim of study was evaluation of the results of the bone scan in patients suffering back for more than 2 weeks. In 120 patients with back pain for more than 2 w ks who referred for bone scan significant numbers showed inflammatory disease including spondylitis and/ or saltcellar's in bone scintigraphy. Because of low sensitivity of the other imaging modalities in detection of this inflammatory lesions, the bone scan can be used as primary imaging method in evaluation of the patients with back pain in certain geographic regions in which special pathogens endemic ally exist. This study was performed in Hamedan in which Brucella infection and to lesser extent Tuberculosis are endemic

  18. Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Westhoff, Paulien G.; Graeff, Alexander de; Monninkhof, Evelyn M.; Pomp, Jacqueline; Vulpen, Marco van; Leer, Jan Willem H.; Marijnen, Corrie A.M.; Linden, Yvette M. van der

    2015-01-01

    Purpose: To study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response. Patients and Methods: The prospectively collected data of 956 patients with breast, prostate, and lung cancer within the Dutch Bone Metastasis Study were used. These patients, irradiated for painful bone metastases, rated pain, QoL, and overall health at baseline and weekly afterward for 12 weeks. Using generalized estimating equations analysis, the course of QoL was studied, adjusted for primary tumor. To identify predictive variables, proportional hazard analyses were performed, taking into account death as a competing risk, and C-statistics were calculated for discriminative value. Results: In total, 722 patients (76%) responded to radiation therapy. During follow-up, responders had a better QoL in all domains compared with nonresponders. Patients with breast or prostate cancer had a better QoL than patients with lung cancer. In multivariate analysis, baseline predictors for a pain response were breast or prostate cancer as primary tumor, younger age, good performance status, absence of visceral metastases, and using opioids. The discriminative ability of the model was low (C-statistic: 0.56). Conclusions: Responding patients show a better QoL after radiation therapy for painful bone metastases than nonresponders. Our model did not have enough discriminative power to predict which patients are likely to respond to radiation therapy. Therefore, radiation therapy should be offered to all patients with painful bone metastases, aiming to decrease pain and improve QoL.

  19. Randall Selitto pressure algometry for assessment of bone-related pain in rats

    DEFF Research Database (Denmark)

    Falk, S.; Ipsen, D. H.; Appel, C. K.

    2015-01-01

    Background: Deep pain is neglected compared with cutaneous sources. Pressure algometry has been validated in the clinic for assessment of bone-related pain in humans. In animal models of bone-related pain, we have validated the Randall Selitto behavioural test for assessment of acute......, and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. Results: Randall Selitto pressure...... demonstrated by the Randall Selitto test on day 17 and 21 post-surgery. A difference was also demonstrated by von Frey testing, weight-bearing and limb use tests. Conclusion: Our results indicate that pressure applied by the Randall Selitto algometer on a region, where the bone is close to the skin, may offer...

  20. Pain and Mean Absorbed Dose to the Pubic Bone After Radiotherapy Among Gynecological Cancer Survivors

    International Nuclear Information System (INIS)

    Waldenstroem, Ann-Charlotte; Olsson, Caroline; Wilderaeng, Ulrica; Dunberger, Gail; Lind, Helena; Al-Abany, Massoud; Palm, Asa; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

    2011-01-01

    Purpose: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. Methods and Materials: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. Results: We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses ≥52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Conclusions: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.

  1. Human brain activity associated with painful mechanical stimulation to muscle and bone

    OpenAIRE

    Maeda, Lynn; Ono, Mayu; Koyama, Tetsuo; Oshiro, Yoshitetsu; Sumitani, Masahiko; Mashimo, Takashi; Shibata, Masahiko

    2011-01-01

    Purpose The purpose of this study was to elucidate the central processing of painful mechanical stimulation to muscle and bone by measuring blood oxygen level-dependent signal changes using functional magnetic resonance imaging (fMRI). Methods Twelve healthy volunteers were enrolled. Mechanical pressure on muscle and bone were applied at the right lower leg by an algometer. Intensities were adjusted to cause weak and strong pain sensation at either target site in preliminary testing. Brain ac...

  2. Successful treatment of pain in melorheostosis with zoledronate, with improvement on bone scintigraphy

    Science.gov (United States)

    Slimani, Samy; Nezzar, Adlen; Makhloufi, Hachemi

    2013-01-01

    Melorheostosis is a very rare sclerosing bone disorder that involves frequently one limb. It may be asymptomatic, but pain and limb deformity may occur and can be very debilitating. Different reports have indicated efficacy of bisphosphonates (pamidronate and etidronate) on symptoms. We report an adult patient with a very painful melorheostosis, who  improved after treatment with zoledronate, either on symptoms or on bone scans. PMID:23813581

  3. The role of purinergic receptors in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Heegaard, Anne-Marie

    2012-01-01

    mechanisms underlying cancer-induced bone pain including the involvement of ATP and the purinergic receptors in the progression of the pain state. In nociception, ATP acts as an extracellular messenger to transmit sensory information both at the peripheral site of tissue damage and in the spinal cord......Cancer-induced bone pain severely compromises the quality of life of many patients suffering from bone metastasis, as current therapies leave some patients with inadequate pain relief. The recent development of specific animal models has increased the understanding of the molecular and cellular....... Several of the purinergic receptors have been shown to be important for the development and maintenance of neuropathic and inflammatory pain, and studies have demonstrated the importance of both peripheral and central mechanisms. We here provide an overview of the current literature on the role...

  4. Fronto-parietal osteoblastoma with secondary aneurysmal bone cyst: a case report.

    Science.gov (United States)

    Kubota, Yoshitaka; Mitsukawa, Nobuyuki; Arikawa, Risa; Akita, Shinsuke; Satoh, Kaneshige

    2013-02-01

    Osteoblastomas and aneurysmal bone cysts each comprise 1% of primary bone tumours. As both osteoblastomas and aneurysmal bone cysts are not common, osteoblastomas with secondary aneurysmal bone cysts of calvaria are extremely rare. Only three cases describing a secondary aneurysmal bone cyst in the setting of a calvarial osteoblastoma can be found in the literature. We report the case of the surgical resection of the fronto-parietal osteoblastoma accompanying a secondary aneurysmal bone cyst. The case is a 24-year-old male with a 2-year history of a painless lump in the hair-bearing region of the left fronto-parietal area without neurologic symptoms. Computed tomography showed an intradiploic tumour with maintained inner and outer cortex of the left front-parietal bones. 3.0-T magnetic resonance imaging showed a well-circumscribed, intradiploic, multilocular cystic tumour. A gadolinium-enhanced sequence showed strong peripheral and septal enhancement. These findings were consistent with an osteoblastoma associated with secondary aneurysmal bone cyst. An en bloc tumour resection with a 10-mm horizontal margin was completed without complications. The calvarial defect was covered by calvarial bone graft harvested from the contralateral fronto-parietal bone. The postoperative course was uneventful. Pathological diagnosis was consistent with the osteoblastoma with secondary aneurysmal bone cyst. After a follow-up period of 2 years, there was no evidence of recurrence. The combination of osteoblastoma and aneurysmal bone cyst of the calvaria is a rare clinical entity. Careful preoperative examination and complete resection of the tumour are essential. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Randall Selitto pressure algometry for assessment of bone-related pain in rats.

    Science.gov (United States)

    Falk, S; Ipsen, D H; Appel, C K; Ugarak, A; Durup, D; Dickenson, A H; Heegaard, A M

    2015-03-01

    Deep pain is neglected compared with cutaneous sources. Pressure algometry has been validated in the clinic for assessment of bone-related pain in humans. In animal models of bone-related pain, we have validated the Randall Selitto behavioural test for assessment of acute and pathological bone pain and compared the outcome with more traditional pain-related behaviour measures. Randall Selitto pressure algometry was performed over the anteromedial part of the tibia in naïve rats, sham-operated rats, and rats inoculated with MRMT-1 carcinoma cells in the left tibia, and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. Randall Selitto pressure algometry over the tibia resulted in reproducible withdrawal thresholds, which were dose-dependently increased by morphine. Cutaneous nociception did not contribute to Randall Selitto measures. In cancer-bearing animals, compared with sham, significant differences in pain-related behaviours were demonstrated by the Randall Selitto test on day 17 and 21 post-surgery. A difference was also demonstrated by von Frey testing, weight-bearing and limb use tests. Our results indicate that pressure applied by the Randall Selitto algometer on a region, where the bone is close to the skin, may offer a way to measure bone-related pain in animal models and could provide a supplement to the traditional behavioural tests and a means to study deep pain. © 2014 European Pain Federation - EFIC®

  6. Metabolic radionuclide therapy of metastatic bone pain using 89SrCl (metastron)

    International Nuclear Information System (INIS)

    Dancheva, Z.

    2009-01-01

    Metabolic radionuclide therapy of metastatic bone pain using 89 SrCl (metastron) is discussed in historical point of view and in perspective. Also its place among the conventional therapeutic options for bone pain palliation and the perspectives for an improvement in its efficiency is evaluated. Pharmacokinetics of 89 SrCl and the mechanism of its impact on pathophysiology of metastatic bone pain were considered. In regard to an optimal selection of patients, that would benefit most of the therapy, the indications, criteria and effectiveness of the therapy in patients in different stages of the malignancy or with different bone metastases were analyzed. In this article are also discussed current changes in treatment approaches. They consist in earlier administration of metastron in the course of the neoplastic disease and in more accurate selection of patients with predominant osteoblastic bone metastases. Radionuclide metabolic therapy has some advantages to conventional therapeutic approaches that are considered in this article. One of them is the opportunity for combined therapy using 89 SrCl and biphosphonates and/ or chemotherapy Together these approaches have a synergistic effect inducing better efficacy in bone pain palliation, delay in new incidence of metastatic bone process, decrease in metastatic bone related complications and may be a better life expectancy. (author)

  7. Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

    International Nuclear Information System (INIS)

    Huisman, Merel; Bosch, Maurice A.A.J. van den; Wijlemans, Joost W.; Vulpen, Marco van; Linden, Yvette M. van der; Verkooijen, Helena M.

    2012-01-01

    Purpose: Reirradiation of painful bone metastases in nonresponders or patients with recurrent pain after initial response is performed in up to 42% of patients initially treated with radiotherapy. Literature on the effect of reirradiation for pain control in those patients is scarce. In this systematic review and meta-analysis, we quantify the effectiveness of reirradiation for achieving pain control in patients with painful bone metastases. Methods and Materials: A free text search was performed to identify eligible studies using the MEDLINE, EMBASE, and the Cochrane Collaboration library electronic databases. After study selection and quality assessment, a pooled estimate was calculated for overall pain response for reirradiation of metastatic bone pain. Results: Our literature search identified 707 titles, of which 10 articles were selected for systematic review and seven entered the meta-analysis. Overall study quality was mediocre. Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation. Overall, a pain response after reirradiation was achieved in 58% of patients (pooled overall response rate 0.58, 95% confidence interval = 0.49–0.67). There was a substantial between-study heterogeneity (I 2 = 63.3%, p = 0.01) because of clinical and methodological differences between studies. Conclusions: Reirradiation of painful bone metastases is effective in terms of pain relief for a small majority of patients; approximately 40% of patients do not benefit from reirradiation. Although the validity of results is limited, this meta-analysis provides a comprehensive overview and the most quantitative estimate of reirradiation effectiveness to date.

  8. Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients

    DEFF Research Database (Denmark)

    Meyer, Steffen; Pedersen, Kirsten Mølsted

    2013-01-01

    The objective was to assess the long-term outcome of secondary alveolar bone grafting (SABG) in cleft lip and palate patients and to examine relationships between preoperative and postoperative factors and overall long-term bone graft success. The records of 97 patients with cleft lip and palate......, who had secondary alveolar bone grafting of 123 alveolar clefts, were examined. Interalveolar bone height was assessed radiographically a minimum of 10 years after grafting using a 4-point scale (I-IV), where types I and II were considered a success. After an average follow-up of 16 years after SABG...... to the cleft. No significant differences were found with regard to the other parameters investigated. The timing of secondary alveolar bone grafting is critical with regard to the age of the patient and the stage of eruption of the tooth distal to the cleft....

  9.  Oncogenic osteomalacia and its symptoms: hypophosphatemia, bone pain and pathological fractures

    Directory of Open Access Journals (Sweden)

    Sonia Kaniuka-Jakubowska

    2012-08-01

    Full Text Available  Oncogenic osteomalacia (OOM is a rare paraneoplastic syndrome induced by tumor produced phosphaturic factors, i.e. phosphatonins. The disorder is characterized by renal tubular phosphate loss, secondary to this process hypophosphatemia and defective production of active form of vitamin D. The clinical course of oncogenic osteomalacia is characterized by bone pain, pathological fractures, muscle weakness and general fatigue. Osteomalacia-associated tumors are usually located in the upper and lower limbs, with half of the lesions primarily situated in the bones. Most of them are small, slow-growing tumors. Their insignificant size and various location coupled with rare occurrence of the disease and non-specificity of clinical symptoms lead to difficulties in reaching a diagnosis, which is often time-consuming and requires a number of additional tests. The average time between the appearance of the first symptoms and the establishment of an accurate diagnosis and the beginning of treatment is over 2.5 years. The aim of this study is to discuss the pathophysiology of disease symptoms, pathomorphology of tumors, diagnostic methods and treatment of oncogenic osteomalacia.

  10. Bone mineral density in the chronic patellofemoral pain syndrome.

    Science.gov (United States)

    Leppälä, J; Kannus, P; Natri, A; Sievänen, H; Järvinen, M; Vuori, I

    1998-06-01

    Bone mineral density (BMD) and clinical status of 40 patients with a chronic, unilateral patellofemoral pain syndrome (PFPS) were determinated. The mean duration of the disease at the time of the follow-up was 7.6 +/- 1.8 (SD) years. The BMD was measured at the spine (L2-L4), and the femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and calcaneus of both lower extremities using a dual-energy X-ray absorptiometric (DXA) scanner. The mean BMD of the affected limb (compared with the unaffected side) was significantly lower in the distal femur (-3.3%; P = 0.002), patella (-2.5%; P = 0.016), and proximal tibia (-1.9%; P = 0.008). The femoral neck, trochanter area of the femur, and calcaneus showed no significant side-to-side differences, and the spinal BMDs of men and women with the PFPS were comparable with the manufacturer's age-adjusted reference values for Western European men and women. The relative BMDs of the affected knee showed strongest correlation with the muscle strength of the same knee: the better the muscle strength compared with the healthy knee, the higher the relative BMD (r = 0.56-0.58 with P < 0.001 in each anatomic site of the knee). In the stepwise regression analysis, low body weight or low body mass index, high level of physical activity, the patient's good subjective overall assessment of his/her affected knee, and short duration of the symptoms were also independent predictors of the high relative BMD in the affected knee so that along with the muscle strength these variables could account for 51% of the variation seen in the relative BMD of the femur, 61% in the patella, and 54% in the proximal tibia. In conclusion, chronic patellofemoral pain syndrome results in a significantly decreased BMD in the knee region of the affected limb. The spine, proximal femur, and calcaneus are not affected. Recovery of normal muscle strength and knee function seems to be of great importance for good BMD.

  11. 32-Phosphorus for bone pain palliation due to bone metastases, its safety and efficacy in patients with advanced cancer

    International Nuclear Information System (INIS)

    Fettich, J.; Nair, G.; Padky, A.K.; Stare, J.; Nair, N.; Moralles, R.; Riccabona, G.; Tanumihardia, M.

    2001-01-01

    Bone pain due to bony metastases can seriously affect a patient's quality of life. External irradiation, narcotic drugs and polyphosphates may cause important side effects or are expensive, therefore in many patients radionuclide treatment using a single dose of beta emitting bone seeking radiopharmaceuticals has become widely accepted. Except 32-Phosphorus (32-P) all of them are expensive and difficult to obtain in certain countries. The aim of the study was to evaluate safety and efficacy of 32-P for palliation of bone pain due to bony metastases by comparing it to 89-Strontium (89-Sr), the most commonly used radiopharmaceutical for bone pain palliation in the framework of a prospective IAEA co-ordinated multicenter study. A very strict protocol for unified patient inclusion and follow up was used. 93 cancer patients with osteoblastic bony metastases were included into the study, 48 were treated by 89-Sr (150 MBq) and 45 by 32-P (450 MBq). Pain score, analgesic consumption, quality of life, and indices of bone marrow depression were monitored 2 weeks pre- and up to 4 months post treatment. Favourable response to treatment was recorded in 75% of the patients treated with 89-Sr and in 60% of those treated with 32-P (p=0,122). There was no significant difference between the duration of favourable effect for both radiopharmaceuticals. Moderate decrease of white blood cell (WBC) and platelet counts, and haemoglobin (Hb) levels was detected more often in the 32-P treated group. Although 32-P appears to be more toxic, no toxic effects requiring specific treatment were seen in either group. Due to its comparable efficacy and safety, general availability and low cost its more widespread use should be encouraged to increase quality of life and reduce cost of medical care of patients with intractable bone pain due to cancer metastases. (author)

  12. Intrauterine retained fetal bones as a cause of secondary infertility ...

    African Journals Online (AJOL)

    It is believed that bones re-tained freely in the endometrial cavity behave as an intrauterine contraceptive device (IUCD). Be-cause of the many complications associated with mid-trimester dilatation and evacuation of the uterus, its role in modern gynaecology should be limited. It is suggested that retained fetal bones should ...

  13. Monostotic fibrous dysplasia of a lumbar vertebral body with secondary aneurysmal bone cyst formation: a case report

    Directory of Open Access Journals (Sweden)

    Snieders Marieke N

    2009-06-01

    Full Text Available Abstract We report the case of a 25-year-old Caucasian woman with symptomatic monostotic fibrous dysplasia of the fourth lumbar vertebral body. The patient suffered from a five-week history of progressive low back pain, radiating continuously to the left leg. Her medical history and physical and neurological examination did not demonstrate any significant abnormalities. Radiographs, computed tomography and magnetic resonance imaging revealed an osteolytic expansive lesion with a cystic component of the fourth lumbar vertebral body. Percutaneous transpedicular biopsy showed histological characteristics of fibrous dysplasia superimposed by the formation of aneurysmal bone cyst components. The patient was treated by subtotal vertebrectomy of the L4 vertebral body with anterior reconstruction and her postoperative course was uncomplicated. To our knowledge, this is the first reported case of a monostotic fibrous dysplasia with superimposed secondary aneurysmal bone cysts of a lumbar vertebral body.

  14. Adolescent low back pain among secondary school students in ...

    African Journals Online (AJOL)

    Abstract. Background: Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or tell- tale sign of future incidence of low back pain in adulthood. Published articles on ALBP in Nigeria are not readily available. Objectives: The study's objectives were to investigate the ...

  15. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Naoki, E-mail: naokinak@luke.or.jp [Department of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan); Shikama, Naoto [Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka (Japan); Wada, Hitoshi [Department of Radiation Oncology, Miyagi Cancer Center, Natori (Japan); Harada, Hideyuki [Division of Radiation Oncology, Shizuoka Cancer Center, Mishima (Japan); Nozaki, Miwako [Department of Radiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya (Japan); Nagakura, Hisayasu [Department of Radiology, KKR Sapporo Medical Center, Sapporo (Japan); Tago, Masao [Department of Radiology, Teikyo University Mizonokuchi Hospital, Kawasaki (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Uchida, Nobue [Department of Radiation Oncology, Shimane University Hospital, Izumo (Japan)

    2012-05-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: 'time until first increase in pain' (85%), 'incidence of spinal cord compression' (50%), and 'incidence of pathologic fractures' (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  16. Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

    International Nuclear Information System (INIS)

    Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N.

    2002-01-01

    Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

  17. Tanshinone IIA Exerts an Antinociceptive Effect in Rats with Cancer-induced Bone Pain.

    Science.gov (United States)

    Hao, Wei; Chen, Lei; Wu, Li-Fang; Yang, Fan; Niu, Jian-Xiang; Kaye, Alan D; Xu, Shi-Yuan

    2016-01-01

    Cancer-induced bone pain (CIBP) is a common chronic pain characterized by 2 components, ongoing pain and breakthrough pain. Tanshinone IIA (TSN IIA) is a bioactive constituent of the traditional Chinese medicine Danshen, which has been reported to have an antinociceptive effect on neuropathic and inflammatory pain through downregulation of the late proinflammatory cytokine high-mobility group protein B1 (HMGB1). To assess the antinociceptive effect of TSN IIA on CIBP. A randomized, double-blind, controlled animal trial was performed. University lab in China. A rat CIBP model was established by injecting Walker 256 mammary gland carcinoma cells into the intramedullary cavity of the tibia. Both ongoing pain, e.g., flinching and guarding, and breakthrough pain, e.g., limb use and von Frey threshold, were evaluated. The effects of intraperitoneally administered TSN IIA on pain behavior and the expression levels of spinal HMGB1, interleukin (IL)-1beta, tumor necrosis factor (TNF)-alpha, and IL-6 were determined. The effect of TSN IIA on the electrically evoked response of spinal wide-dynamic range (WDR) neurons was performed in vivo. TSN IIA dose-dependently inhibited cancer-induced ongoing pain and breakthrough pain. The expression levels of spinal HMGB1 and other inflammatory factors (IL-1beta, TNF-alpha, and IL-6) were increased in the rat model, but they were suppressed by TSN IIA in a dose-dependent manner. Moreover, TSN IIA significantly inhibited the neuronal responses of WDR neurons in spinal deep layers. Further studies are warranted to ascertain how TSN IIA attenuates cancer-induced ongoing pain. Our results indicate that TSN IIA attenuates cancer-induced ongoing pain and breakthrough pain, possibly via suppression of central sensitization in CIBP rats. Therefore, we have provided strong evidence supporting TSN IIA as a potential and effective therapy for relieving CIBP. Cancer-induced bone pain, high-mobility group protein B1, Tanshinone IIA, ongoing pain

  18. Influence of sex differences on the progression of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Appel, Camilla

    2013-01-01

    Background: Pain caused by bone metastases has a severe impact on the quality of life for many patients with cancer. Good translational in vivo models are required to understand the molecular mechanism and develop better treatment. In the current study we evaluated the influence of sex differences...... a significantly greater bioluminescence signal on day 2 compared to male mice and, in addition, a significant earlier onset of pain-related behavior was observed in the females. No sex difference was observed for bone degradation. Finally, a strong correlation between pain-related behavior and bone degradation...... was observed for both sexes. Conclusion: Although differences were observed between the sexes, these were minor and did not affect the overall progression of the pain state....

  19. Use of Animal Models in Understanding Cancer-induced Bone Pain

    Directory of Open Access Journals (Sweden)

    Lauren M. Slosky

    2015-01-01

    Full Text Available Many common cancers have a propensity to metastasize to bone. Although malignancies often go undetected in their native tissues, bone metastases produce excruciating pain that severely compromises patient quality of life. Cancer-induced bone pain (CIBP is poorly managed with existing medications, and its multifaceted etiology remains to be fully elucidated. Novel analgesic targets arise as more is learned about this complex and distinct pain state. Over the past two decades, multiple animal models have been developed to study CIBP's unique pathology and identify therapeutic targets. Here, we review animal models of CIBP and the mechanistic insights gained as these models evolve. Findings from immunocompromised and immunocompetent host systems are discussed separately to highlight the effect of model choice on outcome. Gaining an understanding of the unique neuromolecular profile of cancer pain through the use of appropriate animal models will aid in the development of more effective therapeutics for CIBP.

  20. Analgesic effects of lappaconitine in leukemia bone pain in a mouse model

    Directory of Open Access Journals (Sweden)

    Xiao-Cui Zhu

    2015-05-01

    Full Text Available Bone pain is a common and severe symptom in cancer patients. The present study employed a mouse model of leukemia bone pain by injection K562 cells into tibia of mouse to evaluate the analgesic effects of lappacontine. Our results showed that the lappaconitine treatment at day 15, 17 and 19 could effectively reduce the spontaneous pain scoring values, restore reduced degree in the inclined-plate test induced by injection of K562 cells, as well as restore paw mechanical withdrawal threshold and paw withdrawal thermal latency induced by injection of K562 cells to the normal levels. Additionally, the molecular mechanisms of lappaconitine’s analgesic effects may be related to affect the expression levels of endogenous opioid system genes (POMC, PENK and MOR, as well as apoptosis-related genes (Xiap, Smac, Bim, NF-κB and p53. Our present results indicated that lappaconitine may become a new analgesic agent for leukemia bone pain management.

  1. Feasibility study of Transcutaneous Electrical Nerve Stimulation (TENS) for cancer bone pain.

    Science.gov (United States)

    Bennett, Michael I; Johnson, Mark I; Brown, Sarah R; Radford, Helen; Brown, Julia M; Searle, Robert D

    2010-04-01

    This multicenter study assessed the feasibility of conducting a phase III trial of transcutaneous electrical nerve stimulation (TENS) in patients with cancer bone pain recruited from palliative care services. Eligible patients received active and placebo TENS for 1 hour at site of pain in a randomized crossover design; median interval between applications 3 days. Responses assessed at 30 and 60 minutes included numerical and verbal ratings of pain at rest and on movement, and pain relief. Recruitment, tolerability, adverse events, and effectiveness of blinding were also evaluated. Twenty-four patients were randomised and 19 completed both applications. The intervention was well tolerated. Five patients withdrew: 3 due to deteriorating performance status, and 2 due to increased pain (1 each following active and placebo TENS). Confidence interval estimation around the differences in outcomes between active and placebo TENS suggests that TENS has the potential to decrease pain on movement more than pain on rest. Nine patients did not consider that a placebo was used; the remaining 10 correctly identified placebo TENS. Feasibility studies are important in palliative care prior to undertaking clinical trials. Our findings suggest that further work is required on recruitment strategies and refining the control arm before evaluating TENS in cancer bone pain. Cancer bone pain is common and severe, and partly mediated by hyperexcitability. Animal studies suggest that Transcutaneous Electrical Nerve Stimulation can reduce hyperalgesia. This study examined the feasibility of evaluating TENS in patients with cancer bone pain in order to optimize methods before a phase III trial. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. Postoperative pain in patients undergoing a transcutaneous active bone conduction implant (Bonebridge).

    Science.gov (United States)

    Lassaletta, Luis; Calvino, Miryam; Zernotti, Mario; Gavilán, Javier

    2016-12-01

    The objective of the study was to evaluate postoperative pain following a transcutaneous active conductive hearing implant. 27 patients undergoing Bonebridge (BB) bone conduction implantation were evaluated with two pain-related questionnaires. The Headache Impact Test (HIT-6) was used to measure the degree of disability including none or little impact (≤49), mild (50-55), moderate (56-59), and severe (≥60). The Brief Pain Inventory (BPI) was used to assess pain severity score and function interference (0 = no pain to 10 = worst pain); meaningful pain was considered to be ≥3. The impact of surgical factors on postoperative pain was analyzed. Postoperative BB pain results were compared with 11 Vibrant Soundbridge™ (VSB) and 103 cochlear implant (CI) users. The mean pre- and postoperative HIT-6 scores for BB implantation were 42.6 and 41.8, respectively and the mean preoperative BPI pain severity score changed from 0.6 to 0.9 postoperatively, whereas the preoperative interference score changed from 0.1 to 0.3. None of the mean postoperative values revealed significant pain. The retrosigmoid approach, the need for dural or sinus compression, and the use of bone conduction implant lifts had no significant impact on pain scores. The mean postoperative HIT-6 pain scores for patients with BB, VSB, and CI were 41.8, 46.4, and 42.8, respectively, with the differences not being significant. BB implantation causes no significant postoperative pain irrespective of sinus or dura compression. Pain scores were similar to those experienced by patients with other transcutaneous auditory implants such as middle ear or CIs.

  3. The diagnostic value of bone scintigraphy in patients with low back pain

    International Nuclear Information System (INIS)

    Schuette, H.E.; Park, W.M.

    1983-01-01

    Bone scintigraphy has been studied in two groups of patients presenting with low back pain. In one group of 38 patients suffering ''non-specific'' back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings. (orig.)

  4. Topical Treatment with Xiaozheng Zhitong Paste (XZP Alleviates Bone Destruction and Bone Cancer Pain in a Rat Model of Prostate Cancer-Induced Bone Pain by Modulating the RANKL/RANK/OPG Signaling

    Directory of Open Access Journals (Sweden)

    Yanju Bao

    2015-01-01

    Full Text Available To explore the effects and mechanisms of Xiaozheng Zhitong Paste (XZP on bone cancer pain, Wistar rats were inoculated with vehicle or prostate cancer PC-3 into the tibia bone and treated topically with inert paste, XZP at 15.75, 31.5, or 63 g/kg twice per day for 21 days. Their bone structural damage, nociceptive behaviors, bone osteoclast and osteoblast activity, and the levels of OPG, RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were examined. In comparison with that in the placebo group, significantly reduced numbers of invaded cancer cells, decreased levels of bone damage and mechanical threshold and paw withdrawal latency, lower levels of serum TRACP5b, ICTP, PINP, and BAP, and less levels of bone osteoblast and osteoclast activity were detected in the XZP-treated rats (P<0.05. Moreover, significantly increased levels of bone OPG but significantly decreased levels of RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were detected in the XZP-treated rats (P<0.05 for all. Together, XZP treatment significantly mitigated the cancer-induced bone damage and bone osteoclast and osteoblast activity and alleviated prostate cancer-induced bone pain by modulating the RANKL/RANK/OPG pathway and bone cancer-related inflammation in rats.

  5. 3D computed tomographic evaluation of secondary alveolar bone grafts in cleft lip and palate patients

    International Nuclear Information System (INIS)

    Ohkubo, Fumio; Akai, Hidemi; Hosaka, Yoshiaki

    2001-01-01

    Alveolar bone grafting in patients with cleft lip and palate has becomes a routine part of most treatment regimes. This study was undertaken to estimate how much bone needs to be grafted into the cleft cavity and to evaluate the grafted bone using 3-DCT over a period from the early postoperative stage to after one year. Seventy-five patients divided into four groups according to the type of cleft were studied. All patients underwent secondary alveolar bone grafting using particulate cancellous bone from the anterior iliac crest. The bone graft areas were divided into two regions: the extra-cleft region and the intra-cleft region. The weight and the volume of the grafted bone were correlated and the average density was 1.5 g/ml regardless of the cleft type. The bone in the extra-cleft region could be seen in almost all slices of the CT scans, from the lower alveolar process to the piriform aperture. The extra-cleft graft ratio of unilateral and bilateral cleft lip and palate is higher than that of cleft lip and alveolus. The extra-cleft grafting is necessary to restore facial symmetry. The grafted bone was decreased in both height and volume following three months and adequate bone bridging was maintained for one year. We concluded that 3-DCT findings are one of the most valuable methods to evaluate postoperative conditions after alveolar bone grafting. (author)

  6. 3D computed tomographic evaluation of secondary alveolar bone grafts in cleft lip and palate patients

    Energy Technology Data Exchange (ETDEWEB)

    Ohkubo, Fumio; Akai, Hidemi; Hosaka, Yoshiaki [Showa Univ., Tokyo (Japan). School of Medicine

    2001-04-01

    Alveolar bone grafting in patients with cleft lip and palate has becomes a routine part of most treatment regimes. This study was undertaken to estimate how much bone needs to be grafted into the cleft cavity and to evaluate the grafted bone using 3-DCT over a period from the early postoperative stage to after one year. Seventy-five patients divided into four groups according to the type of cleft were studied. All patients underwent secondary alveolar bone grafting using particulate cancellous bone from the anterior iliac crest. The bone graft areas were divided into two regions: the extra-cleft region and the intra-cleft region. The weight and the volume of the grafted bone were correlated and the average density was 1.5 g/ml regardless of the cleft type. The bone in the extra-cleft region could be seen in almost all slices of the CT scans, from the lower alveolar process to the piriform aperture. The extra-cleft graft ratio of unilateral and bilateral cleft lip and palate is higher than that of cleft lip and alveolus. The extra-cleft grafting is necessary to restore facial symmetry. The grafted bone was decreased in both height and volume following three months and adequate bone bridging was maintained for one year. We concluded that 3-DCT findings are one of the most valuable methods to evaluate postoperative conditions after alveolar bone grafting. (author)

  7. Is heat pain detection threshold associated with the area of secondary hyperalgesia following brief thermal sensitization?

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Wetterslev, Jørn; Pipper, Christian Bressen

    2016-01-01

    if HPDT, a known quantitative sensory test, is associated with areas of secondary hyperalgesia following brief thermal sensitization TRIAL REGISTRATION: Clinicaltrials.gov (Identifier: NCT02527395 ). Danish Research Ethics Committee (Identifier: H-8-2014-012). Danish Data Protection Agency (Identifier: 30-1436)....... investigates different aspects of the human pain response. Brief thermal sensitization induces a mild burn injury, resulting in development of primary hyperalgesia at the site of stimulation, and secondary hyperalgesia surrounding the site of stimulation. Central sensitization is believed to play an important...... role in the development of secondary hyperalgesia; however, a possible association of secondary hyperalgesia following brief thermal sensitization and other heat pain models remains unknown. Our aim with this study is to investigate how close the heat pain detection threshold is associated...

  8. Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor.

    Science.gov (United States)

    Majuta, Lisa A; Longo, Geraldine; Fealk, Michelle N; McCaffrey, Gwen; Mantyh, Patrick W

    2015-01-01

    The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nonsteroidal anti-inflammatory drugs and opiates, both of which have significant unwanted side effects. To assess the efficacy of novel therapies, mouse models of orthopedic and fracture pain were developed and evaluated here. These models, orthopedic surgery pain and bone fracture pain, resulted in skeletal pain-related behaviors that lasted 3 weeks and 8 to 10 weeks, respectively. These skeletal pain behaviors included spontaneous and palpation-induced nocifensive behaviors, dynamic weight bearing, limb use, and voluntary mechanical loading of the injured hind limb. Administration of anti-nerve growth factor before orthopedic surgery or after bone fracture attenuated skeletal pain behaviors by 40% to 70% depending on the end point being assessed. These data suggest that nerve growth factor is involved in driving pain due to orthopedic surgery or bone fracture. These animal models may be useful in developing an understanding of the mechanisms that drive postoperative orthopedic and bone fracture pain and the development of novel therapies to treat these skeletal pains.

  9. Bisphosphonates inhibit pain, bone loss, and inflammation in a rat tibia fracture model of complex regional pain syndrome

    Science.gov (United States)

    Wang, Liping; Guo, Tian-Zhi; Wei, Tzuping; Li, Wen-wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-01-01

    BACKGROUND Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that anti-resorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, post-fracture cutaneous cytokine up-regulation, and adaptive immune responses in this CRPS model. METHODS Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by uCT and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed and skin cytokine (TNF, IL-1, IL-6) and nerve growth factor (NGF) levels were determined by EIA. Skin and sciatic nerve immunoglobulin levels were determined by EIA. RESULTS Tibia fracture rats developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression, trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by uCT, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression and elevated immunocomplex deposition in skin and nerve. Alendronate (60 μg/kg/day s.c.) or zoledronate (3 mg/kg/day p.o.) treatment for 28 days, started

  10. Bisphosphonates Inhibit Pain, Bone Loss, and Inflammation in a Rat Tibia Fracture Model of Complex Regional Pain Syndrome.

    Science.gov (United States)

    Wang, Liping; Guo, Tian-Zhi; Hou, Saiyun; Wei, Tzuping; Li, Wen-Wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-10-01

    Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenesis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that antiresorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously, we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS, and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, postfracture cutaneous cytokine upregulation, and adaptive immune responses in this CRPS model. Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by microcomputed tomography, and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed, and skin cytokine (tumor necrosis factor, interleukin [IL]-1, IL-6) and nerve growth factor (NGF) levels were determined by enzyme immunoassay. Skin and sciatic nerve immunoglobulin levels were determined by enzyme immunoassay. Rats with tibia fractures developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression and trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by microcomputed tomography, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression, and elevated immunocomplex deposition in skin and nerve

  11. Radiation-induced relief of pain in an animal model with bone invasion from cancer

    International Nuclear Information System (INIS)

    Seong, J.; Kim, J.; Kim, K.H.; Kim, U.J.; Lee, B.W.

    2003-01-01

    In clinic, local radiation is effective for relief of pain from cancer invasion into the bones. This effect is usually observed before the regression of tumor occurs, which implies radiation-induced pain relief by mechanisms other than tumor irradication. In this study, possible mechanisms were explored in animal model system. To establish an animal model, syngeneic hepatocarcinoma, HCa-I was transplanted on femoral periosteum of C3H/HeJ male mice and bone-invasive tumor growth was identified through the histological analysis. Development of tumor-induced pain was assessed by von Frey filament test, acetone test, and radiant heat test. Animals were also irradiated for their tumors. Any change in pain was analyzed by above tests for the quantitative change and by immunohistochemical stain for the expression of molecules such as c-fos, substance P, and calcitonin gene-related peptide (CGRP) in lumbar spinal cord. Cancer invasion into the bone was started from 7th day after transplantation and became evident at day 14. Objective increase of pain in the ipsilateral thigh was observed at day 14 on von Frey filament test and acetone test, while there was no remarkable regression of the tumors. In this model system, local radiation of tumor resulted in decrease in objective pain on von Frey filament test and acetone test. In the immunohistochemical stain for lumbar spinal cord, the expression of substance P and CGRP but not c-fos increased in tumor-bearing animal compared to the control. The expression of these molecules decreased in animals given local radiation. In summary, an animal model system was established for objective pain from cancer invasion into the bones. Local radiation of tumor induced objective pain relief and this effect seems to be mediated not by tumor regression but through altered production of pain-related molecules

  12. Association of bone scintigraphic abnormalities with knee malalignment and pain.

    Science.gov (United States)

    Kraus, V B; McDaniel, G; Worrell, T W; Feng, S; Vail, T P; Varju, G; Coleman, R E

    2009-11-01

    The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms. A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase (99m)Technetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data. The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001). To the authors' knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

  13. Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

    International Nuclear Information System (INIS)

    Ayati, Narjess; Aryana, Kamran; Jalilian, Amir; Hoseinnejad, Toktam; Samani, Ali Bahrami; Ayati, Zahra; Shariati, Farzane; Zakavi, S. Rasoul

    2013-01-01

    Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases. 28 patients (14 males and 14 females) aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed. 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8). 64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%). The lowest amount of peripheral blood cells was detected in the fourth week for RBCs and in the 6th week for WBCs and PLTs. No

  14. A case of thyroid medullary carcinoma with multiple painful bone metastases successfully treated with strontium-89 chloride

    International Nuclear Information System (INIS)

    Oshiro, Chiya; Kamigaki, Shunji; Arai, Takashi; Nakamura, Yukio; Fukunaga, Mutsumi; Ichida, Wakako; Ikeda, Hiroshi

    2012-01-01

    A 70-year-old man was diagnosed as thyroid medullary carcinoma with multiple bone metastases. He underwent total thyroidectomy and cervical lymph node dissection. After one year, the pain from his bone lesions was becoming severe. To relieve the pain, he was administered opioids and external-beam radiation therapy. However, he continued to have substantial multiple bone pain. We used combination therapy of strontium-89 chloride for the treatment of widespread multiple bone pain and external-beam radiation therapy for localized pain. That combination therapy was effective and improved the quality of life (QOL) of the patient. We used strontium-89 chloride four times within one year, and no serious side effects occurred during therapy. Our thoroughly investigated case suggests that strontium-89 therapy is one of the effective and safe therapies for patients with painful bone metastases of thyroid medullary carcinoma. (author)

  15. 188Rhenium-HEDP in the Treatment of Pain in Bone Metastases

    International Nuclear Information System (INIS)

    Gaudiano, J.; Savio, E.; Robles, A.; Muniz, S.; Leon, A.; Verdera, S.; Martinez, G.; Hermida, J.C.; Knapp, F.F. Jr.

    1999-01-01

    Systemic use of radiopharmaceuticals is a recognized alternative method for the treatment of pain in patients with multiple bone metastasis. A new option, 188 Re-HEDP is proposed, using generator-obtained 188 Rhenium (β energy = 2.1 MeV, γ energy = 155 keV, half-life = 16.9 hours). After establishing parameters of biodistribution, dosimetry and image acquisition in mice, rats and rabbits, Phase I and II studies were conducted on 12 patients with multiple metastasis from carcinomas, with pain surpassing other analgesic options. More than 50% pain relief was found in 91% of the patients, with total relief during a variable period in 41% of them allowing opiate and other analgesic drugs to be decreased or withdrawn, and showing a lower bone marrow contribution to total absorbed dose than that reported for other similar radiopharmaceuticals. Further study of this option is recommended in order to determine higher dose protocols without toxic bone marrow reaction possibilities

  16. Cost of palliative radiation to the bone for patients with bone metastases secondary to breast or prostate cancer

    Directory of Open Access Journals (Sweden)

    Hess Gregory

    2012-10-01

    Full Text Available Abstract Background To estimate the costs (paid amounts of palliative radiation episodes of care (REOCs to the bone for patients with bone metastases secondary to breast or prostate cancer. Methods Claims-linked medical records from patients at 98 cancer treatment centers in 16 US states were analyzed. Inclusion criteria included a primary neoplasm of breast or prostate cancer with a secondary neoplasm of bone metastases; ≥2 visits to ≥1 radiation center during the study period (1 July 2008 through 31 December 2009 on or after the metastatic cancer diagnosis date; radiation therapy to ≥1 bone site; and ≥1 complete REOC as evidenced by a >30-day gap pre- and post-radiation therapy. Results The total number of REOCs was 220 for 207 breast cancer patients and 233 for 213 prostate cancer patients. In the main analysis (which excluded records with unpopulated costs the median number of fractions per a REOC for treatment of metastases was 10. Mean total radiation costs (i.e., radiation direct cost + cost of radiation-related procedures and visits per REOC were $7457 for patients with breast cancer and $7553 for patients with prostate cancer. Results were consistent in sensitivity analyses excluding patients with unpopulated costs. Conclusions In the US, current use of radiation therapy for bone metastases is relatively costly and the use of multi-fraction schedules remains prevalent.

  17. Bone marrow lesions on magnetic resonance imaging in hand osteoarthritis are associated with pain and interact with synovitis.

    Science.gov (United States)

    Liu, R; Damman, W; Reijnierse, M; Bloem, J L; Rosendaal, F R; Kloppenburg, M

    2017-07-01

    To determine the association between bone marrow lesions (BMLs) and (teno)synovitis as assessed on magnetic resonance (MR) imaging in patients with pain in hand osteoarthritis (OA). In 105 consecutive primary hand OA patients (83% women, mean age 59 years), who were diagnosed by rheumatologists and included in the HOSTAS (Hand OSTeoArthritis in Secondary care) cohort, contrast enhanced MR imaging of right distal and proximal interphalangeal joints were obtained. In 92 patients joint site specific pain upon palpation was assessed within 3 weeks of magnetic resonance imaging (MRI) examination. MR features were scored (0-3) following the Oslo hand OA score: BMLs, synovitis, cysts, flexor tenosynovitis (FTS). Additionally, extensor tendon inflammation (ETI) (0-3) was scored. Odds ratios (OR, 95% confidence interval (CI)) were calculated using generalized estimating equations for MR features with joint pain, adjusted for putative confounders. Stratified analyses were performed to investigate interaction. BMLs, synovitis, cysts, FTS and ETI were demonstrated in 56%, 90%, 22%, 16% and 30% of patients, respectively. BMLs (grade 2/3 vs 0: 3.5 (1.6-7.7)) and synovitis (3 vs 0: OR 3.6 (95% CI 1.9-6.6)) were severity-dependent associated with joint pain, but FTS and ETI were not. Stratified analyses showed that BMLs did not associate with pain in the absence of synovitis, whereas synovitis was associated with pain in the absence of BMLs. Interaction was seen between BMLs and synovitis grade 2 or 3. In hand OA patients severe synovitis is associated with joint pain, which is worsened when BMLs co-occur, suggesting synovitis as primary target of treatment. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  18. 153Sm-EDTMP for moderate and severe bone cancer pain

    International Nuclear Information System (INIS)

    Deng Houfu; Tan Tianzhi; Mo Tingshu

    1995-01-01

    136 patients with bone cancer pain were treated with 153 Sm-EDTMP (ethylenediamine-tetramethylene phosphonic acid). Pain free was noted in 49 cases (36%, 49/136) and pain relief in 77 cases (56.6%, 77/136), the total relief rate being 92.6%(126/136). The data from 76 patients with moderate and severe pain showed there were no significant relationships between the patients' age, the dose of 153 Sm-EDTMP and the analgesic effects (P>0.05). The pain relief observed in the patients with chest pain (ribs metastases) was earlier than that in other groups (P 153 Sm-EDTMP is safe for use

  19. Sulcular translation flap in secondary bone grafting: retrospective study of 72 alveolar clefts.

    Science.gov (United States)

    Paris, M; Paquin, R; Valcourt, A-C

    2015-08-01

    Secondary bone grafting from the iliac crest is the gold standard in the reconstruction of maxillary alveolar bone defects in cleft patients. Numerous techniques for this graft have been described, although none is considered clearly superior at this time. A retrospective chart study was performed of 72 alveolar clefts in 59 patients who underwent an alveolar iliac crest bone graft with nasal floor reconstruction, with or without concomitant secondary cheilorhinoplasty. Forty-four patients were included in the bone grafting group and 15 in the concomitant cheilorhinoplasty group. Both groups had a sulcular translation mucoperiosteal flap with anterior repositioning of the gingival papilla as the preferred intraoral flap technique. One-third of patients had undergone previous attempts at oronasal fistula closure. Results showed 100% Bergland stage 1 in the cheilorhinoplasty group and 96% in the bone graft group. Two failures (stage 4) were observed in the bone graft group. The infection rate was 9% in the cheilorhinoplasty group and 2% in the bone graft group. Of clefts in the bone graft group, 10% showed postoperative residual fistulas; none were observed in the cheilorhinoplasty group. The sulcular translation flap is a simple surgical approach and shows a low complication rate. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Therapy for bone pain palliation in skeletal metastases with Samarium -153 EDTMP (Indonesian experience)

    International Nuclear Information System (INIS)

    Purnomo, E.

    2007-01-01

    Full text: Radiopharmaceutical therapy may be used for the treatment of cases with painful skeletal metastases. We evaluate and want to share an experience with application and efficacy of Sm-153 EDTMP in palliative painful bone metastases therapy. Our aim was to determine the efficacy and toxicity of single-dose Sm- 153 EDTMP as a palliative treatment for painful skeletal metastases. Material and methods: we selected 18 patients (9 male, 9 female). The average age 35-65 years weight 40- 60 kg; with metastatic bone confirmed with bone scan examination. 6 with breast cancer, 5 with nasopharyngeal cancer, 5 with prostatic cancer, 2 with lung cancer were treated with 30 mCi ( 1110 MBq) Sm-153 EDTMP. All showed extensive metastatic bone disease. The patients were given intravenous injections of 30 mCi Sm-153 EDTMP, after reconditioning, hydration . We established intensity of pain, haematological parameters, scintigraphic, Karnofsky scale. Clinical assessment was performed one month later. Responses were classified in completed (good response), partial and absent taking into account symptoms and drugs reduction. The discontinuation or the reduction of analgesic drugs like opiate dosage was also considered as successful palliative results of the treatment. Result: pain relief was obtained in 16/18 patients, Sm-153 was effective in patients with reduced drug assumption. The response to Sm-153 was good in 14/18(77,7%) of the patients and partial in 3/18(16,6%) and no response in 1/18(0,5%). The application of Sm-153 in patients with painful disseminated bone metastases has a satisfactory pain alleviating effects. Sides effects were noted, decrease hemoglobin counts and white blood cell and platelets, which gradually returned to near normal after 6 weeks. Easy application and low cost and produced in own country are important factors. Conclusion: radiopharmaceutical therapy can be recommended because of the favorable palliation effect and the low cost of Sm-153, especially

  1. Palmar Eccrine Hidradenitis Secondary to Trauma from Computer Gaming in an Adolescent After Bone Marrow Transplantation.

    Science.gov (United States)

    Lee, Lynette Ying; Koh, Mark Jean-Aan

    2017-09-01

    A 14-year-old boy who had undergone a matched sibling bone marrow transplant for acute lymphoblastic leukemia presented with painful nodules on his palms after prolonged gaming on his computer and mobile phone. Histology showed a neutrophilic inflammatory infiltrate surrounding the acrosyringium and eccrine sweat coils in the deep dermis. The lesions resolved spontaneously with conservative management. © 2017 Wiley Periodicals, Inc.

  2. Influence of sex differences on the progression of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria Schmidt; Appel, Camilla

    2013-01-01

    Pain caused by bone metastases has a severe impact on the quality of life for many patients with cancer. Good translational in vivo models are required to understand the molecular mechanism and develop better treatment. In the current study we evaluated the influence of sex differences on the pro......Pain caused by bone metastases has a severe impact on the quality of life for many patients with cancer. Good translational in vivo models are required to understand the molecular mechanism and develop better treatment. In the current study we evaluated the influence of sex differences...

  3. Back Pain in Children and Diagnostic Value of (99m)Tc MDP Bone Scintigraphy.

    Science.gov (United States)

    Alkhawaldeh, Khaled; Ghuweri, Ali Al; Kawar, Jane; Jaafreh, Amany

    2014-10-01

    The aim of our study is to assess the diagnostic value of Technituim-(99m)-Methyle diphosphonate ((99m)Tc-MDP) Bone scintigraphy in the assessment of children with back pain. Included in this retrospective study were 68 child referred to us complaining of back pain (mean age of 13+ 2). There were 45 boys and 23 girls. All children have been investigated with conventional x-ray which revealed normal or inconclusive result. All underwent bone scintigraphy after the injection of (99m)Tc-MDP with calculated doses according to there body weights. Bone scintigraphy revealed 17 (25%) abnormal scans in 11 boys and 6 girls. Scans findings were suggestive of spondylolysis (n=4); malignancy including primary tumors and metastases (n=3); infection including osteomyelitis and discitis (n=3); sacroiliitis (n=2); benign tumors (n=2); pseudo fractures in ribs (n=1); necrosis in femoral head epiphysis(n=1) and nonskeletal-renal retention due to hydronephrosis (n=1). Sensitivity, specificity and accuracy of bone scan in detecting gross skeletal abnormality as a cause for back pain were 94% and 100% and 99% respectively. Bone isotope scan is a sensitive imaging modality in the assessment of pediatric patients with back pain. It is a reliable modality to detect and role out most benign and aggressive serious etiologies.

  4. Bone hyperalgesia after mechanical impact stimulation: a human experimental pain model.

    Science.gov (United States)

    Finocchietti, Sara; Graven-Nielsen, Thomas; Arendt-Nielsen, Lars

    2014-12-01

    Hyperalgesia in different musculoskeletal structures including bones is a major clinical problem. An experimental bone hyperalgesia model was developed in the present study. Hyperalgesia was induced by three different weights impacted on the shinbone in 16 healthy male and female subjects. The mechanical impact pain threshold (IPT) was measured as the height from which three weights (165, 330, and 660 g) should be dropped to elicit pain at the shinbone. Temporal summation of pain to repeated impact stimuli was assessed. All these stimuli caused bone hyperalgesia. The pressure pain threshold (PPT) was assessed by a computerized pressure algometer using two different probes (1.0 and 0.5 cm(2)). All parameters were recorded before (0), 24, 72, and 96 h after the initial stimulations. The IPTs were lowest 24 h after hyperalgesia induction for all three weights and the effect lasted up to 72 h (p pain and hyperalgesia model may provide the basis for studying this fundamental mechanism of bone-related hyperalgesia and be used for profiling compounds developed for this target.

  5. Animal models of bone cancer pain: systematic review and meta-analyses.

    Science.gov (United States)

    Currie, Gillian L; Delaney, Ada; Bennett, Michael I; Dickenson, Anthony H; Egan, Kieren J; Vesterinen, Hanna M; Sena, Emily S; Macleod, Malcolm R; Colvin, Lesley A; Fallon, Marie T

    2013-06-01

    Pain can significantly decrease the quality of life of patients with advanced cancer. Current treatment strategies often provide inadequate analgesia and unacceptable side effects. Animal models of bone cancer pain are used in the development of novel pharmacological approaches. Here we conducted a systematic review and meta-analysis of publications describing in vivo modelling of bone cancer pain in which behavioural, general health, macroscopic, histological, biochemical, or electrophysiological outcomes were reported and compared to appropriate controls. In all, 150 publications met our inclusion criteria, describing 38 different models of bone cancer pain. Reported methodological quality was low; only 31% of publications reported blinded assessment of outcome, and 11% reported random allocation to group. No publication reported a sample size calculation. Studies that reported measures to reduce bias reported smaller differences in behavioural outcomes between tumour-bearing and control animals, and studies that presented a statement regarding a conflict of interest reported larger differences in behavioural outcomes. Larger differences in behavioural outcomes were reported in female animals, when cancer cells were injected into either the tibia or femur, and when MatLyLu prostate or Lewis Lung cancer cells were used. Mechanical-evoked pain behaviours were most commonly reported; however, the largest difference was observed in spontaneous pain behaviours. In the spinal cord astrocyte activation and increased levels of Substance P receptor internalisation, c-Fos, dynorphin, tumor necrosis factor-α and interleukin-1β have been reported in bone cancer pain models, suggesting several potential therapeutic targets. However, the translational impact of animal models on clinical pain research could be enhanced by improving methodological quality. Copyright © 2013. Published by Elsevier B.V.

  6. Bone tumor

    Science.gov (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

  7. Examining pain, body image, and depressive symptoms in patients with lymphedema secondary to breast cancer.

    Science.gov (United States)

    Teo, Irene; Novy, Diane M; Chang, David W; Cox, Matthew G; Fingeret, Michelle Cororve

    2015-11-01

    Depression and reduced quality of life are often reported in patients with upper-extremity lymphedema secondary to breast cancer treatment. Little is known about how pain and body image influence depression in patients with lymphedema. The current study examined the association of pain intensity and body integrity beliefs with depressive symptoms and the extent to which body image dissatisfaction mediated these associations. A cross-sectional sample of patients with lymphedema secondary to breast cancer treatment completed self-report questionnaires of pain, body image, and depressive symptoms. Hierarchical regression analyses and tests of mediation were conducted to examine the associations among the variables of interest. Pain intensity and body integrity beliefs were positively associated with depressive symptoms. Further, body image dissatisfaction mediated the relationship between pain and depressive symptoms, indicating that higher levels of pain led to higher states of body image dissatisfaction, which, in turn, led to greater depressive symptoms. Body image dissatisfaction also mediated the relationship between body integrity beliefs and depressive symptoms, suggesting that greater body integrity beliefs led to higher dissatisfaction with one's body and subsequently to greater depressive symptoms. Our findings provide preliminary evidence that pain intensity and body image are important factors in understanding depressive symptoms in patients with lymphedema. Clinical implications include screening for pain and body image concerns in this population to identify patients who are in distress. Counseling interventions targeting body image dissatisfaction can also be potentially helpful for patients with lymphedema. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Differential effects of repeated low dose treatment with the cannabinoid agonist WIN 55,212-2 in experimental models of bone cancer pain and neuropathic pain

    DEFF Research Database (Denmark)

    Hald, Andreas; Ding, Ming; Egerod, Kristoffer Lihme

    2008-01-01

    Pain due to bone malignancies is one of the most difficult types of cancer pain to fully control and may further decrease the patients' quality of life. Animal models of chronic pain conditions resulting from peripheral inflammatory reactions or nerve injuries are responsive to treatment with can......Pain due to bone malignancies is one of the most difficult types of cancer pain to fully control and may further decrease the patients' quality of life. Animal models of chronic pain conditions resulting from peripheral inflammatory reactions or nerve injuries are responsive to treatment...... with cannabinoid agonists. However, the use of cannabinoid agonists in humans may be hampered by CNS related side effects and development of tolerance. In the present study, we investigated the effect of repeated low dose administration of the synthetic cannabinoid agonist WIN 55,212-2 on bone cancer pain...... and neuropathic pain in mice. In addition, we investigated the development of CNS related side effects and tolerance. We found that 0.5 mg/kg/day for 18 days reduced pain related behavior and expression of spinal glial fibrillary acidic protein in the bone cancer pain model but not in the neuropathic pain model...

  9. Cortical and trabecular bone are equally affected in rats with renal failure and secondary hyperparathyroidism.

    Science.gov (United States)

    Bajwa, Nikita M; Sanchez, Cheryl P; Lindsey, Richard C; Watt, Heather; Mohan, Subburaman

    2018-02-02

    Changes in mineral metabolism and bone structure develop early in the course of chronic kidney disease and at end-stage are associated with increased risk of fragility fractures. The disruption of phosphorus homeostasis leads to secondary hyperparathyroidism, a common complication of chronic kidney disease. However, the molecular pathways by which high phosphorus influences bone metabolism in the early stages of the disease are not completely understood. We investigated the effects of a high phosphorus diet on bone and mineral metabolism using a 5/6 nephrectomy model of chronic kidney disease. Four-week old rats were randomly assigned into groups: 1) Control with standard diet, 2) Nephrectomy with standard rodent diet, and 3) Nephrectomy with high phosphorus diet. Rats underwent in vivo imaging at baseline, day 14, and day 28, followed by ex vivo imaging. Cortical bone density at the femoral mid-diaphysis was reduced in nephrectomy-control and nephrectomy-high phosphorus compared to control rats. In contrast, trabecular bone mass was reduced at both the lumbar vertebrae and the femoral secondary spongiosa in nephrectomy-high phosphorus but not in nephrectomy-control. Reduced trabecular bone volume adjusted for tissue volume was caused by changes in trabecular number and separation at day 35. Histomorphometry revealed increased bone resorption in tibial secondary spongiosa in nephrectomy-control. High phosphorus diet-induced changes in bone microstructure were accompanied by increased serum parathyroid hormone and fibroblast growth factor 23 levels. Our study demonstrates that changes in mineral metabolism and hormonal dysfunction contribute to trabecular and cortical bone changes in this model of early chronic kidney disease.

  10. Minimally invasive procedures for the management of vertebral bone pain due to cancer

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pål; Kurita, Geana Paula

    2016-01-01

    BACKGROUND: Image-guided percutaneous ablation methods have proved effective for treatment of benign bone tumors and for palliation of metastases involving the bone. However, the role of these techniques is controversial and has to be better defined in the setting of palliative care. METHODS......: A systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network. RESULTS: Only five papers were taken into consideration after performing rigorous screening according...

  11. The value of SPECT bone scans in diagnosis of patients with zygapophseal joint pain

    International Nuclear Information System (INIS)

    Hu Jiajia; Liang Yu; Li Biao; Zhu Chengmo; Chen Gang; Wang Chao; Tian Weijia; Qu Liumin

    2008-01-01

    Objective: Bone scintigraphy with SPECT of the lumbar spine allows identification of lesions not seen with planar imaging, in patients with chronic low back pain. The aim of this study was to investigate the value of SPECT bone scans in diagnosis of patients with zygapophyseal joint pain. Methods: Thirty-five consecutive patients in Ruijin hospital from July 2006 to March 2007 with low back pain were en- rolled. All patients underwent bone scintigraphy with SPECT. According to the results of SPECT, patients with isotope-uptake joints received injections at the levels where abnormalities were identified on the scan. Patients with negative scans received other treatment (conservative treatment or surgery) but not facet joint injection. Clinical records were collected at 1-, 3-, and 6-month in SPECT-positive group after their initial treatment. And the SPECT-negative group were followed up at 6-month after therapy. Statistical analysis was performed with SPSS 10.0. Patients with SPECT-positive and -negative results were performed with the grouped t-test. Visual analog scales (VAS) were with the paired t-test used in patients with positive scans at before and after treatment. Results: Fifteen cases had facetal uptake of isotope on SPECT bone scans. After facet joint injection, 85.7% patients (12/14, 1 patient was excluded for operation) had improvement in pain score at 1-month, 78.6% (11/14) at 3-month, and 50.0% (7/14) at 6-month. Of 20 negative cases, 3 were treated by surgery and 17 by conservative treatment. All 20 cases were followed up for 6 months and 70.0% (14/20) had long time pain relief. Conclusion: SPECT bone scans are helpful to identify patients with low back pain who would benefit from facet joint injections. (authors)

  12. Bone SPECT-CT: An additional diagnostic tool for undiagnosed wrist pain.

    Science.gov (United States)

    Shirley, R A; Dhawan, R T; Rodrigues, J N; Evans, D M

    2016-10-01

    Diagnosis of wrist pain can be difficult to determine with clinical examination and conventional imaging techniques alone. Bone SPECT-CT (single-photon emission tomography with computerized tomography) is a hybrid imaging technique that overlays functional bone scintigraphy in tomographic/3D mode with conventional CT. Data from the two modalities are complementary; areas of abnormal bone metabolism can be localized with anatomical precision, hitherto lacking in conventional bone scans, while structural information from the CT scan further embellishes the diagnostic information. Over the last 6 years, one surgeon (David Evans) has used bone SPECT and later bone SPECT-CT as an additional line of investigation. This is a series of 21 consecutive patients with wrist pain that could not be diagnostically resolved with the usual combination of history, examination, and conventional imaging, and therefore underwent bone SPECT-CT. Clinical and imaging findings, management, and outcomes of these cases are discussed to explore the potential role of this hybrid functional modality in hand and wrist surgical practice. Copyright © 2016. Published by Elsevier Ltd.

  13. Frequency of non-traumatic anterior knee pain in secondary school students

    International Nuclear Information System (INIS)

    Shafiq, W.; Ajmad, F.; Ahmed, A.; Fatima, M.

    2017-01-01

    To find out the frequency of non-traumatic anterior knee pain in secondary school students of Lahore, Pakistan. Methodology: This observational study was conducted among 350 students of secondary school of Lahore during a 3 months period. Both males and females of age 11-17 years were included in the study. A questionnaire was completed which included demographic data, Numeric Rating scale (NRS) and Kujala Scale. The data were being analyzed using SPSS version 21.0. Results: Out of 350 secondary school students, 145 (41%) had anterior knee pain (AKP). Twenty seven (19%) had pain in the left knee only, 54 (37%) had pain in right knee only while 64 (44%) had pain in both knees. The incidence of AKP was highest among 11 to 15 years old students. Moreover, the girls reported high frequency of AKP then the boys. The activities that were affected because of AKP included running, walking, stair climbing and jumping. Conclusion: Non-traumatic AKP is common among students of age 11-17 years, with a peak during adolescence (11-15). This pain not only affects the sports activities but also affects the activity of daily livings. (author)

  14. Knowledge of pain management in patients with painful bone metastases : A multicentre randomized trial on pain education

    NARCIS (Netherlands)

    Geerling, J. I.; Reyners, A.; van der Linden, Y.; Mul, V.; Westhoff, P.; de Graeff, A.; Rodenhuis, C.; de Nijs, E.; Muilenburg, T.

    2016-01-01

    Background: Education of patients regarding pain management may improve patient empowerment and, consequently, reduce pain intensity. To investigate the effect of education on pain intensity, a multicentre phase 3 study was conducted between 1-3-2011 and 1-4-2016. A total of 354 patients who

  15. [Oncological patients' decision making processes concerning their pain medication at home: a qualitative secondary analysis].

    Science.gov (United States)

    Lüscher-Buffet, C; Koller, A; Schaefer, I; Spichiger, E

    2012-10-01

    Unrelieved pain affects up to 75 % of cancer patients. Possible reasons for the undertreatment of pain are, amongst others, patient-related barriers towards cancer pain management. However the way patients decide on the use of analgesics remains unclear. The purpose of this qualitative study was to explore decision-making processes of four women and four men with diverse cancers concerning their pain medications. Audiotaped protocols of the 10-week-intervention and interviews of the PEINCA-pilot study provided data for a secondary analysis. This pilot study was conducted at a comprehensive cancer centre in Germany to test the German version of a cancer pain self-management intervention to enhance oncology patients' pain self-management for the first time. The data of purposively selected patients were analysed using content analysis. The results showed that these patients were very ambivalent about their analgesic use. The need to relieve severe pain conflicted with the desire to avoid opioids at any price. Decisions were reconsidered and overturned even after good experiences with analgesics. This study seems to provide a first look into decision-making processes over 10 weeks during a self-management education. Individually tailored counselling by a professional within the education programme helped the patients adopt new attitudes towards analgesics and gradually reduce their pain levels. Previous experiences of the patients and their possible ambivalence towards analgesics should be considered in a pain therapy, and patients should be coached by professionals.

  16. Bone scanning in patients with low back pain following minimal trauma

    International Nuclear Information System (INIS)

    Weidinger, W.; Hatzl-Griesenhofer, M.; Pichler, R.; Huber, H.; Maschek, W.

    2002-01-01

    Full text: Low back pain following minimal trauma may be caused by insufficiency fracture of the sacrum, which is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analyzed retrospectively. Bone scintigraphy was done on 228 patients treated by the departments of orthopedics at the General Hospital Linz. Predominantly after (minor) trauma, they suffered from lower back pain and their conventional radiographic findings were negative. During a 24 month period, a sacral insufficiency fracture was diagnosed in 68 patients (29,8 %). H-shaped hyperfixation of the tracer - described as typical - was present in only 12 % of the gases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (39 % / 9 %), horizontal (31 %) and half H-shaped (9 %). In the majority of the gases bone scan detected farther fractures with main localization in the pubic bones, in the spine and the ribs. The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitand fractures. (author)

  17. Behavioral and neurochemical analysis of ongoing bone cancer pain in rats.

    Science.gov (United States)

    Remeniuk, Bethany; Sukhtankar, Devki; Okun, Alec; Navratilova, Edita; Xie, Jennifer Y; King, Tamara; Porreca, Frank

    2015-10-01

    Cancer-induced bone pain is described as dull, aching ongoing pain. Ongoing bone cancer pain was characterized after intratibial injection of breast cancer cells in rats. Cancer produced time-dependent bone remodeling and tactile hypersensitivity but no spontaneous flinching. Conditioned place preference (CPP) and enhanced dopamine (DA) release in the nucleus accumbens (NAc) shell was observed after peripheral nerve block (PNB) selectively in tumor-bearing rats revealing nociceptive-driven ongoing pain. Oral diclofenac reversed tumor-induced tactile hypersensitivity but did not block PNB-induced CPP or NAc DA release. Tumor-induced tactile hypersensitivity, and PNB-induced CPP and NAc DA release, was blocked by prior subcutaneous implantation of a morphine pellet. In sham rats, morphine produced a modest but sustained increase in NAc DA release. In contrast, morphine produced a transient 5-fold higher NAc DA release in tumor bearing rats compared with sham morphine rats. The possibility that this increased NAc DA release reflected the reward of pain relief was tested by irreversible blockade of rostral anterior cingulate cortex (rACC) μ-opioid receptors (MORs). The rACC MOR blockade prevented the morphine-induced transient increased NAc DA release in tumor bearing rats but did not affect morphine-induced effects in sham-operated animals. Consistent with clinical experience, ongoing cancer pain was controlled by morphine but not by a dose of diclofenac that reversed evoked hypersensitivity. Additionally, the intrinsic reward of morphine can be dissociated from the reward of relief of cancer pain by blockade of rACC MOR. This approach allows mechanistic and therapeutic assessment of ongoing cancer pain with likely translation relevance.

  18. 186Re-Etidronate. Efficacy of palliative radionuclide therapy for painful bone metastases

    International Nuclear Information System (INIS)

    Han, S. H.; De Klerk, J. M. H.; Tan, S.; Van Rijk, P. P.; Zonnenberg, B. A.

    2001-01-01

    Pain palliation with bone-seeking radiopharmaceuticals is an effective treatment modality in patients with advanced metastatic bone cancer. Several studies have shown encouraging clinical results of palliative therapy using 186 Re-HEDP, with an overall reported response rate of ± 71% for painful osseous metastasize prostate and breast cancer patients. 186 Re-HEDP is a very potential isotope with numerous advantageous characteristics for this purpose. Myelosuppressive toxicity is limited and reversible, which makes repetitive treatment safe. However, individual studies are difficult to compare, and are hampered by the numerous and different methods used to assess clinical responses. Standardized clinical response assessment using the objective multi-dimensional pain evaluation model should therefore be implemented

  19. Inhibition of breast cancer-cell glutamate release with sulfasalazine limits cancer-induced bone pain.

    Science.gov (United States)

    Ungard, Robert G; Seidlitz, Eric P; Singh, Gurmit

    2014-01-01

    Cancer in bone is frequently a result of metastases from distant sites, particularly from the breast, lung, and prostate. Pain is a common and often severe pathological feature of cancers in bone, and is a significant impediment to the maintenance of quality of life of patients living with bone metastases. Cancer cell lines have been demonstrated to release significant amounts of the neurotransmitter and cell-signalling molecule l-glutamate via the system xC(-) cystine/glutamate antiporter. We have developed a novel mouse model of breast cancer bone metastases to investigate the impact of inhibiting cancer cell glutamate transporters on nociceptive behaviour. Immunodeficient mice were inoculated intrafemorally with the human breast adenocarcinoma cell line MDA-MB-231, then treated 14days later via mini-osmotic pumps inserted intraperitoneally with sulfasalazine, (S)-4-carboxyphenylglycine, or vehicle. Both sulfasalazine and (S)-4-carboxyphenylglycine attenuated in vitro cancer cell glutamate release in a dose-dependent manner via the system xC(-) transporter. Animals treated with sulfasalazine displayed reduced nociceptive behaviours and an extended time until the onset of behavioural evidence of pain. Animals treated with a lower dose of (S)-4-carboxyphenylglycine did not display this reduction in nociceptive behaviour. These results suggest that a reduction in glutamate secretion from cancers in bone with the system xC(-) inhibitor sulfasalazine may provide some benefit for treating the often severe and intractable pain associated with bone metastases. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  20. A randomized trial of nature scenery and sounds versus urban scenery and sounds to reduce pain in adults undergoing bone marrow aspirate and biopsy.

    Science.gov (United States)

    Lechtzin, Noah; Busse, Anne M; Smith, Michael T; Grossman, Stuart; Nesbit, Suzanne; Diette, Gregory B

    2010-09-01

    Bone marrow aspiration and biopsy (BMAB) is painful when performed with only local anesthetic. Our objective was to determine whether viewing nature scenes and listening to nature sounds can reduce pain during BMAB. This was a randomized, controlled clinical trial. Adult patients undergoing outpatient BMAB with only local anesthetic were assigned to use either a nature scene with accompanying nature sounds, city scene with city sounds, or standard care. The primary outcome was a visual analog scale (0-10) of pain. Prespecified secondary analyses included categorizing pain as mild and moderate to severe and using multiple logistic regression to adjust for potential confounding variables. One hundred and twenty (120) subjects were enrolled: 44 in the Nature arm, 39 in the City arm, and 37 in the Standard Care arm. The mean pain scores, which were the primary outcome, were not significantly different between the three arms. A higher proportion in the Standard Care arm had moderate-to-severe pain (pain rating ≥4) than in the Nature arm (78.4% versus 60.5%), though this was not statistically significant (p = 0.097). This difference was statistically significant after adjusting for differences in the operators who performed the procedures (odds ratio = 3.71, p = 0.02). We confirmed earlier findings showing that BMAB is poorly tolerated. While mean pain scores were not significantly different between the study arms, secondary analyses suggest that viewing a nature scene while listening to nature sounds is a safe, inexpensive method that may reduce pain during BMAB. This approach should be considered to alleviate pain during invasive procedures.

  1. Radiopharmaceuticals for the palliation of painful bone metastases-a systematic review

    International Nuclear Information System (INIS)

    Bauman, Glenn; Charette, Manya; Reid, Robert; Sathya, Jinka

    2005-01-01

    Background and Purpose: The purpose was to develop a systematic review that would address the following question: what is the role of radiopharmaceuticals in the palliation of metastatic bone pain in adults with uncomplicated, multifocal painful bone metastases whose pain is not controlled with conventional analgesic regimens? The outcomes of interest are pain response, analgesic consumption, overall survival, adverse effects and quality of life. Materials and methods: A systematic review of the English published literature was undertaken to provide evidence relevant to the above outcomes. Results: Six randomized phase III trials, two randomized phase II trials and one randomized crossover trial of strontium-89 were reviewed. A randomized phase III trial comparing strontium-89 plus cisplatin with strontium-89 plus placebo reported a significantly higher proportion of patients experiencing pain relief for a significantly longer duration with strontium-89 plus cisplatin. A randomized phase III trial comparing adjuvant strontium-89 with placebo following radiotherapy reported a higher proportion of pain-free patients with strontium-89. Patients who received strontium-89 also experienced fewer new sites of bone pain. A second, but underpowered study failed to confirm these results. In one randomized trial of strontium-89 versus radiotherapy (hemibody or local), patients treated with strontium-89 developed fewer new sites of pain. In a second trial comparing strontium-89 versus local radiotherapy, median overall survival was improved with radiotherapy, while pain response and time-to-progression were similar in the two groups. One randomized phase III trial reported no difference in pain relief between strontium-89 and placebo. Three randomized phase III trials and two randomized phase II trials investigating samarium-153 were reviewed. In a randomized phase III trial of three different doses of samarium-153, the pain responses were similar for all three doses. In a

  2. Assessment of bone density in patients with scoliosis neuromuscular secondary to cerebral palsy

    Directory of Open Access Journals (Sweden)

    Charbel Jacob Júnior

    2014-09-01

    Full Text Available OBJECTIVE: To evaluate bone mineral density in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy. METHODS: A prospective descriptive study in which, in addition to bone densitometry, the anthropometric data of the patients were assessed. As inclusion criterion we adopted patients with spastic quadriplegic cerebral palsy, wheelchair users, aged between 10 and 20 years and with neuromuscular scoliosis. RESULTS: We evaluated 31 patients, 20 female, whose average age was 14.2 years. The mean bone density was -3.2 standard deviation (Z-score, with mean biceps circumference of 19.4 cm, calf circumference 18.6 cm and BMI of 13.6 kg/m². CONCLUSION: There is a high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy.

  3. Cancer-induced bone loss and associated pain-related behavior is reduced by risedronate but not its phosphonocarboxylate analog NE-10790

    DEFF Research Database (Denmark)

    Hald, Andreas; Hansen, Rikke Rie; Thomsen, Mette W

    2009-01-01

    Prostate, breast and lung cancers readily develop bone metastases which lead to fractures, hypercalcemia and pain. Malignant growth in the bones depends on osteoclast-mediated bone resorption and in this regard bisphosphonate compounds, which have high-bone affinity and inhibit osteoclast activity......, have been found to alleviate bone cancer symptoms. In this study, the bisphosphonate risedronate and its phosphonocarboxylate derivative NE-10790 was tested in a murine bone cancer pain model. Risedronate decreased bone cancer-related bone destruction and pain-related behavior and decreased the spinal...

  4. An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures

    NARCIS (Netherlands)

    Milstein, Dan M. J.; Cheung, Yuk Wah; Žiūkaitė, Laura; Ince, Can; van den Akker, Hans P.; Lindeboom, Jérôme A. H.

    2013-01-01

    The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bone grafting procedures.

  5. The role of alpha 6 integrin in prostate cancer migration and bone pain in a novel xenograft model.

    Directory of Open Access Journals (Sweden)

    Tamara E King

    Full Text Available Of the estimated 565,650 people in the U.S. who will die of cancer in 2008, almost all will have metastasis. Breast, prostate, kidney, thyroid and lung cancers metastasize to the bone. Tumor cells reside within the bone using integrin type cell adhesion receptors and elicit incapacitating bone pain and fractures. In particular, metastatic human prostate tumors express and cleave the integrin A6, a receptor for extracellular matrix components of the bone, i.e., laminin 332 and laminin 511. More than 50% of all prostate cancer patients develop severe bone pain during their remaining lifetime. One major goal is to prevent or delay cancer induced bone pain. We used a novel xenograft mouse model to directly determine if bone pain could be prevented by blocking the known cleavage of the A6 integrin adhesion receptor. Human tumor cells expressing either the wildtype or mutated A6 integrin were placed within the living bone matrix and 21 days later, integrin expression was confirmed by RT-PCR, radiographs were collected and behavioral measurements of spontaneous and evoked pain performed. All animals independent of integrin status had indistinguishable tumor burden and developed bone loss 21 days after surgery. A comparison of animals containing the wild type or mutated integrin revealed that tumor cells expressing the mutated integrin resulted in a dramatic decrease in bone loss, unicortical or bicortical fractures and a decrease in the ability of tumor cells to reach the epiphyseal plate of the bone. Further, tumor cells within the bone expressing the integrin mutation prevented cancer induced spontaneous flinching, tactile allodynia, and movement evoked pain. Preventing A6 integrin cleavage on the prostate tumor cell surface decreased the migration of tumor cells within the bone and the onset and degree of bone pain and fractures. These results suggest that strategies for blocking the cleavage of the adhesion receptors on the tumor cell surface can

  6. Pneumolabyrinth secondary to temporal bone fracture: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bacciu A

    2014-09-01

    Full Text Available Andrea Bacciu,1 Vincenzo Vincenti,1 Sampath Chandra Prasad,1 Daniela Tonni,1 Elisa Ventura,2 Salvatore Bacciu,1 Enrico Pasanisi1 1Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, 2Department of Neuroradiology, University Hospital of Parma, Parma, Italy Abstract: Pneumolabyrinth following temporal bone fracture is an extremely rare condition. It results from air entering the inner ear when a communication between the air-filled middle ear spaces and inner ear is established. The imaging modality of choice for pneumolabyrinth is high-resolution computed tomography of the temporal bone. Treatment options include conservative management (bed rest, antibiotics, corticosteroids or surgery (exploratory tympanotomy. We present the case of a 31-year-old female who had pneumolabyrinth secondary to a temporal bone fracture. The patient was treated surgically and made a full clinical recovery. Keywords: pneumolabyrinth, temporal bone fractures, head trauma

  7. Shoulder pain and dysfunction secondary to neural injury.

    Science.gov (United States)

    Brown, Kari E; Stickler, Laurie

    2011-09-01

    Resident's Case Study The reports of spinal accessory nerve injury in the literature primarily focus on injury following surgical dissection or traumatic stretch injury. There is limited literature describing the presentation and diagnosis of this injury with an unknown cause. The purpose of this case report is to describe the clinical decision-making process that guided the diagnosis and treatment of a complex patient with spinal accessory nerve palsy (SANP) whose clinical presentation and response to therapy were inconsistent with the results of multiple diagnostic tests. The patient was a 27-year-old female triathlete with a five month history of right-sided neck, anterior shoulder, and chest pain. Based on the physical exam, magnetic resonance imaging, radiographs, electrodiagnostic and nerve conduction testing, the patient was diagnosed by her physician with right sterno-clavicular joint strain and scapular dyskinesis and was referred to physical therapy. Care was initiated based on this initial diagnosis. Upon further examination and perusal of the literature, the physical therapist proposed a diagnosis of spinal accessory nerve injury. Intervention included manual release of soft tissue tightness, neuromuscular facilitation and sport-specific strengthening, resulting in full return to functional and sport activities. These interventions focused on neurological re-education and muscular facilitation to address SANP as opposed to a joint sprain and dysfunction, as initially diagnosed. Proper diagnosis is imperative to effective treatment in all patients. This case illustrates the importance of a thorough examination and consideration of multiple diagnostic findings, particularly when EMG/NCV tests were negative, the cause was not apparent, and symptoms were less severe than other cases documented in the literature. Diagnosis, level 4.

  8. Bone Degeneration, Inflammation and Secondary Complications of Arthritis: Potential Targets and their Natural Inhibitors.

    Science.gov (United States)

    Hemshekhar, Mahadevappa; Thushara, Ram M; Kumar, Somanathapura K Naveen; Paul, Manoj; Sundaram, Mahalingam S; Kemparaju, Kempaiah; Girish, Kesturu S

    2018-01-01

    Arthritis is marked by joint deterioration that affects articular cartilage and subchondral bone. Though cartilage degradation does the major damage during arthritis, subsequent bone degeneration cannot be neglected. Recent progress in arthritis research has identified the clinical importance of bone erosion in destructive arthritis. Studies have showed the key role played by osteoclasts and receptor activator of nuclear factor kappaB ligand (RANKL) signaling in bone erosion. Cathepsins and tartrate resistant acid phosphatase (TRAP) are considered key enzymatic factors contributing to bone erosion. Further, reactive oxygen species (ROS) formed at the ruffled border of osteoclasts also causes bone resorption and matrix degradation. Besides, severe inflammation during arthritis induces bone erosion by aiding in Ca2+ removal and activating osteoclastogenesis. The inflammatory cytokines and ROS influence osteoclast differentiation by regulating osteoclast-lineage cells or by acting on other cells to regulate the expression of RANKL and osteoprotegerin (OPG). The enhanced production of pro-inflammatory cytokines and ROS in arthritis stimulates tissue injury by means of oxidative damage leading to vital organ damage and synovial and circulatory cell apoptosis. Thus, blocking enzymatic and non-enzymatic factors responsible for bone erosion and inflammation is considered a prime strategy in the management of arthritis. In this review we provide an overview of the mechanisms of bone erosion, inflammation and associated oxidative stress/damage during arthritis perpetuation along with shedding light on potential targets. The article also describes the possible natural therapeutic agents that could prevent bone loss and inflammation, and related secondary complications of arthritis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Lutetium-177-EDTMP for pain palliation in bone metastases

    International Nuclear Information System (INIS)

    Rutty Sola, Gisela A.; Arguelles, Maria G.; Bottazzini, Debora L.; Furnari, Juan C.; Vera Ruiz, H.

    1999-01-01

    Experiences with the new palliative agent Lu-177 EDTMP are summarized. The production of primary 177 Lu by the 176 Lu(n,γ) 177 Lu reaction and the synthesis of the radioactive complex are described as well as the procedures used for the control of the radionuclidic and the radiochemical purity. The stability of the compound has been also studied. The in vivo essays with rats and the use of the radiopharmaceutical, after a careful dose evaluation, in a patient with bone metastases from a breast cancer, show that the behaviour of Lu-177 EDTMP is similar to that of the analogue Sm-153 EDTMP. (author)

  10. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies

    International Nuclear Information System (INIS)

    Choi, Yun Sun; Lee, Kyung Tai; Kim, Eun Kyung; Kang, Heung Sik

    2004-01-01

    To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients

  11. Painful lateral knee condyle bone marrow edema after treatment with lateral wedged insole.

    Science.gov (United States)

    Chaler, Joaquim; Torra, Mercè; Dolz, Josep Lluís; Müller, Bertram; Garreta, Roser

    2010-05-01

    A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.

  12. P2X7 receptor-mediated analgesia in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; D. Schwab, Samantha; Frøsig-Jørgensen, Majbrit

    2015-01-01

    for cancer-induced bone pain. The P2X7 receptor (P2X7R) is involved in a variety of cellular functions and has been linked to both inflammatory and neuropathic pain. Here we study the analgesic potential of P2X7 receptor antagonism in a rat model of cancer-induced bone pain. In cancer-bearing animals, the P2....... The results suggest that the P2X7R is involved in the mechanisms of cancer-induced bone pain, and that P2X7R antagonism might be a useful analgesic target. No effect was observed in sham or naïve animals, indicating that the P2X7R-mediated effect is state-dependent, and might therefore be an advantageous......X7R antagonist A839977 attenuated dorsal horn neuronal responses in a modality and intensity specific way. Spinal application of 0.4mg/kg and 1.2mg/kg A839977 significantly reduced the evoked responses to high intensity mechanical and thermal stimulation, whereas no effect was seen in response...

  13. Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging

    International Nuclear Information System (INIS)

    Buck, Florian M.; Hoffmann, Alexander; Hofer, Bernhard; Allgayer, Bernhard; Pfirrmann, Christian W.A.

    2009-01-01

    The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI). Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed. At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm 3 ; range, 1,200-39,200 mm 3 ). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p=0.004; MCL signal changes p=0.002). Only MCL signal changes predicted pain during exercise significantly (p=0.001). In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL. (orig.)

  14. Evidence on the analgesic role of bisphosphonates and denosumab in the treatment of pain due to bone metastases: A systematic review within the European Association for Palliative Care guidelines project.

    Science.gov (United States)

    Porta-Sales, Josep; Garzón-Rodríguez, Cristina; Llorens-Torromé, Silvia; Brunelli, Cinzia; Pigni, Alessandra; Caraceni, Augusto

    2017-01-01

    Bisphosphonates and denosumab are well-established therapies to reduce the frequency and severity of skeletal-related events in patients with bone metastasis. However, the analgesic effect of these medications on bone pain is uncertain. To identify, critically appraise and synthesize existing evidence to answer the following questions: 'In adult patients with metastatic bone pain, what is the evidence that bisphosphonates and denosumab are effective and safe in controlling pain?' and 'What is the most appropriate schedule of bisphosphonate/denosumab administration to control bone pain?'. This review also updates the 2002 Cochrane review 'Bisphosphonates for the relief of pain secondary to bone metastases'. Standard systematic review and narrative synthesis. MEDLINE, EMBASE and Cochrane CENTRAL databases were searched for relevant articles published through 31 January 2014. A manual search was also performed. Study inclusion criteria were: a) conducted in adult patients; b) randomized controlled trial or meta-analisys; c) reported efficacy of bisphosphonates or denosumab on pain and/or decribed side effects versus placebo or other bisphosphonate; and d) English language. The database search yielded 1585 studies, of which 43 (enrolling 8595 and 7590 patients, respectively, in bisphosphonate and denosumab trials) met the inclusion criteria. Twenty-two (79%) of the 28 placebo-controlled trials found no analgesic benefit for bisphosphonates. None of the denosumab studies assessed direct pain relief. Evidence to support an analgesic role for bisphosphonates and denosumab is weak. Bisphosphonates and denosumab appear to be beneficial in preventing pain by delaying the onset of bone pain rather than by producing an analgesic effect per se.

  15. Studying on process for labeling of EDTMP with 90Y using for bone pain palliation

    International Nuclear Information System (INIS)

    Pham Ngoc Dien; Duong Van Dong; Dang Ho Hong Quang; Nguyen Thanh Binh; Bui Van Cuong; Nguyen Dang Khoa; Nguyen Thi Thu; Mai Phuoc Tho; Vo Cam Hoa

    2013-01-01

    This Study describes the method for preparation of labelling compound Ethylene diamine tetramethylene phosphonic acid (EDTMP) with 90 Y. Malignant cancer is one of the most important resulting in human death. Bone metastases in nearly 25% of all cancer patients; so it is useful to develop radiopharmaceuticals for the treatment of bone cancer. Yttrium-90 is high energy (2.3 MeV) beta emitter required with a physical haft life of 2.7 days which has limited bone-seeking properties. Its physical properties make it ideal for therapeutic application, the most energetic beta emission being able to penetrate to 1 cm from the site of deposition in soft tissue with an average range of approximately 4 mm. Theoretically, therefore, it can penetrate all marrow spaces in normal trabecular bone and conceivably even to the centre of large tumours where bone destruction may be extensive. Specific deposition of 90 Y into the skeleton demands its delivery in a chemical form with affinity for bone mineral alone. Compounds with these properties are the phosphonate analogues of polyaminocarboxylic acids, and one in particular EDTMP (ethylen diamine tetra methylene phosphonate) has already been used to target 153 Sm to bone mineral with success. Because of chemical similarities between 90 Y and the rare earths, EDTMP should form stable complexes with 90 Y and carry it specifically to the bone with comparable efficiency. Skeletal uptake of β - emitting radionuclides may be used for bone pain palliation or myeloablation. The physical characteristics of the β - particles required for the two conditions are, however, different, that is, higher energies are favorable for destruction of bone marrow. (author)

  16. Imaging findings, prevalence and outcome of de novo and secondary malignant fibrous histiocytoma of bone

    International Nuclear Information System (INIS)

    Koplas, Monica C.; Ilaslan, Hakan; Sundaram, Murali; Lefkowitz, Robert A.; Landa, Jonathan; Bauer, Thomas W.; Joyce, Michael J.

    2010-01-01

    To evaluate the radiographic and magnetic resonance (MR) imaging features of primary and secondary malignant fibrous histiocytoma in bone and determine the demographics, prevalence and outcome of patients with this tumor. A retrospective search of files from two institutions identified 28 patients with malignant fibrous histiocytoma (MFH) of bone. Microscope slides were reviewed to confirm diagnosis and identify any pre-existing lesions. Medical records were reviewed with respect to patients' demographic characteristics and outcomes. Radiographic features demonstrated an aggressive osteolytic lesion with a permeative pattern of bone destruction. Periosteal reaction was seen in three of 13 lesions. T1-weighted images (T1WIs) demonstrated signal intensity iso- to slightly hyperintense to muscle. T2-weighted images (T2WIs) demonstrated mildly higher signal intensity than that of muscle. The 5-year survival rate was 53%. The tumor arose secondarily in pre-existing lesions in 43% of patients. Metastases occurred in 46% of patients during the course of the disease, with pulmonary and osseous metastases being the most common. Secondary MFH of bone was slightly less common than primary MFH and had a prognosis similar to that of primary MFH of bone. MR imaging showed variable and somewhat unusual low to intermediate T2 signal characteristics for a radiographically malignant osteolytic lesion. (orig.)

  17. Palliative radiotherapy in painful bone metastases - different schemes of irradiation and their application

    International Nuclear Information System (INIS)

    Yaneva, M.

    2006-01-01

    The purpose of this investigation is to assess statistically the effect of different schemes of radiation therapy in patients with painful bone metastases: 2 x 8.5 Gy, 10 x 3 Gy, 5 x 4 Gy, 4 x 5 Gy, 5 Gy and 8 Gy and the reasons for their choice. In the investigation are included 523 patients - 71 % were with cancer of the breast, 16 % with lung cancer and 13% with other locations, 65 % (340) were women and 35 % (183) were men. They were randomized in different groups according to the radiation scheme as follows: 2 x 8.5 Gy - 392 patients, 10 x 3 Gy - 31 patients, 5 x 4 Gy - 43 patients, 4 x 5 Gy - 39 patients, 5 Gy - 9 patients and 8 Gy - 9 patients. In the group 2 x 8.5 Gy the measurement of pain relief was done after the first fraction, after the second fraction and a month later. In the other schemes the pain relief was measured after radiation treatment and 1 month later. The assessment of pain intensity was done after the WHO scale. The statistical processing of data was done as nonparametric analyses using SPSS-10 version with defining χ 2 and p=0.001. All versions of radiation therapeutic regimens relieved pain in different degree in each patient. Except data for bone metastases it was also important the general condition of the patient in combination with age for the choice of radiation treatment schedule. All radiation treatment schedules are effective in relieving pain in cancer patients with bone metastases and they have to be used adequately and competently by the radiation oncologist

  18. Use of 89sr for Bone Pain Palliation. Experience in Our Department

    International Nuclear Information System (INIS)

    Marinescu, G.; Rambu, A.; Ghita, A.; Mazilu, C.; Mititelu, R.; Murgoci, P.; Codorean, I.

    2006-01-01

    Full text: Introduction: Bone metastases are the most common cause of pain in patients with cancer, and postmortem studies have been shown that up to 85% of patients with breast or prostate cancer have bone metastases at the time of death. The palliation of bone pain is one of the goals of treatments in oncologic patients, due to the fact that patients with bone metastases may survive many years with severe pain and seriously impaired mobility. Bone pain palliation can be attempted by using different modalities analgesics (nonsteroid, opioides), biphosphonates, external beam radiotherapy or radionuclide therapy. Purpose The aim of our study was to review the database and to analyze the results of the treatments performed in our department, in the field of radionuclide metastatic bone pain palliation with 89 Sr Method: 12 patients (47-73 years old) were treated with 89 Sr in the past two years in our department. All patients had confirmed prostate adenocarcinoma and refractory bone pain due to skeletal metastasis involving more than one site, associated with osteoblastic response on bone scan. All patients had a good hematological and renal status (Hb> 9 mg/dl, leukocytes > 4000/ μl, platelets > 150.000/ μl, GFR > 30 ml/min), an increased alkaline phosphatase and recent bisphosphonate therapy interrupted within 48h before treatment. The standard administered dose was 150 MBq [4 mCi] of 89 Sr (Metastron Amersham). In 8 cases single dose was given, while in 4 patients a second dose was administered at 4, 6 or 9 months after the first injection. Clinical and biological evaluation was repeated at 3 weeks and 3-6 months after treatment. Hematological assessment was performed monthly for all patients. Results The most important criterion of pain relief was objective pain score. Significant improvement of life quality was seen in 4 patients with major reduction of analgesic needs. In 4 patients in addition to external beam radiotherapy we obtained a stable effect of more

  19. Use of Sr-89 for bone pain palliation: Experience in our Department

    International Nuclear Information System (INIS)

    Mititelu, M.R.; Mazilu, C.; Rimbu, A.; Ghita, S.T.; Marinescu, G.; Codorean, I.

    2005-01-01

    Full text: Bone metastases are the most common cause of pain in patients with cancer, and postmortem studies have been shown that up to 85% of patients with breast or prostate cancer have bone metastases at the time of death. The palliation of bone pain is one of the goals of treatments in oncologic patients, due to the fact that patients with bone metastases may survive many years with severe pain and serious impaired mobility. Bone pain palliation can be attempt by using different modalities analgesics (nonsteroid, opioides), biphosphonates, external beam radiotherapy or radionuclide therapy. The aim of our study was to review the database and to analyze the results of the treatments performed in our department, in the field of radionuclide metastatic bone pain palliation with 89Sr 12 patients (47-73 years old) were treated with 89Sr in the past two years in our department. All patients had confirmed prostate adenocarcinoma and refractory bone pain due to skeletal metastasis involving more than one site, associated with osteoblastic response on bone scan. All patients had a good hematological and renal status (Hb> 9 mg/dl, leukocytes > 4000/il, platelets > 150.000/ il, GFR > 30 ml/min), an increased alkaline phosphatase and recent bisphosphonate therapy interrupted within 48h before treatment. The standard administered dose was 150 MBq [4 mCi] of 89Sr (Metastron Amersham). In 8 cases single dose was given, while in 4 patients a second dose was administered at 4, 6 and 9 months after the first injection. Clinical and biological evaluation was repeated at 3 weeks and 3-6 months after treatment. Hematological assessment was performed monthly at all patients. The most important criterion of pain relief was objective pain score. Significant improvement of life quality was seen in 4 patients with major reduction of analgesic needs. In 4 patients in addition to external beam radiotherapy we obtained a stable effect of more than 6 months. 3 patients had moderate response

  20. Sports nuclear medicine. Bone imaging for lower extremity pain in athletes

    International Nuclear Information System (INIS)

    Brill, D.R.

    1983-01-01

    Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes

  1. Bone growth during daily or intermittent calcitriol treatment during renal failure with advanced secondary hyperparathyroidism.

    Science.gov (United States)

    Sanchez, C P; He, Y Z

    2007-09-01

    Calcitriol is a standard therapy for secondary hyperparathyroidism in chronic renal failure. We evaluated whether the effect of daily or intermittent calcitriol administration is more efficient in enhancing bone growth in renal failure with advanced secondary hyperparathyroidism in weanling 5/6 nephrectomized rats loaded with phosphorus to induce severe secondary hyperparathyroidism. The animals were treated daily or three times weekly with calcitriol for 4 weeks but the total weekly dose of calcitriol was the same. Although calcitriol increased the serum calcium, it did not lower parathyroid hormone (PTH) or improve tibia and body length. Animals with renal failure and advanced secondary hyperparathyroidism had decreased PTH/PTHrP, which was accompanied by an increase in the cyclin kinase inhibitor p57(Kip2). Calcitriol treatment upregulated the PTH/PTHrP receptor but also increased inhibitors of cell proliferation such as p21(Waf1/Cip1), IGFBP3, and FGFR3. Calcitriol also enhanced markers of chondrocyte differentiation, such as IGF1, Vitamin D receptor, FGF23, and bone morphogenetic protein-7. Receptor activator of nuclear factor-kappabeta ligand levels improved with calcitriol treatment but without changes in osteoprotegerin suggesting an enhancement of osteo/chondroclastogenesis and mineralization. Overall, both daily and intermittent calcitriol had similar effects on endochondral bone growth in phosphorus-loaded rats with renal failure.

  2. Summary of: Paracetamol overdose secondary to dental pain: a case series.

    Science.gov (United States)

    Rice, Scott

    2015-09-25

    There have been documented cases of serious and life-threatening health effects due to patients taking unintentional analgesia overdose secondary to dental pain. We aimed to determine firstly what proportion of unintentional paracetamol overdose cases admitted to an acute medical assessment unit (MAU) were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally what clinical burden such cases placed on the hospital services. The clinical coding department provided information to allow appropriate identification and data collection from patient discharge summaries and case notes of all unintentional paracetamol overdose cases secondary to dental pain over a 24 month period (1 March 2012 to 28 February 2014). One hundred and sixteen admissions were identified specifically for unintentional paracetamol overdose. Dental pain accounted for 48 (41%) of all cases. Females (67%) were twice as likely to be admitted, compared to males (33%), with a mean age of 36 years and four months. Thirty-two (63%) non-dentally registered and all nine (100%) registered patients were unable to access timely emergency dental care before their admission. Forty cases (83%) were referred to the hospital oral and maxillofacial services (OMFS). Thirty-seven (93%) patients underwent elective outpatient dental extractions and the remaining three (7%) patients were admitted for intravenous antibiotics, incision and drainage and dental extractions. All patients were treated under local anaesthetic. Dental pain is the single most common cause of acute medical admission secondary to unintentional paracetamol overdose. Patients registered with a general dental practitioner (GDP), as well as those not registered with a GDP, had difficulty accessing timely emergency primary dental care.

  3. Vitamin D levels appear to be normal in Danish patients attending secondary care for low back pain and a weak positive correlation between serum level Vitamin D and Modic changes was demonstrated

    DEFF Research Database (Denmark)

    Johansen, Jannick Vaaben; Manniche, Claus; Kjær, Per

    2013-01-01

    with non-specific LBP and associations with low levels of Vitamin D have been suggested. The objectives of this study were to investigate (1) Vitamin D levels in patients seeking care for LBP in a Danish out-patient secondary care setting, and (2) their possible relationship with myopathy-related symptoms......Hypovitaminosis D has previously been reported in both the general population, in people with chronic musculoskeletal pain, and in people with low back pain (LBP). Myopathy-related symptoms such as diffuse bone and muscle pain, weakness and paresthesia in the legs, have also been observed in people...

  4. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

    OpenAIRE

    Kevin E. Kip; Laney Rosenzweig; Diego F. Hernandez; Amy Shuman; David M. Diamond; Sue Ann Girling; Kelly L. Sullivan; Trudy Wittenberg; Ann M. Witt; Cecile A. Lengacher; Brian Anderson; Susan C. McMillan

    2014-01-01

    Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. Methods: A random...

  5. Palliative bone pain treatment with 153Samarium EDTMP in prostate and breast cancer in Paraguay

    International Nuclear Information System (INIS)

    Jara Yorg, J.A.; Pusineri, H.; Ruiz Perez, V.; Mendoza, D.

    2004-01-01

    Full text: Pain is an extremely prevalent symptom in patients with cancer. Tumor size location of the lesion, stage of the disease is directly related to pain. Several studies have established that more than two third of cancer patients develop pain as a direct result of neoplasm. Bone metastases occur in more than 50% of breast and prostate cancer patients. Chronic pain relief is the goal of the treatments, which is tried to be achieved with narcotic analgesics, external beam radiotherapy and internal radiotherapy. This report describes the results of 153 Ethylenediaminetetramethylene phosphonate (EDTMP) in patients having multiple skeletal metastases from prostate and breast cancer in Paraguay. We report thirty male patients of prostate cancer and twenty female patients of breast cancer in ages between 59 and 73 years having multiple skeletal metastases. They were administered 100 mCi of 153Sm-EDTMP. Post-therapy imaging was done 2hrs. later under a large filed of view scintillation camera coupled with low energy all purpose (LEAP) parallel hole collimator. Good correlation was seen between this scan and the bone scan done earlier with 20 MCi of 99Tc-MDP. Most of the patients showed disappearance of pain one week after the treatment. Minimal decrease in platelets count that recovered within two weeks was also noted. Analgesic medication was suspended 3 weeks post treatment. In conclusion, our experience shows that palliative therapy with 153Sm-EDTMP gives good pain relief in patients with bony metastases in one or two weeks time and this procedure can be routinely employed for relief of pain relief. (author)

  6. Radiation therapy for painful bone metastases. Aiming at optimal treatment schedules

    International Nuclear Information System (INIS)

    Murakami, Ryuji; Saito, Ryuichi; Miyazaki, Toshiyuki; Takahashi, Mutsumasa

    2001-01-01

    The purpose of this study is to evaluate the pain relief obtained by radiation therapy for painful bone metastases, with a special regard to general condition. Between June 1998 and May 2000, 54 patients with 86 painful bone metastases were treated with radiation therapy whose effects could be evaluated for a minimum period of 6 months or until death. Treatment schedules were 3 Gy/fraction/day (30-36 Gy/10-12 fractions) in usual cases (61 lesions), 4-8 Gy/fraction/day (8-20 Gy/1-5 fractions) in patients with a poor general condition (9 lesions), and 2 Gy/fraction/day (40-50 Gy/20-25 fractions) in lesions with a large radiation field (16 lesions). Complete pain relief without medication (CR) was achieved in 40 lesions (47%). Significant predictors for CR were primary site (p=0.0003), performance status (p=0.0060), pain score (p=00190), narcotic score (p<0.0001), and prognosis (p<0.0001), but no difference was found in CR among treatment schedules. No evidence of severe radiation-induced complication was seen. General condition (performance status and prognosis) has an influence on pain relief. Compared with the daily 2 Gy protocol, the daily 3 Gy protocol has the advantage of shorter treatment time. The treatment schedule should be assessed in patients with a large radiation field and/or poor general condition. Especially for the patients with poor general condition, combined pain medication should be considered. (author)

  7. Clinical usefulness of dental X-ray computed tomography for postoperative assessment of secondary alveolar bone grafting

    International Nuclear Information System (INIS)

    Noguchi, Kazuhide; Hamada, Yoshiki; Kondoh, Toshirou; Ishii, Hiroaki; Sonoyama, Tomoo; Kawarada, Takashi; Seto, Kanichi

    2003-01-01

    In this study, the clinical usefulness of dental X-ray computed tomography (CT) for postoperative assessment of secondary alveolar bone grafting was investigated. Nineteen bone-grafted alveolar clefts in 15 patients with cleft lip and palate were studied. All bone bridges were examined by dental three-dimensional (3D)-CT (PSR 9000: Asahi Roentgen, Kyoto, Japan). The postoperative 3D morphology of the bone bridges was easily recognized. Dental 3D-CT images were suggested to be useful for assessment before installation of dental implants in bone bridges. In addition, the status of bone surrounding the installed dental implants and the periodontal space of teeth adjacent to the cleft could be clearly evaluated. In conclusion, dental 3D-CT provides clinically valuable information for the postoperative assessment of secondary alveolar bone grafting. (author)

  8. Chronic Osteoporotic Pain in Mice: Cutaneous and Deep Musculoskeletal Pain Are Partially Independent of Bone Resorption and Differentially Sensitive to Pharmacological Interventions

    Science.gov (United States)

    Millecamps, Magali; Naso, Lina; Mori, Chisato

    2017-01-01

    Although the pathological changes in osteoporotic bones are well established, the characterization of the osteoporotic pain and its appropriate treatment are not fully elucidated. We investigated the behavioral signs of cutaneous and deep musculoskeletal pain and physical function; time-dependent changes in bone mineral density (BMD) and the emergence of the behavioral phenotype; and the effects of pharmacological interventions having different mechanisms of action (chronic intraperitoneal administration of pamidronate [0.25 mg/kg, 5x/week for 5 weeks] versus acute treatment with intraperitoneal morphine [10 mg/kg] and pregabalin [100 mg/kg]) in a mouse model of ovariectomized or sham-operated mice 6 months following surgery. We observed reduced BMD associated with weight gain, referred cutaneous hypersensitivity, and deep musculoskeletal pain that persisted for 6 months. Chronic bisphosphonate treatment, 6 months after ovariectomy, reversed bone loss and hypersensitivity to cold, but other behavioral indices of osteoporotic pain were unchanged. While the efficacy of acute morphine on cutaneous pain was weak, pregabalin was highly effective; deep musculoskeletal pain was intractable. In conclusion, the reversal of bone loss alone is insufficient to manage pain in chronic osteoporosis. Additional treatments, both pharmacological and nonpharmacological, should be implemented to improve quality of life for osteoporosis patients. PMID:28299231

  9. A randomized controlled trial to compare the efficacy of bisphosphonates in the management of painful bone metastasis

    Directory of Open Access Journals (Sweden)

    Krishnangshu Bhanja Choudhury

    2011-01-01

    Conclusion: The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm.

  10. Effect of Distraction Technique and Hypnosis in Pain of Bone Marrow Aspiration in Children: a Narrative Review

    Directory of Open Access Journals (Sweden)

    Alimorad Heidari Gorji

    2017-03-01

    Full Text Available BackgroundThe present review study provides specific evidence to assess the impact of distraction techniques and hypnosis on the pain of bone marrow aspiration in children.Materials and MethodsThis review study aimed to determine the effects of distraction techniques and hypnosis on the controlling pain of bone marrow aspiration in children. Internal databases (SID, Magiran, IranMedex and Irandoc, and international databases (Google-Scholar, Medline, PubMed, Elsevier, ProQuest, Springer and Web of Science, were searched by using the Mesh key words including "cancer", "bone marrow", "aspiration", "distraction", "hypnosis", "pain", "children" and "pediatric", with no time limit since the foundation of these databases until December 2016.ResultsIn overall review of the articles, based on the issues expressed, the effect of most of various distraction interventions and hypnosis on the pain severity of children under the bone marrow aspiration procedure was significant and positive (P

  11. Transcranial magnetic stimulation over human secondary somatosensory cortex disrupts perception of pain intensity.

    Science.gov (United States)

    Lockwood, Patricia L; Iannetti, Gian Domenico; Haggard, Patrick

    2013-09-01

    Pain is a complex sensory experience resulting from the activity of a network of brain regions. However, the functional contribution of individual regions in this network remains poorly understood. We delivered single-pulse transcranial magnetic stimulation (TMS) to the contralateral primary somatosensory cortex (S1), secondary somatosensory cortex (S2) and vertex (control site) 120 msec after selective stimulation of nociceptive afferents using neodymium:yttrium-aluminium-perovskite (Nd:YAP) laser pulses causing painful sensations. Participants were required to judge either the intensity (medium/high) or the spatial location (proximal/distal) of the stimulus in a two-alternative forced choice paradigm. When TMS pulses were delivered over S2, participants' ability to judge pain intensity was disrupted, as compared to S1 and vertex (control) stimulation. Signal-detection analysis demonstrated a loss of sensitivity to stimulation intensity, rather than a shift in perceived pain level or response bias. We did not find any effect of TMS on the ability to localise nociceptive stimuli on the skin. The novel finding that TMS over S2 can disrupt perception of pain intensity suggests a causal role for S2 in encoding of pain intensity. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Effect of age on response to palliative radiotherapy and quality of life in patients with painful bone metastases

    International Nuclear Information System (INIS)

    Westhoff, Paulien G.; Graeff, Alexander de; Reyners, Anna K.L.; Monninkhof, Evelyn M.; Rodenhuis, Carla C.; Vulpen, Marco van; Leer, Jan Willem H.; Marijnen, Corrie A.M.; Linden, Yvette M. van der

    2014-01-01

    Background: Multimorbidity and declining performance in elderly cancer patients may result in less treatment benefit. We investigated whether age is a predictor for pain response and quality of life (QoL) after radiotherapy in patients with painful bone metastases. Methods: The database of the Dutch Bone Metastasis Study was used (1996–1999). 1157 patients, irradiated for painful bone metastases, rated their pain, QoL-domains and overall health at baseline and during follow-up. Response was calculated taking into account changes in pain score and medication. Patients were grouped into three age cohorts: A: <65 (n = 520), B: 65–74 (n = 410) and C: ⩾75 years (n = 227). Results: No significant difference existed in pain response between cohorts: 78% in cohort A, 74% in B and 67% in C. When assessing baseline QoL, a significant difference in activity level was noticed, with more impairment in elderly compared to younger patients (C versus B (p = 0.01), C versus A (p < 0.001)). Other QoL-domains were similar at baseline and during follow-up among cohorts. A pain response was significantly associated with improvement of health-related QoL (OR 3.74, 95% CI 2.66–5.25). Conclusion: The majority of elderly patients with painful bone metastases responded to radiotherapy and showed comparable overall QoL compared to their younger counterparts. Age is not a predictor for pain response or QoL

  13. Determining the Incidence of Pain Flare Following Palliative Radiotherapy for Symptomatic Bone Metastases: Results From Three Canadian Cancer Centers

    International Nuclear Information System (INIS)

    Hird, Amanda; Chow, Edward; Zhang Liying; Wong, Rebecca; Wu, Jackson; Sinclair, Emily; Danjoux, Cyril; Tsao, May; Barnes, Elizabeth; Loblaw, Andrew

    2009-01-01

    Purpose: To determine the incidence of pain flare following radiotherapy (RT) for painful bone metastases. Materials and Methods: Patients with bone metastases treated with RT were eligible. Worst pain scores and analgesic consumption were collected before, daily during, and for 10 days after treatment. Pain flare was defined as a 2-point increase in the worst pain score (0-10) compared to baseline with no decrease in analgesic intake, or a 25% increase in analgesic intake with no decrease in worst pain score. Pain flare was distinguished from progression of pain by requiring the worst pain score and analgesic intake return to baseline levels after the increase/flare (within the 10-day follow-up period). Results: A total of 111 patients from three cancer centers were evaluable. There were 50 male and 61 female patients with a median age of 62 years (range, 40-89 years). The primary cancers were mainly breast, lung, and prostate. Most patients received a single 8 Gy (64%) or 20 Gy in five fractions (25%). The overall pain flare incidence was 44/111 (40%) during RT and within 10 days following the completion of RT. Patients treated with a single 8 Gy reported a pain flare incidence of 39% (27/70) and, with multiple fractions, 41% (17/41). Conclusion: More than one third of the enrolled patients experienced a pain flare. Identifying at-risk individuals and managing potential pain flares is crucial to achieve an optimal level of care.

  14. {sup 188}Rhenium-HEDP in the Treatment of Pain in Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Gaudiano, J.; Savio, E.; Robles, A.; Muniz, S.; Leon, A.; Verdera, S.; Martinez, G.; Hermida, J.C.; Knapp, F.F., Jr.

    1999-01-18

    Systemic use of radiopharmaceuticals is a recognized alternative method for the treatment of pain in patients with multiple bone metastasis. A new option, {sup 188}Re-HEDP is proposed, using generator-obtained {sup 188}Rhenium ({beta} energy = 2.1 MeV, {gamma} energy = 155 keV, half-life = 16.9 hours). After establishing parameters of biodistribution, dosimetry and image acquisition in mice, rats and rabbits, Phase I and II studies were conducted on 12 patients with multiple metastasis from carcinomas, with pain surpassing other analgesic options. More than 50% pain relief was found in 91% of the patients, with total relief during a variable period in 41% of them allowing opiate and other analgesic drugs to be decreased or withdrawn, and showing a lower bone marrow contribution to total absorbed dose than that reported for other similar radiopharmaceuticals. Further study of this option is recommended in order to determine higher dose protocols without toxic bone marrow reaction possibilities.

  15. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com; Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy); Ballicu, Nicola, E-mail: nicolaballicu77@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy)

    2016-01-15

    PurposeTo retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture.Materials and MethodsThirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure.ResultsIn all patients, pain reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients’ walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites.ConclusionOur results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.

  16. The characteristics of physical activity and gait in patients receiving radiotherapy in cancer induced bone pain

    International Nuclear Information System (INIS)

    Sande, Tonje A.; Scott, Angela C.; Laird, Barry J.A.; Wan, Hong I.; Fleetwood-Walker, Susan M.; Kaasa, Stein; Klepstad, Pål; Mitchell, Rory; Murray, Gordon D.; Colvin, Lesley A.; Fallon, Marie T.

    2014-01-01

    Background and purpose: An objective measure of pain relief may add important information to patients’ self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP. Materials and methods: Patients were assessed before (baseline) and 6–8 weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann–Whitney and Pearson statistical analyses were done. Results: Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p < 0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r = 0.469, p = 0.002) and gait (cadence r = 0.341, p = 0.03). The activPAL and GAITRite parameters did not change following XRT (p > 0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p > 0.05). Conclusion: Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT

  17. Contribution of the bone scintigraphy in unexplained pains of the thigh

    International Nuclear Information System (INIS)

    Oufroukhi, Y.; Ech Charraq, I.; Ben Rais, N.

    2006-01-01

    Mr. R.N. 32 year's old, high level sportsman, without particular pathological antecedents, consults for pains of the area above the knee of the left thigh, of mechanical pace being exacerbated with the effort. The clinical examination notes pains induced by the deep of the left thigh. The biological assessment, in particular blood cell formula and CRP were normal. The standard radiography of the femurs did not find an anomaly of the osseous structure. Because of the persistence of the pains, an osseous scintiscan was carried out and orientated towards pathology of soft tissues. The doppler and the TDM made it possible to pose the diagnosis of intra-tissues muscular hemangioma. The early times of the bone scintigraphy appears important in the approach diagnosis of many osseous disease of the sportsman. (author)

  18. Antinociceptive Effect of Intrathecal Microencapsulated Human Pheochromocytoma Cell in a Rat Model of Bone Cancer Pain

    Directory of Open Access Journals (Sweden)

    Xiao Li

    2014-07-01

    Full Text Available Human pheochromocytoma cells, which are demonstrated to contain and release met-enkephalin and norepinephrine, may be a promising resource for cell therapy in cancer-induced intractable pain. Intrathecal injection of alginate-poly (l lysine-alginate (APA microencapsulated human pheochromocytoma cells leads to antinociceptive effect in a rat model of bone cancer pain, and this effect was blocked by opioid antagonist naloxone and alpha 2-adrenergic antagonist rauwolscine. Neurochemical changes of cerebrospinal fluid are in accordance with the analgesic responses. Taken together, these data support that human pheochromocytoma cell implant-induced antinociception was mediated by met-enkephalin and norepinephrine secreted from the cell implants and acting at spinal receptors. Spinal implantation of microencapsulated human pheochromocytoma cells may provide an alternative approach for the therapy of chronic intractable pain.

  19. The Role of the Three Phase Bone Scintigraphy in the Management of the Patients with Costochondral Pain

    Directory of Open Access Journals (Sweden)

    Zehra Pınar Koç

    2013-12-01

    Full Text Available Aim: The bone scintigraphy is indicated in patients with costochondral pain in order to identify the organic etiology. We aimed to investigate the local and projecting pain, or incidental findings in the three phase bone scintigraphy of the patients referred for costochondral pain. Methods: We included 50 patients (36F, 24M; mean: 41±18 years-old referred to our department for three phase bone scintigraphy for costochondral pain between January 2009-July 2012. Results: Among the 50 patients 22 had normal scintigraphy. An increased activity accumulation in the sternoclavicular joint was observed in 12 patients (right in 4, left in 4 and bilateral in 4 only in late phase and in 9 patients (right in 2, left in 1 and bilateral in 6 with increased vascularity. Among projecting pain causes, activity was present on sternum in 4 patients, on humerus in 2 patients and on the first costae in 2 patients. For the characterization of inflammatory pathology, the three phase bone scintigraphy showed sensitivity, specificity, accuracy, positive and negative predictive values of 43%, 94%, 78%, 77% and 78% respectively. Conclusion: Bone scintigraphy is an effective diagnostic method for the identification of local or projecting pain, and additionally unexpected incidental pathologies associated with costochondral pain. However regarding the characterization of inflammatory process false negatives should be considered.

  20. An Easy Tool to Predict Survival in Patients Receiving Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Westhoff, Paulien G.; Graeff, Alexander de; Monninkhof, Evelyn M.; Bollen, Laurens; Dijkstra, Sander P.; Steen-Banasik, Elzbieta M. van der; Vulpen, Marco van; Leer, Jan Willem H.; Marijnen, Corrie A.; Linden, Yvette M. van der

    2014-01-01

    Purpose: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and patient-reported scores of pain and quality of life, to predict survival in patients with painful bone metastases. Methods and Materials: In the Dutch Bone Metastasis Study, 1157 patients were treated with radiation therapy for painful bone metastases. At randomization, physicians determined the KPS; patients rated general health on a visual analogue scale (VAS-gh), valuation of life on a verbal rating scale (VRS-vl) and pain intensity. To assess the predictive value of the variables, we used multivariate Cox proportional hazard analyses and C-statistics for discriminative value. Of the final model, calibration was assessed. External validation was performed on a dataset of 934 patients who were treated with radiation therapy for vertebral metastases. Results: Patients had mainly breast (39%), prostate (23%), or lung cancer (25%). After a maximum of 142 weeks' follow-up, 74% of patients had died. The best predictive model included sex, primary tumor, visceral metastases, KPS, VAS-gh, and VRS-vl (C-statistic = 0.72, 95% CI = 0.70-0.74). A reduced model, with only KPS and primary tumor, showed comparable discriminative capacity (C-statistic = 0.71, 95% CI = 0.69-0.72). External validation showed a C-statistic of 0.72 (95% CI = 0.70-0.73). Calibration of the derivation and the validation dataset showed underestimation of survival. Conclusion: In predicting survival in patients with painful bone metastases, KPS combined with primary tumor was comparable to a more complex model. Considering the amount of variables in complex models and the additional burden on patients, the simple model is preferred for daily use. In addition, a risk table for survival is

  1. Differential diagnosis of metastatic bone disease and benign bone disease on spine SPECT in patients with low back pain

    International Nuclear Information System (INIS)

    Lee, Seung Hun; Choi, Yun Young; Cho, Suk Shin

    2001-01-01

    One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients, as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. We reviewed spine SPECT studies obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2 Posterior element; posterior to body (pedicle), posterior to intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Sixty-nine bone lesions were detected on SPECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis: linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients

  2. Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Driban, Jeffrey B; Lohmander, Stefan; Frobell, Richard B

    2017-06-02

      After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.   To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.   Cross-sectional exploratory analysis of a randomized clinical trial.   Orthopaedic departments at 2 hospitals in Sweden.   As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied.   The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.   Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = -0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = -0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = -0.48, P = .02) but not lateral (β = -0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.   We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between

  3. A Rare Case of Painful Trigeminal Neuropathy Secondary to Lateral Medullary Infarct: Neuroimaging and Electrophysiological Studies.

    Science.gov (United States)

    Huang, Ching-Tang; Lo, Chung-Ping; Chen, Ying-Chu; Tu, Min-Chien

    2015-06-01

    To report a rare case of painful trigeminal neuropathy after lateral medullary infarct and probe its underlying pathogenesis on the basis of neuroimaging and electrophysiological study. A 45-year-old man presented acute onset of unsteady gait followed by paroxysmal and electric shock-like headache in the distribution of ophthalmic branch of left trigeminal nerve in 2 days. Neurological examinations showed hypoesthesia in the distribution of mandibular branch of left trigeminal nerve and left appendicular ataxia. Muscle powers and deep tendon reflexes were normal. Brain magnetic resonance imaging revealed infarct within the left cerebellum and middle portion of dorsolateral medulla. Vascular compression at the root entry zone of trigeminal nerve was excluded. Painful trigeminal neuropathy secondary to lateral medullary infarct was diagnosed. Ancillary blink reflex study 3 days after the stroke event showed abnormal late responses (R2), either ipsilateral or contralateral, after stimulation of left supraorbital nerve, suggesting left medullary lesion. Followup study 3 weeks later demonstrated normalization in absolute latencies of bilateral late responses, in line with remission of pain paroxysms on low-dose gabapentin treatment. Painful trigeminal neuropathy attributed to lateral medullary infarct is a unique disease entity. Ophthalmic branch involvement, coexisting sensory deficits, absence of triggers, and rapid evolvement and remission are its characteristics. Our neuroimaging study delineated ischemic stroke pathology within descending tract and spinal nucleus of trigeminal nerve. Serial electrophysiological studies provide evidences supporting ephaptic transmission as the main pathogenesis concordant with dynamics of neuropathic pain and therapeutic implications.

  4. Imaging findings in a child with calcineurin inhibitor-induced pain syndrome after bone marrow transplant for beta thalassemia major

    Energy Technology Data Exchange (ETDEWEB)

    Ayyala, Rama S.; Arnold, Staci D.; Bhatia, Monica; Dastgir, Jahannaz [Columbia University Medical Center, Morgan Stanley Children' s Hospital, Department of Radiology, New York, NY (United States)

    2016-10-15

    Calcineurin inhibitor-induced pain syndrome is an entity recognized in patients on immunosuppressive therapy after transplantation. Diagnosis is characterized by onset of pain beginning in the setting of an elevated calcineurin-inhibitor trough level. Reducing the medication dose relieves symptoms. Imaging findings can be nonspecific, including bone marrow edema and periosteal reaction. We present the unique case of calcineurin inhibitor-induced pain syndrome in a child and review the imaging findings. (orig.)

  5. Imaging findings in a child with calcineurin inhibitor-induced pain syndrome after bone marrow transplant for beta thalassemia major

    International Nuclear Information System (INIS)

    Ayyala, Rama S.; Arnold, Staci D.; Bhatia, Monica; Dastgir, Jahannaz

    2016-01-01

    Calcineurin inhibitor-induced pain syndrome is an entity recognized in patients on immunosuppressive therapy after transplantation. Diagnosis is characterized by onset of pain beginning in the setting of an elevated calcineurin-inhibitor trough level. Reducing the medication dose relieves symptoms. Imaging findings can be nonspecific, including bone marrow edema and periosteal reaction. We present the unique case of calcineurin inhibitor-induced pain syndrome in a child and review the imaging findings. (orig.)

  6. Disparate effects of mild, moderate, and severe secondary hyperparathyroidism on cancellous and cortical bone in rats with chronic renal insufficiency.

    Science.gov (United States)

    Miller, M A; Chin, J; Miller, S C; Fox, J

    1998-09-01

    The subtotally nephrectomized rat has often been used to investigate the etiology and treatment of secondary hyperparathyroidism (secondaryHPT), but it has been used less frequently to study the effects of secondaryHPT on bone. The recent development of a reliable and specific rat parathyroid hormone (PTH) immunoradiometric assay has provided an opportunity for a thorough investigation of the relationship between circulating, biologically active PTH, and the skeletal abnormalities that occur in chronic renal insufficiency (CRI). Rats were 5/6 nephrectomized (Nx) or sham operated and fed diets with varying levels of Ca and P for 12-14 weeks to induce differing magnitudes of secondaryHPT. Parathyroid gland volume increased by 80%-90% in 5/6 Nx rats in the mild and moderate secondaryHPT groups (2.3- and 7.7-fold higher PTH levels, respectively) and by 3.3-fold in the severe secondaryHPT group (12-fold increase in PTH). The increases in gland volume were caused primarily by cell hyperplasia. Mild secondaryHPT resulted in a 12% decrease in bone mineral density (BMD) across the entire femur, increased osteoclast numbers (N.Oc), unchanged osteoblast numbers (N.Ob), and decreased cancellous bone volume (Cn.BV) in the tibial metaphysis but, apart from increased marrow area, no major changes in cortical bone at the tibio-fibular junction. Moderate secondaryHPT was associated with no changes in femoral BMD, or in tibial Cn.BV, but N.Ob and bone formation rate (BFR) were markedly elevated. Increased periosteal, intracortical, and endocortical BFR and turnover were evident, and contributed to increased cortical porosity (Ct.Po). The changes were exaggerated in the severe secondaryHPT group; BMD was lower in the proximal, but higher in the distal femur, and Cn.BV, N.Ob, N.Oc, and BFR were increased by six-, seven-, three-, and 30-fold, respectively. Endocortical BFR was elevated 31-fold and the extensive Ct.Po (10%) decreased bone strength. However, Ct.Po was not apparent until

  7. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone.

    Science.gov (United States)

    Munk, Peter L; Rashid, Faisal; Heran, Manraj K; Papirny, Michael; Liu, David M; Malfair, David; Badii, Maziar; Clarkson, Paul W

    2009-07-01

    To assess the safety and effectiveness of combined radiofrequency (RF) ablation and cementoplasty in the treatment of painful neoplastic lesions of bone. The authors performed a retrospective analysis of 25 combined treatments comprising RF ablation followed by injection of polymethylmethacrylate cement performed in 19 patients during a 22-month period. Patients ranged in age from 42 to 82 years (mean, 58.9 years) and included five women and 14 men. Eleven vertebrae (eight lumbar and three thoracic), nine acetabulae, three sacra, one pubis, and one humerus were treated with a total of 36 RF ablations (in several instances, overlapping ablations were used). The location of the primary neoplasm, lesion size, pain before and after the procedure (as determined with a 10-point visual analog scale [VAS]), number of RF treatments, type of device used for cementoplasty, RF time, cement volume, and extravasation were documented. A total of 25 combined RF ablations and cementoplasties were performed. The technical success rate was 100% (25 of 25 treatments). There were seven minor complications: six limited cement extravasations and a transient thermal nerve injury. The mean RF time was 9.1 minutes (range, 6-12 minutes). The mean cement volume injected was 6.1 mL (range, 0.8-16 mL). The mean preprocedure pain (as measured with a VAS) was 7.9 (range, 7.0-9.0) and the mean posttreatment pain was 4.2 (range, 0-6); the difference was statistically significant (mean score, 4.08; 95% confidence interval: 3.92, 4.87; P < .0001) using a paired t test. Combined RF ablation and cementoplasty appears to be safe and effective in the treatment of painful neoplastic lesions of bone.

  8. Metastatic Bone Pain Palliation with P-32 in Combination with Vitamin D: Our Preliminary Experience

    International Nuclear Information System (INIS)

    Khan, A.U.; Khan, S.U.; Iqbal, M.; Khan, A.; Shahid, S.

    2009-01-01

    Phosphorus-32 ( 32 P) is a routinely used bone pain palliation agent at our institute due to its cost, availability and proven efficacy with mild and self limiting myelo-suppression. Vitamin D is known to de-differentiate tumors and supposed to enhance calcium deposition onto metastatic foci with a hope of reducing the marrow effects. A pilot study showing an increase in the 99m Tc-MDP uptake by skeletal metastatic foci, using single pulse dose of Vitamin D, in some of the patients preceded this study and found the basis for this study. The aim of this study was to evaluate the role of 32 P alone and in combination with vitamin D in the palliation of bone pain from osseous metastases and to look for its clinical efficacy and reduction in marrow suppression in our clinical environment. 62 patients with extensive osteoblastic bone metastases were randomly divided into 3 groups. Group A received 32 P alone, group B combination therapy of 32 P and Vitamin D and group C Vitamin D alone. All these patients were evaluated by a standard protocol on broad parameters of pain reduction, reduction in analgesic consumption, improvement in quality of life and effect on bone marrow suppression at the end of 4th and 8th week post-therapy. Favorable response (≥25%) to treatment was recorded in 55% of cases in-group A, 81% in- group B and 9% in-group C. Reduction in pain score of 50% to 100% were obtained in two cases in group A and 10 in group B. A decrease in pain of 26% to 50% and ≤ 25% was observed in 10 (45%) and 4 (18%) cases respectively in group A, and 8 (36%) and 2 (9%) cases respectively in group B. Analgesic consumption was reduced in both the groups of 32 P, comparatively more in group B. The improvement in mobility and quality of life was observed to be better in group B than A and C. A decrease of white blood cells, hemoglobin level and platelets counts was observed in both groups of 32 P but no significant difference was noted in group A and B was noted at the end

  9. Catestatin, vasostatin, cortisol, and pain assessments in dogs suffering from traumatic bone fractures.

    Science.gov (United States)

    Srithunyarat, Thanikul; Hagman, Ragnvi; Höglund, Odd V; Stridsberg, Mats; Olsson, Ulf; Hanson, Jeanette; Nonthakotr, Chalermkwan; Lagerstedt, Anne-Sofie; Pettersson, Ann

    2017-03-21

    Traumatic bone fractures cause moderate to severe pain, which needs to be minimized for optimal recovery and animal welfare, illustrating the need for reliable objective pain biomarkers for use in a clinical setting. The objectives of this study were to investigate catestatin (CST) and vasostatin (VS) concentrations as two new potential biomarkers, and cortisol concentrations, scores of the short form of the Glasgow composite measure pain scale (CMPS-SF), and visual analog scale (VAS) in dogs suffering from traumatic bone fractures before and after morphine administration in comparison with healthy dogs. Fourteen dogs with hind limb or pelvic fractures and thirty healthy dogs were included. Dogs with fractures were divided into four groups according to analgesia received before participation. Physical examination, CMPS-SF, pain and stress behavior VAS scores were recorded in all dogs. Saliva and blood were collected once in healthy dogs and in dogs with fractures before and 35-70 min after morphine administration. Blood samples were analyzed for CST, VS, and cortisol. Saliva volumes, however, were insufficient for analysis. Catestatin and cortisol concentrations, and CMPS-SF, and VAS scores differed significantly between dogs with fractures prior to morphine administration and healthy dogs. After morphine administration, dogs with fractures had significantly decreased CMPS-SF and VAS scores and, compared to healthy dogs, CST concentrations, CMPS-SF, and VAS scores still differed significantly. However, CST concentrations remained largely within the normal range. Absolute delta values for CST significantly correlated with delta values for CMPS-SF. Catestatin and cortisol did not differ significantly before and after morphine administration. Vasostatin concentrations did not differ significantly between groups. Catestatin and cortisol concentrations, CMPS-SF, and VAS scores differed significantly in the dogs with traumatic bone fractures compared to the healthy dogs

  10. Impact of educational strategies in positioning Samarium-153 EDTMP as a treatment for metastatic bone pain

    International Nuclear Information System (INIS)

    Seminario, C.; Morales, R.; Castro, M.; Cano, R.A.; Mendoza, G.

    2005-01-01

    To educate is a difficult task but its results make efforts worthwhile. Many patients in Peru suffer from intractable bone pain due to metastases. Since 1993 radionuclides were used to palliate bone pain due to metastases in Peru. First, with the help of the IAEA, Peru participated in a clinical trial using Phosphorus 32 and Strontium 89. Then, efforts were performed to produce Samarium 153 EDMTP locally, which was achieved in 1995. Nevertheless, years passed and Samarium use did not increase proportionally to the needs of people with cancer and bone pain, mainly the poor. Educational strategies have been proven useful for delivering solutions to many health problems in other diseases and also in cancer. Health education makes patients and their relatives assume responsible care of their problems. The purpose of this work was to increase Samarium EDTMP use as palliative treatment in patients with bone pain due to metastases, using educational strategies as means to change attitudes towards this health problem. In September 2003, a task group conducted studies in order to apply several methods to achieve the goal of increasing Samarium EDTMP use. Educational strategies employed were performed to provide verbal and written information to patients, physicians, medical students, residents, pain specialists, oncologists and neurologists, as well as general public. Verbal information included radio interviews, television spots and a phone number (in charge of two secretaries, prepared for answering and if not possible, a physician was in charge of attending patient consultation), e-mail and a web page for consultation. Written material was delivered to several newspapers, including clinical use of Samarium, possibilities of being elected for treatment, benefits and risks and a photography of the product. Politics of the institution producing Samarium changed, in order to achieve minimum cost of the product and it was delivered to all publics at the lowest cost for a year

  11. Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer.

    Science.gov (United States)

    Çelebioğlu, Ayda; Gürol, Ayşe; Yildirim, Zuhal Keskin; Büyükavci, Mustafa

    2015-12-01

    Cancer and its treatment are stressful and reduce the quality of life in children. The aim of this study was to investigate the effect of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer. We conducted a controlled pretest/posttest quasi-experimental study at a paediatric oncology unit in Turkey. Twenty-five children were enrolled in this study. Their pain and anxiety were determined using a visual analogue scale. When the pretest and posttest pain and anxiety levels of the groups were compared, no statistically significant difference was found (P > 0.05). It was determined that pain and anxiety levels in the experimental group decreased significantly. This study provides preliminary evidence for the effectiveness in children of massage in reducing pain and anxiety arising from intrathecal therapy or bone marrow aspiration. © 2014 Wiley Publishing Asia Pty Ltd.

  12. An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures

    NARCIS (Netherlands)

    Milstein, D.M.J.; Cheung, Y.W.; Ziukaite, L.; Ince, C.; van den Akker, H.P.; Lindeboom, J.A.H.

    2013-01-01

    Objective The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. Study Design This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary

  13. 99m technetium-MDP bone scintigraphy in evaluation of painful joint prosthesis

    International Nuclear Information System (INIS)

    Milosevic, D.; Jaukovic, M.; Jaukovic, Lj.; Ajdinovic, B.

    2004-01-01

    In addition of clinical evaluation and x-ray radiography, the diagnosis of a loose joint prosthesis is often made by nuclear medicine imaging techniques. Differentiation between loosening and infected prosthesis is important for better treatment of those patients. Aim: The aim of this study was to reevaluate the scintigraphic patterns in patients with painful hip of knee arthroplasty. Material and Method: From 1996. to 2003. forty patients aged 49-78 years were referred for evaluation of possible loosening/infection joint prosthesis: 36 pts with 39 total/ partial hip prosthesis, 1 pt with knee prosthesis and 3 pts with history of previously extracted hip prosthesis due to infection. Whole body acquisition had been performed with a single head gamma camera three hours after the injection of 740 MBq 99m Tc-MDP. Scans were classified as: positive for loosening if abnormal uptake was shown at the tip of the prosthesis; positive for infection if diffuse abnormal uptake was shown around the implant; negative and indeterminate scans. Scintigraphic findings were compared to clinical follow up, histology or cultures. Results: Positive findings were found in 17 bone scans strongly suggesting loosening in 10 cases, infection of prosthesis in 4 cases and both loosening/infection in 3 cases. Bone scintigraphy was normal in 11pts. Scans of three pts with previously extracted hip prosthesis and scheduled for reimplatation, showed inhomogeneously and mildly increased uptake in femur. Most of scans classified as indeterminate (n=12) showed slightly increased tracer uptake in region of acetabular roof, greater or lesser tho chanter, suggesting bone remodeling due to the presence of implant, rather than loosening. Conclusion: 99m Tc-MDP bone scintigraphy had a significant role in assessing the painful joint prosthesis. Complementary diagnostic procedures should be considered in indeterminate scintiscans. (authors)

  14. (153)Sm-EDTMP for pain relief of bone metastases from prostate and breast cancer and other malignancies.

    Science.gov (United States)

    Correa-González, Luis; Arteaga de Murphy, Consuelo; Pichardo-Romero, Pablo; Pedraza-López, Martha; Moreno-García, Claudia; Correa-Hernández, Luis

    2014-05-01

    Approximately 85% of patients with cancer suffer severe metastatic bone pain for which radionuclide therapy has been employed for pain palliation. We undertook this study to evaluate the pain relief effect of (153)Sm-EDTMP in Mexican patients with severe and painful bone metastases from mainly prostate, breast, and renal cancer and other malignancies. Patients (277) with intense sustained pain caused by bone metastases were referred to the Nuclear Medicine Department of the Oncology Hospital of the Mexican Social Security Institute. The patients had to have acceptable physical conditions, a previous positive (99m)Tc-MDP scan and blood values within normal range. (153)Sm-EDTMP was prepared at the Instituto Nacional de Investigaciones Nucleares (ININ) and 37 MBq/kg of body weight was injected intravenously. Pain palliation was evaluated with a visual analogue scale (VAS) and a verbal rating scale (VRS) before treatment and 3 and 12 weeks after treatment was started. The age interval of the patients was 24-92 years with a mean age of 64 ± 12 years. Mean values for hemoglobin, leukocyte and platelet counts did not statistically differ at zero time, 3 and 12 weeks after treatment. Pain intensity and relief assessment were statistically different: 9.1 ± 0.61 units initially; 4.2 ± 1.3 units 3 weeks later (54%) and after 12 weeks the pain diminished to 2.4 ± 1.4 units (74%) in the pain relief score scales. (153)Sm-EDTMP was readily available, safe and well tolerated. We conclude that (153)Sm-EDTMP was an adequate palliative agent and was the best option for our Mexican patients to relieve their severe metastatic bone pain. Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.

  15. Chondroblastoma with secondary aneurysmal bone cyst in the anterior skull base

    Directory of Open Access Journals (Sweden)

    Ming Jie Wang, MD, PhD

    2016-06-01

    Full Text Available Chondroblastoma with secondary aneurysmal bone cyst (ABC, especially in the anterior skull base, is an extremely rare condition. A 5-year-old boy presented with a large space-occupying lesion in the anterior skull base along with a left sided-epistaxis, proptosis and decreased vision. Radical excision of the lesion was performed by an endoscopic transnasal and transethmoidal approach. The patient recovered without any recurrence during a follow-up period of up to 28 months. Here, we review this rare case and discuss the clinical presentation and surgical treatment.

  16. Characterization of a rat model of metastatic prostate cancer bone pain

    Directory of Open Access Journals (Sweden)

    Paolo Donato De Ciantis

    2010-11-01

    Full Text Available Paolo Donato De Ciantis1, Kiran Yashpal2, James Henry3, Gurmit Singh11Department of Pathology and Molecular Pathology, 2Pain Research Laboratories, 3Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, CanadaPurpose: The objectives of this study were to establish and characterize a novel animal model of metastatic prostate cancer-induced bone pain.Methods: Copenhagen rats were injected with 106 MATLyLu (MLL prostate cancer cells or phosphate-buffered saline by per cutaneous intra femoral injections into the right hind leg distal epiphysis. Over 13 days, rats progressively developed a tumor within the distal femoral epiphysis. On days 3, 7, 10, and 13 post injection, rats were subjected to the incapacitance and Randall–Selitto behavioral tests as they are believed to be indirect reflections of tumor induced pain. Ipsilateral hind limbs were subjected to X-ray and computed tomography (CT scans and histological sections were stained with hematoxylin and eosin (H&E.Results: Intra femoral injections of MLL cells resulted in the progressive development of a tumor leading to bone destruction and nociceptive behaviors. Tumor development resulted in the redistribution of weight to the contralateral hind leg and significantly reduced the paw withdrawal threshold of the ipsilateral hind paw as observed via the incapacitance and Randall–Selitto tests, respectively. X-ray and computed tomography scans along with H&E stains indicated tumor-associated structural damage to the distal femur. This model was challenged with administration of meloxicam. Compared with vehicle-injected controls, the meloxicam-treated rats displayed smaller nociceptive responses as observed with the incapacitance and Randall–Selitto tests, suggesting that meloxicam was effective in reducing the pain-related symptoms displayed by model animals and that the model behaved in a predictable way to cyclooxygenase-2 treatment.Conclusions: This

  17. Assessment of therapeutic effect in patients with secondary hyperparathyroidism using bone scintigraphy

    International Nuclear Information System (INIS)

    Kaida, Hayato; Ishibashi, Masatoshi; Baba, Kenkichi; Okuda, Seiya; Hayabuchi, Naofumi; Nishida, Hidemi; Hiromatsu, Yuji

    2005-01-01

    The semi-quantitative method of bone scintigraphy [bone to soft tissue (B/ST) ratio] has been used in diagnosing and evaluating systemic metabolic bone diseases. The aim of this study is to evaluate of the therapeutic effect of secondary hyperparathyroidism (SHP). The subjects were ten hemodialysis patients with SHP. Seven patients underwent parathyroidectomy (PTX), and 22-Oxacalcitoriol (derivative of 1, 25-dihydroxyvitamin D 3 ) (OCT) was given to three patients. Bone scintigraphy and blood tests [intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca), phosphorus (P), bone alkaline phosphatase (BALP), and deoxypridinoline (DPYD)] were performed before and after treatment. Regions of interest were drown around cranium, lumbar vertebrae, femoral neck and soft tissue of left medial thigh to calculate the B/ST ratio. The B/ST ratios of cranium, lumbar vertebrae, and femoral neck were reduced significantly after PTX (cranium, p=0.0079, lumbar vertebrae, p=0.0282, femoral neck, p=0.0252). Intact PTH, ALP, Ca, P, BALP and DPYD levels were reduced significantly after PTX (intact PTH, p=0.003, Ca, p=0.0005, P, p=0.0393, ALP, p=0.005 1, DPYD, p=0.0232, BALP, p=0.0324). After OCT administration, the B/ST ratio of each bony region showed tendency to diminish, although not significantly. Intact PTH levels were reduced significantly, although ALP, BALP, and DPYD levels were not. Ca and P levels were increased significantly because of the medicinal action of OCT. The B/ST ratio of cranium may be non-invasive method and have potential in evaluating the therapeutic effect of SHP. (author)

  18. Radionuclide Treatment with 153Sm-EDTMP is Effective for the Palliation of Bone Pain in the Context of Extensive Bone Marrow Metastases: A Case Report

    Directory of Open Access Journals (Sweden)

    Kalevi Kairemo

    2014-10-01

    Full Text Available Radionuclide therapy is widely used as an effective modality in the management of bone pain. The main indication for this treatment is symptomatic bone metastases, confirmed by bone scintigraphy. We present a case of small cell lung cancer (SCLC stage T4N2M1b, with a good metabolic response to systemic therapy and radiotherapy of the primary tumor and locoregional disease, which became metabolically less active and remarkably smaller in size (reduction to 1/6 of the original volume. In spite of the good overall response, the patient developed a syndrome with severe bone pain and had progression in the bone marrow metastases, confirmed by 18F-FDG PET/CT. The patient received 153Sm-EDTMP treatment with a good clinical response. However, in the whole body bone scan with the therapeutic dose, there was no visual evidence of bone metastasis. Retrospectively, by drawing the region of interest, it was possible to identify one metastatic site. The possible mechanisms of the efficacy of this treatment modality, in this specific setting, are also discussed.

  19. Radionuclide Treatment with 153Sm-EDTMP is Effective for the Palliation of Bone Pain in the Context of Extensive Bone Marrow Metastases: A Case Report

    International Nuclear Information System (INIS)

    Kairemo, Kalevi; Rasulova, Nigora; Suslaviciute, Justina; Alanko, Tuomo

    2014-01-01

    Radionuclide therapy is widely used as an effective modality in the management of bone pain. The main indication for this treatment is symptomatic bone metastases, confirmed by bone scintigraphy. We present a case of small cell lung cancer (SCLC) stage T 4 N 2 M 1b , with a good metabolic response to systemic therapy and radiotherapy of the primary tumor and locoregional disease, which became metabolically less active and remarkably smaller in size (reduction to 1/6 of the original volume). In spite of the good overall response, the patient developed a syndrome with severe bone pain and had progression in the bone marrow metastases, confirmed by 18 F-FDG PET/CT. The patient received 153 Sm-EDTMP treatment with a good clinical response. However, in the whole body bone scan with the therapeutic dose, there was no visual evidence of bone metastasis. Retrospectively, by drawing the region of interest, it was possible to identify one metastatic site. The possible mechanisms of the efficacy of this treatment modality, in this specific setting, are also discussed

  20. Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules

    International Nuclear Information System (INIS)

    Gaze, Mark N.; Kelly, Charles G.; Kerr, Gillian R.; Cull, Ann; Cowie, Valerie J.; Gregor, Anna; Howard, Grahame C.W.; Rodger, Alan

    1997-01-01

    Background: The optimum dose and fractionation schedule for the palliative irradiation of painful bone metastases is controversial. Purpose: To compare the efficacy, side-effects and effect on quality of life of two commonly used radiotherapy schedules in the management of painful bone metastases. Materials and methods: In a prospective trial, 280 patients were randomised to receive either a single 10 Gy treatment or a course of 22.5 Gy in five daily fractions for the relief of localised metastatic bone pain. Results: Response rates have been calculated from 240 assessable treated sites of pain. The overall response rates were 83.7% (single treatment) and 89.2% (five fractions). The complete response rates were 38.8% (single treatment) and 42.3% (five fractions). The median duration of pain control was 13.5 weeks (single treatment) and 14.0 weeks (five fractions). None of these differences was statistically significant. There were no differences between the groups in the effect of treatment on a variety of quality of life parameters. Conclusions: It is concluded that a single 10 Gy treatment is as effective as a course of 22.5 Gy in five fractions in the management of painful bone metastases

  1. Role of technetium-99m planar bone scanning in the evaluation of low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Valdez, D.C. [Texas Univ., San Antonio, TX (United States). Health Science Center]|[St. Luke`s Lutheran Hospital, San Antonio, TX (United States); Johnson, R.G. [Texas Univ., San Antonio, TX (United States). Health Science Center]|[St. Luke`s Lutheran Hospital, San Antonio, TX (United States)

    1994-02-01

    The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scannings as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudoarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decision-making in many conditions. (orig.)

  2. The role of bone scintigraphy in determining the etiology of heel pain

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemir, H.; Soyuncu, Y.; Urguden, M. [Akdeniz Univ., Antalya (Turkey). Medical School; Ozdemir, A. [General State Hospital, Antalya (Turkey)

    2002-09-01

    In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. Sixty-seven heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging

  3. Femoral mesenchymal chondrosarcoma with secondary aneurysmal bone cysts mimicking a small-cell osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Amukotuwa, Shalini A. [St. Vincent' s Hospital, Melbourne (Australia); Choong, Peter F.M.; Powell, Gerard J. [St. Vincent' s Hospital, Department of Orthopaedics, Melbourne (Australia); Smith, Peter J.; Schlicht, Stephen M. [St. Vincent' s Hospital, Department of Medical Imaging, Melbourne (Australia); Thomas, David [Peter MacCallum Cancer Centre, Ian Potter Centre for Cancer Genomics and Predictive Medicine, Melbourne (Australia)

    2006-05-15

    Mesenchymal chondrosarcoma is a rare but aggressive, high-grade malignancy of primitive cartilage-forming mesenchyme that arises most commonly from skeletal sites. Although there are radiological findings suggestive of the diagnosis, imaging features often overlap with those of other skeletal sarcomas. The definitive diagnosis relies on the histological finding of a typical bimorphic appearance, consisting of nests of small, round, poorly differentiated cells and more mature cartilaginous tissue. To highlight this, we present the case of a 21-year-old man who was referred to our institution with a history of right knee pain. Initial imaging and histological evaluation of a core biopsy of the lesion suggested osteosarcoma of the distal right femur; after review, however, the correct diagnosis of mesenchymal chondrosarcoma was made. Adequate tissue sampling and thorough histological evaluation of biopsy specimens is vital for the accurate diagnosis of primary bone malignancies, especially those of chondroid origin. (orig.)

  4. Femoral mesenchymal chondrosarcoma with secondary aneurysmal bone cysts mimicking a small-cell osteosarcoma

    International Nuclear Information System (INIS)

    Amukotuwa, Shalini A.; Choong, Peter F.M.; Powell, Gerard J.; Smith, Peter J.; Schlicht, Stephen M.; Thomas, David

    2006-01-01

    Mesenchymal chondrosarcoma is a rare but aggressive, high-grade malignancy of primitive cartilage-forming mesenchyme that arises most commonly from skeletal sites. Although there are radiological findings suggestive of the diagnosis, imaging features often overlap with those of other skeletal sarcomas. The definitive diagnosis relies on the histological finding of a typical bimorphic appearance, consisting of nests of small, round, poorly differentiated cells and more mature cartilaginous tissue. To highlight this, we present the case of a 21-year-old man who was referred to our institution with a history of right knee pain. Initial imaging and histological evaluation of a core biopsy of the lesion suggested osteosarcoma of the distal right femur; after review, however, the correct diagnosis of mesenchymal chondrosarcoma was made. Adequate tissue sampling and thorough histological evaluation of biopsy specimens is vital for the accurate diagnosis of primary bone malignancies, especially those of chondroid origin. (orig.)

  5. Magnetic resonance guided focused ultrasound surgery (MRgFUS) of bone metastases: From primary pain palliation to local tumor control

    Science.gov (United States)

    Napoli, A.; Leonardi, A.; Andrani, F.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    Purpose: To evaluate the clinical performance of MRgFUS in primary pain palliation of painful bone metastases and in local tumor control. Materials and Methods: We enrolled 26 consecutive patients (female/male 12/14; age: 64.7±7.5yrs) with painful bone metastases. Before and 3 months after MRgFUS treatment pain severity and pain interference scores were assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) criteria and patients underwent both CT and MRI. Local tumor control was evaluated according to lesion size, density and perfusion at CT, dynamic contrast enhancement at MRI (Discovery 750HD, GE; Gd-Bopta, Bracco) and metabolic activity at PET or scintigraphy. Patients were classified as responders or non-responders. Results: No treatment-related adverse events were recorded during the study. As statistically significant difference between baseline and follow-up values for both pain severity and pain interference scores was observed (pbone density was observed in 9/26 (34.6%) patients. Non-Perfused Volume values ranged between 20% and 92%. There was no difference in NPV values between responders and non-responders (46.7±24.2% [25 - 90 %] vs. 45±24.9% [20 - 93 %]; p=0.7). In 6 patients (5 prostate and 1 breast primary cancer) there was nearly absence of metabolic activity after treatment (mean SUV=1.2). Conclusion: MRgFUS can be safely and effectively used as the primary treatment for pain palliation in patients with painful bone metastases; moreover our experience demonstrated also a potential role for the MRgFUS in local tumor control.

  6. International Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: Evidence-Based Practice?

    International Nuclear Information System (INIS)

    Fairchild, Alysa; Barnes, Elizabeth; Ghosh, Sunita; Ben-Josef, Edgar; Roos, Daniel; Hartsell, William; Holt, Tanya; Wu, Jackson; Janjan, Nora; Chow, Edward

    2009-01-01

    Purpose: Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice. Methods and Materials: The members of three global radiation oncology professional organizations (American Society for Radiology Oncology [ASTRO], Canadian Association of Radiation Oncology [CARO], Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy. Results: A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status. Conclusion: Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of

  7. International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice?

    Science.gov (United States)

    Fairchild, Alysa; Barnes, Elizabeth; Ghosh, Sunita; Ben-Josef, Edgar; Roos, Daniel; Hartsell, William; Holt, Tanya; Wu, Jackson; Janjan, Nora; Chow, Edward

    2009-12-01

    Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice. The members of three global radiation oncology professional organizations (American Society for Radiology Oncology [ASTRO], Canadian Association of Radiation Oncology [CARO], Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy. A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status. Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of previous randomized controlled trials. Our results have

  8. Bone elongation in rats with renal failure and mild or advanced secondary hyperparathyroidism.

    Science.gov (United States)

    Sanchez, Cheryl P; He, Yu-Zhu; Leiferman, Ellen; Wilsman, Norman J

    2004-05-01

    Impairment of growth in children with chronic renal failure may be due, in part to the insensitivity to the actions of growth hormone by insulin-like growth factor-I (IGF-I) because of accumulations of IGF binding proteins. There are a few studies describing the changes that occur in the growth plate in renal failure. None of these studies has simultaneously compared the modifications in the expression of selected markers of endochondral bone formation in renal failure with mild or advanced secondary hyperparathyroidism. Forty-six rats that underwent 5/6 nephrectomy (Nx) were fed either standard rodent diet (Nx-control) or high phosphorus diet to induce advanced secondary hyperparathyroidism (Nx-phosphorus) for 4 weeks. Sections of the tibia were obtained for growth plate histomorphometry, immunohistochemistry studies, and in situ hybridization experiments for selected markers of endochondral bone formation. Weight gain, gain in length, and tibial length were less in Nx animals. Serum parathyroid hormone (PTH) and phosphorus levels were higher and serum calcium levels were lower in the Nx-phosphorus group. The width of the growth plate was much shorter in the Nx-phosphorus group due to a decrease in both proliferative and hypertrophic zones. IGF-I protein and IGF binding protein-3 staining were diminished in both Nx groups without changes in the IGF-I receptor expression; the decline in IGF-I protein expression was much lower in the Nx-phosphorus group. PTH/PTH receptor protein (PTHrP) receptor mRNA transcripts decline and tartrate-resistant acid phosphastase (TRAP) staining increased only in the Nx-phosphorus group. The growth impairment in renal failure may be worsened by the severity of secondary hyperparathyroidism.

  9. Eligibility audits for the randomized neuropathic bone pain trial (TROG 96.05)

    International Nuclear Information System (INIS)

    Roos, D.E.; Turner, S.L.

    2000-01-01

    In February 1996 the Trans-Tasman Radiation Oncology Group (TROG) initiated a two-arm, multicentre, prospective randomized trial on radiotherapy for neuropathic pain due to bone metastases (TROG 96.05). This trial compares the response to a single 8-Gy fraction with 20 Gy in five fractions. The accrual target is 270 patients. In order to evaluate compliance with eligibility criteria after approximately 1 year of accrual, an independent audit of the first 42 randomized patients was commissioned. This found that only one of these patients did not have genuine neuropathic pain, but that this patient and seven others (19%) had infringements of other eligibility/exclusion criteria for the trial. Accordingly it was decided to continue the full audit up to 90 patients. This detected no further patients without genuine neuropathic pain, and found only one other eligibility infringement (1/48; 2%). It is concluded that this quality assurance (QA) measure undertaken early in the trial led to significantly improved clinician awareness of, and compliance with, eligibility/exclusion criteria. It also enabled an accurate comparison of outcome data for all randomized versus all eligible patients at the time of the preplanned first interim analysis at 90 patients. In view of the excellent compliance demonstrated in the second audit, a one-in-five sampling is proposed for future audits from centres that have already accrued at least five consecutive eligible patients. This is consistent with TROG QA guidelines now operational. Copyright (2000) Blackwell Science Pty Ltd

  10. Bone SPECT in low back pain: Results of an IAEA co-ordinated research project

    International Nuclear Information System (INIS)

    Buscombe, J.; Cwikla, J.B.; Kolasinska, A.D.; Xing-Dang, L.; Dave, P.K.; Dougall, P.; Fettich, J.; Fettich-Seliger, M.; Frangos, S.; Van Heerden, B.B.; Kanmaz, B.; Lele, V.; Szilvasi, I.; Soricelli, A.; Padhy, A.K.

    2003-01-01

    The aim of this study was to determine if it would be possible to use spinal bone single photon emission computed tomography (SPECT) in patients with unexplained back pain in varied clinical backgrounds and to determine if a positive or negative study had any prognostic value. The study was co-ordinated by the International Atomic Energy Agency (IAEA) and involved 8 centres in 7 countries. A total of 174 patients (mean age 42 years, range 15-80 years) were screened and found to have no obvious cause for their back pain at the time of the SPECT scan. All patients had a CT, and planar radiology. There was clinical follow-up data for 6 months without active treatment (such as surgery) in 147 patients. A panel of 9 specialists in nuclear medicine, radiology and orthopaedics reviewed all images and histories. Final assessment determined that 141 patients had skeletal causes for their back pain. SPECT was abnormal in 64% of these patients as compared to 58% with CT and 18% with planar radiology. CT was most likely to be diagnostic in disc degeneration (sensitivity 92%). SPECT was most diagnostic in facet joint disease (sensitivity 96%). In the 43 patients without any skeletal disease the specificity of SPECT was 79%, compared to 65% for CT. Follow-up of patients at 6 months showed that on average 71% had improvement of symptoms, suggesting a benign course for their back pain, with the exception of patients with pure facet joint disease, identified on SPECT but with no treatment. Spinal skeletal SPECT can be applied in a wide range of social and clinical settings. Results compare well with CT, providing additional information in 30% of patients, especially in facet joint disease where a positive SPECT study, suggests a worse clinical outcome at 6 months. (author)

  11. Effect of sex in the MRMT-1 model of cancer-induced bone pain [version 3; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sarah Falk

    2015-11-01

    Full Text Available An overwhelming amount of evidence demonstrates sex-induced variation in pain processing, and has thus increased the focus on sex as an essential parameter for optimization of in vivo models in pain research. Mammary cancer cells are often used to model metastatic bone pain in vivo, and are commonly used in both males and females. Here we demonstrate that compared to male rats, female rats have an increased capacity for recovery following inoculation of MRMT-1 mammary cells, thus potentially causing a sex-dependent bias in interpretation of the data.

  12. Bone morphogenetic protein-2-mediated pain and inflammation in a rat model of posterolateral arthrodesis.

    Science.gov (United States)

    Mitchell, Kendall; Shah, Jill P; Dalgard, Clifton L; Tsytsikova, Lyubov V; Tipton, Ashley C; Dmitriev, Anton E; Symes, Aviva J

    2016-12-01

    Bone morphogenetic protein-2 (BMP-2) is a pleiotropic, secreted molecule with diverse effects. The potent ability of BMP-2 to stimulate bone growth prompted its widespread clinical use for arthrodesis (spine fusion). However, elevated post-operative pain in patients treated with BMP-2 has been increasingly reported. Determining whether BMP-2 induces pain directly or whether it induces neuroinflammation, which could lower the threshold for pain, is important for developing therapeutic interventions. We therefore modeled the clinical use of BMP-2 for posterior lumbar fusion by implanting absorbable collagen sponges soaked with either recombinant human BMP-2 (rhBMP-2) or vehicle above the L4-L5 transverse processes of rat spine. Using microarray analysis we found that implantation of rhBMP-2-soaked absorbable collagen sponges resulted in altered expression of numerous pro-inflammatory genes in the adjacent dorsal root ganglia (DRG) showing that implantation of rhBMP-2/absorbable collagen sponges triggers potent neuroinflammatory responses in the DRG-2. Interestingly, direct BMP-2 treatment of DRG explants resulted in changes in gene expression that were not specifically pro-inflammatory. Rats implanted with rhBMP-2 in absorbable collagen sponges also exhibited a transient change in thermal and mechanical sensitivity indicating that rhBMP-2 applied to the lumbar spine could increase pain sensitivity. Immunohistochemical analysis indicated macrophage infiltration in the DRG and spinal nerve in rats implanted with rhBMP-2/absorbable collagen sponges or absorbable collagen sponges alone, but not in rats that underwent surgery without implantation of the absorbable collagen sponges suggesting that the sponges contributed to the biological response. Indeed, analysis of DRGs taken from rats implanted with absorbable collagen sponges without rhBMP-2 showed a significant change in gene expression distinct from DRGs from rats undergoing surgery only. Our data indicate that

  13. Tolvaptan and Kidney Pain in Patients With Autosomal Dominant Polycystic Kidney Disease: Secondary Analysis From a Randomized Controlled Trial

    Science.gov (United States)

    Casteleijn, Niek F.; Blais, Jaime D.; Chapman, Arlene B.; Czerwiec, Frank S.; Devuyst, Olivier; Higashihara, Eiji; Leliveld, Anna M.; Ouyang, John; Perrone, Ronald D.; Torres, Vicente E.; Gansevoort, Ron T.

    2017-01-01

    Background Kidney pain is a common complication in patients with autosomal dominant polycystic kidney disease (ADPKD), and data from the TEMPO 3:4 trial suggested that tolvaptan, a vasopressin V2 receptor antagonist, may have a positive effect on kidney pain in this patient group. Because pain is difficult to measure, the incidence of kidney pain leading to objective medical interventions was used in the present study to assess pain. Study Design Secondary analysis from a randomized controlled trial. Setting & Participants Patients with ADPKD with preserved kidney function. Intervention Tolvaptan or placebo. Outcomes Kidney pain events defined by objective medical interventions. Measurements Kidney pain events were recorded and independently adjudicated. Incidence of a first kidney pain event was assessed overall and categorized into 5 subgroups according to severity. Results Of 1,445 participating patients (48.4% women; mean age, 39 ± 7 [SD] years; mean estimated glomerular filtration rate, 81 ± 22 mL/min/1.73 m2; median total kidney volume, 1,692 [IQR, 750–7,555] mL), 50.9% reported a history of kidney pain at baseline. History of urinary tract infections, kidney stones, or hematuria (all P kidney pain. Tolvaptan use resulted in a significantly lower incidence of kidney pain events when compared to placebo: 10.1% versus 16.8% (P 0.05). The effect of tolvaptan was explained at least in part by a decrease in incidence of urinary tract infections, kidney stones, and hematuria when compared to placebo. Limitations Trial has specific inclusion criteria for total kidney volume and kidney function. Conclusions Tolvaptan decreased the incidence of kidney pain events independent of patient characteristics predisposing for kidney pain and possibly in part due to reductions in ADPKD-related complications. PMID:27856088

  14. Effect of paricalcitol on mineral bone metabolism in kidney transplant recipients with secondary hyperparathyroidism.

    Science.gov (United States)

    Borrego Utiel, Francisco José; Bravo Soto, Juan Antonio; Merino Pérez, María José; González Carmelo, Isabel; López Jiménez, Verónica; García Álvarez, Teresa; Acosta Martínez, Yelenei; Mazuecos Blanca, María Auxiliadora

    2015-01-01

    Secondary hyperparathyroidism is highly prevalent in kidney transplant recipients, and commonly results in hypercalcaemia; an association to osteopenia and bone fractures has also been observed. Paricalcitol has proved effective to control secondary hyperparathyroidism in chronic kidney disease in both dialysed and non-dialysed patients, with a low hypercalcaemia incidence. Currently available experience on paricalcitol use in kidney transplant recipients is scarce. Our main aim was to show the effect of paricalcitol on mineral bone metabolism in kidney transplant recipients with secondary hyperparathyroidism. A retrospective multicentre study in kidney transplant recipients aged>18 years with a 12-month or longer post-transplantation course, stable renal function, having received paricalcitol for more than 12 months, with available clinical follow-up for a 24-month period. A total of 69 patients with a 120 ± 92-month post-transplantation course were included. Baseline creatinine was 2.2 ± 0.9 mg/dl y GFR-MDRD was 36 ± 20 ml/min/1.73 m(2). Paricalcitol doses were gradually increased during the study: baseline 3.8 ± 1.9 μg/week, 12 months 5.2 ± 2.4 μg/week; 24 months 6.0 ± 2.9 μg/week (P10mg/dl showed gradually decreasing levels. Fifteen (21.7%) patients had received prior calcitriol therapy. When shifted to paricalcitol, such patients required paricalcitol doses significantly larger than those not having received calcitriol. Paricalcitol was used concomitantly to cinacalcet in 11 patients with significant PTH reductions being achieved; clinical course was similar to other patients and paricalcitol doses were also similar. Paricalcitol is an effective therapy for secondary hyperparathyroidism in kidney transplant recipients. Overall, no significant changes were observed in calcium and phosphorus levels or urinary excretion. Patients having previously received calcitriol required higher paricalcitol doses. When used in patients receiving cinacalcet

  15. The Use of Intravenous Lidocaine for the Management of Acute Pain Secondary to Traumatic Ankle Injury: A Case Report.

    Science.gov (United States)

    Sin, Billy; Gritsenko, Diana; Tam, Grace; Koop, Kimberly; Mok, Eva

    2018-02-01

    Sports-related injuries are a frequent cause of visits to the emergency department (ED) across the United States. A majority of these injuries affect the lower extremities with the ankle as the most frequently reported site. Most sports-related injuries are not severe enough to require inpatient hospitalization; however, they often lead to acute distress and pain which require prompt treatment with analgesics. Approximately 22% of patients who presented to the ED required pharmacotherapy for acute pain management. Opioids have been traditionally used for the management of severe acute pain in the ED; however, there are growing concerns for opioid overuse and misuse. As a result, there is growing controversy regarding the appropriate selection of analgesic agents, optimal dosing, and need for outpatient therapy which has contributed to changes in prescribing patterns of opioids in the ED. Lidocaine, a class 1b antiarrhythmic, has been utilized as an analgesic agent. Its use has been documented for the management of intractable chronic pain caused by cancer, stroke, neuropathies, or nephrolithiasis. However, literature describing the use of intravenous lidocaine for the management of acute pain secondary to trauma is limited to a single case series. This case report describes the use of intravenous lidocaine in a 17-year-old male who presented to the ED in acute distress secondary to ankle dislocation and fracture. This report serves to describe additional clinical experience with intravenous lidocaine for the management of acute pain secondary to ankle fracture in the emergency department.

  16. [Osteogenon in therapy of distal radial bone fractures in patients with secondary osteoporosis].

    Science.gov (United States)

    Varga, O Iu; Vezikova, N N; Marusenko, I M; Kheĭfets, L M

    2007-01-01

    To assess efficacy of osteogenon in consolidation of solitary fractures of distal part of the radial bone (RB) in patients with secondary osteoporosis (SO) due to rheumatoid arthritis (RA) and chronic renal failure (CRF). The study group consisted of 7 patients with documented RA and 8 patients with CRF caused by chronic glomerulonephritis or chronic pyelonephritis in the predialysis period. The control group comprised 13 patients (6 and 7 patients, respectively). The patients were matched by clinico-demographic and therapy characteristics. Patients of the study group received osteogen from the fracture diagnosis to its consolidation. Osteogenon has an analgetic effect, improves well being, raises physical activity, reduces duration of fracture consolidation in patients with SO.

  17. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

    Energy Technology Data Exchange (ETDEWEB)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Goetz, Matthew P.; Rubin, Joseph [Mayo Clinic, Department of Oncology, Rochester, MN (United States)

    2006-01-01

    Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

  18. Effects of Denosumab and Calcitriol on Severe Secondary Hyperparathyroidism in Dialysis Patients With Low Bone Mass.

    Science.gov (United States)

    Chen, Chien-Liang; Chen, Nai-Ching; Liang, Huei-Lung; Hsu, Chih-Yang; Chou, Kang-Ju; Fang, Hua-Chang; Lee, Po-Tsang

    2015-07-01

    Secondary hyperparathyroidism (SHPT) may worsen with administration of denosumab in chronic renal failure patients with low bone mass. This study aimed to evaluate the short-term effect of coadministration of calcitriol and denosumab on PTH secretion and parathyroid structure and the incidence of adverse effects in patients with SHPT and low bone mass. This was a 24-week, open-label study at Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan. Dialysis patients with SHPT (intact parathyroid hormone [iPTH] > 800 pg/mL) and low bone mass (T score < -2.5) were enrolled. Patients received denosumab (60 mg) and doses of calcitriol adjusted to achieve iPTH < 300 pg/mL. Parathyroid gland volume was assessed upon study initiation and completion. Serum calcium, phosphate, alkaline phosphatase, iPTH, and adverse effects were assessed at each visit (Day 7, 14, and 21, and every month thereafter). iPTH significantly decreased (mean decrease, 58.28 ± 6.12%) with denosumab/calcitriol administration (P < .01) but not in the controls (patients not receiving denosumab). Parathyroid gland volume decreased (mean decrease, 21.98 ± 5.54%) with denosumab/calcitriol administration (P < .01) and progressively increased (20.58 ± 4.48%) in the controls (P < .05). Serum alkaline phosphatase and iPTH levels were significantly correlated to decreased iPTH and regression of parathyroid hyperplasia (P < .05). The most common adverse events were hypocalcemia (33.33%) and respiratory tract infection (4.17%). Hypocalcemia rapidly resolved with calcium and calcitriol supplements. Denosumab allows for supra-physiologic doses of calcitriol resulting in decreased parathyroid secretion and parathyroid hyperplasia. Supervised administration and weekly laboratory and clinical monitoring of serum calcium are recommended during the first month to prevent hypocalcemia.

  19. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K

    2012-01-01

    imaging (MRI) scan was performed shortly after the injury, and at 2 weeks, 1 month and 2 months. The patients reported the level of pain every day and filled in a Knee injury and Osteoarthritis Outcome Score sheet in connection with MRI. For every MRI of the knee, volume of bone bruise was calculated...

  20. Etelcalcetide (AMG 416), a peptide agonist of the calcium-sensing receptor, preserved cortical bone structure and bone strength in subtotal nephrectomized rats with established secondary hyperparathyroidism.

    Science.gov (United States)

    Li, Xiaodong; Yu, Longchuan; Asuncion, Frank; Grisanti, Mario; Alexander, Shawn; Hensley, Kelly; Han, Chun-Ya; Niu, Qing-Tian; Dwyer, Denise; Villasenor, Kelly; Stolina, Marina; Dean, Charles; Ominsky, Michael S; Ke, Hua Zhu; Tomlinson, James E; Richards, William G

    2017-12-01

    Sustained elevation of parathyroid hormone (PTH) is catabolic to cortical bone, as evidenced by deterioration in bone structure (cortical porosity), and is a major factor for increased fracture risk in chronic kidney disease (CKD). Etelcalcetide (AMG 416), a novel peptide agonist of the calcium-sensing receptor, reduces PTH levels in subtotal nephrectomized (Nx) rats and in hemodialysis patients with secondary hyperparathyroidism (SHPT) in clinical studies; however, effects of etelcalcetide on bone have not been determined. In a rat model of established SHPT with renal osteodystrophy, etelcalcetide or vehicle was administered by subcutaneous (s.c.) injection to subtotal Nx rats with elevated PTH (>750pg/mL) once per day for 6weeks. Sham-operated rats receiving vehicle (s.c.) served as non-SHPT controls. Prior to treatment, significant increases in serum creatinine (2-fold), blood urea nitrogen (BUN, 3-fold), PTH (5-fold), fibroblast growth factor-23 (FGF23; 13-fold) and osteocalcin (12-fold) were observed in SHPT rats compared to non-SHPT controls. Elevations in serum creatinine and BUN were unaffected by treatment with vehicle or etelcalcetide. In contrast, etelcalcetide significantly decreased PTH, FGF23 and osteocalcin, whereas vehicle treatment did not. Cortical bone porosity increased and bone strength decreased in vehicle-treated SHPT rats compared to non-SHPT controls. Cortical bone structure improved and energy to failure was significantly greater in SHPT rats treated with etelcalcetide compared to vehicle. Mineralization lag time and marrow fibrosis were significantly reduced by etelcalcetide. In conclusion, etelcalcetide reduced bone turnover, attenuated mineralization defect and marrow fibrosis, and preserved cortical bone structure and bone strength by lowering PTH in subtotal Nx rats with established SHPT. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Analysis of effectiveness of the palliative treatment of metastatic bone's pain with 188Re-HEDP

    International Nuclear Information System (INIS)

    Savio, E.; Zeledon, P.; Paolino, A.; De Marco, E.; Gaudino, J.

    2003-01-01

    The objective of the study was to evaluate the treatment effectiveness with 188Re-HEDP in a group of 27 patients, who had received 36 doses. A pharmaceutical care programme was also added in order to improve drug follow-up after treatment. Two levels of doses were administered: 30 or 60 mCi. Initially a trace dose was given in order to estimate the therapeutic dose, which was individualise according to bone uptake of the radiopharmaceutical. Bone uptake was determined measuring radioactivity in urine samples (0, 1, 2, 4 and 6 hs), because the radiopharmaceutical showed only renal elimination. Multiple dose schedules with with 3 months between both doses were also tried. Seventy two percent showed an algesic effect during the first week post-treatment, with was kept during one month, while seven tenn (17%) percent of the patients the effect was kept for two of more months. Opioid analgesic (third level of OMS scale) were diminished in eighty two percent of the patients and AINES drugs in seventy one percent. The pharmaceutical care programme also showed the importance of the radio pharmacist role to improve treatment outcomes. 188Re-HEDP effectiveness was achieved in 100% of the patients, but with different pain palliation response in time and/or drug intake, with a suitable radiological safety

  2. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder.

    Science.gov (United States)

    Kip, Kevin E; Rosenzweig, Laney; Hernandez, Diego F; Shuman, Amy; Diamond, David M; Girling, Sue Ann; Sullivan, Kelly L; Wittenberg, Trudy; Witt, Ann M; Lengacher, Cecile A; Anderson, Brian; McMillan, Susan C

    2014-01-01

    As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93%) reported pain. The majority (78%) used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ) was -16.9±16.6 in the ART group versus -0.7±14.2 in the AC group (p=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006), pain-related impairment in mobility (effect size = 0.69, p=0.01), and negative affect (effect size = 1.01, p=0.001). Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain.

  3. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Kevin E. Kip

    2014-05-01

    Full Text Available Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA system may have posttraumatic stress disorder (PTSD, and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART, a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. Methods: A randomized controlled trial of ART versus an attention control (AC regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. Results: Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93% reported pain. The majority (78% used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ was −16.9±16.6 in the ART group versus −0.7±14.2 in the AC group (p=0.0006. Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006, pain-related impairment in mobility (effect size = 0.69, p=0.01, and negative affect (effect size = 1.01, p=0.001. Conclusions: Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain.

  4. [Recurrent painful ophthalmoplegia secondary to polyostotic fibrous dysplasia of the maxillary sinuses with involvement of the superior orbital fissure].

    Science.gov (United States)

    Navarro-Munoz, S; Rueda-Medina, I; Recio-Bermejo, M; Del Saz-Saucedo, P; Espejo-Martinez, B; Garcia-Ruiz, R; Ortega-Leon, T; Turpin-Fenoll, L

    2011-01-16

    Fibrous dysplasia is a bone disease that is usually accompanied by asymptomatic lesions but which may sometimes display neurological manifestations due to the involvement of the craniofacial bones. A 25-year-old female, with a history of migraines, who visited at the age of 18 due to pain in the right retro-ocular and maxillary region, although with characteristics that were unlike those of her usual migraines, and which was associated with ipsilateral ophthalmoparesis. The condition had a self-limiting course and responded well to corticoids, although it was recurring. Examination revealed intense pain on palpation of the right-hand maxillary sinus and incomplete paralysis of the ipsilateral oculomotor nerve with palpebral ptosis. Results of complementary studies were normal, except for magnetic resonance imaging of the head and computerised axial tomography of the face, which revealed an expansive lesion with involvement of the right superior maxillary sinus and the greater wing of the sphenoid bone, with probable compromise of the superior orbital fissure, consistent with the diagnosis of fibrous dysplasia, which was confirmed by means of a pathology study. Fibrous dysplasia is a benign bone disorder, of unknown causation, in which normal bone tissue is replaced by amorphous conjunctive tissue. There is sometimes craniofacial involvement and a hypertrophic bone mass is formed which can fill the paranasal sinuses and the orbit, resulting in exophthalmus and visual disorders. To date the scientific literature does not include any reports of this disease manifesting as bouts of recurrent painful ophthalmoparesis which responds to corticoids, as happened in the case of our patient.

  5. Spinal high-mobility group box 1 contributes to mechanical allodynia in a rat model of bone cancer pain

    International Nuclear Information System (INIS)

    Tong, Wei; Wang, Wei; Huang, Jing; Ren, Ning; Wu, Sheng-Xi; Li, Yong-Qi

    2010-01-01

    Mechanisms underlying bone cancer-induced pain are largely unknown. Previous studies indicate that neuroinflammation in the spinal dorsal horn is especially involved. Being first reported as a nonhistone chromosomal protein, high-mobility group box 1 (HMGB1) is now implicated as a mediator of inflammation. We hypothesized that HMGB1 could trigger the release of cytokines in the spinal dorsal horn and contribute to bone cancer pain. To test this hypothesis, we first built a bone cancer pain model induced by intratibal injection of Walker 256 mammary gland carcinoma cells. The structural damage to the tibia was monitored by radiological analysis. The mechanical allodynia was measured and the expression of spinal HMGB1 and IL-1β was evaluated. We observed that inoculation of cancer cells, but not heat-killed cells, induced progressive bone destruction from 9 d to 21 d post inoculation. Behavioral tests demonstrated that the significant nociceptive response in the cancer cells-injected rats emerged on day 9 and this kind of mechanical allodynia lasted at least 21 d following inoculation. Tumor cells inoculation significantly increased HMGB1 expression in the spinal dorsal horn, while intrathecal injecting a neutralizing antibody against HMGB1 showed an effective and reliable anti-allodynia effect with a dose-dependent manner. IL-1β was significantly increased in caner pain rats while intrathecally administration of anti-HMGB1 could decrease IL-1β. Together with previous reports, we predict that bone cancer induces HMGB1 production, enhancing spinal IL-1β expression and thus modulating spinal excitatory synaptic transmission and pain response.

  6. The Analgesic and Antineuroinflammatory Effect of Baicalein in Cancer-Induced Bone Pain

    Directory of Open Access Journals (Sweden)

    Shan Hu

    2015-01-01

    Full Text Available Cancer-induced bone pain (CIBP is a severe type of chronic pain. It is imperative to explore safe and effective analgesic drugs for CIBP treatment. Baicalein (BE, isolated from the traditional Chinese herbal medicine Scutellaria baicalensis Georgi (or Huang Qin, has been demonstrated to have anti-inflammatory and neuroprotective effects. In this study, we examined the effect of BE on CIBP and the mechanism of this effect. Intrathecal and oral administration of BE at different doses could alleviate the mechanical allodynia in CIBP rats. Intrathecal 100 μg BE could inhibit the production of IL-6 and TNF-α in the spinal cord of CIBP rats. Moreover, intrathecal 100 μg BE could effectively inhibit the activation of p-p38 and p-JNK MAPK signals in CIBP rats. The analgesic effect of BE may be associated with the inhibition of the expression of the inflammatory cytokines IL-6 and TNF-α and through the activation of p-p38 and p-JNK MAPK signals in the spinal cord. These findings suggest that BE is a promising novel analgesic agent for CIBP.

  7. Rhemium-186-monoaminemonoamidedithiol-conjugated bisphosphonate derivatives for bone pain palliation

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Kazuma [Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida Shimoadachi-cho, Sakyo-ku, Kyoto 606-8501 (Japan); Advanced Science Research Center, Kanazawa University, Kanazawa 920-8640 (Japan); Mukai, Takahiro [Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida Shimoadachi-cho, Sakyo-ku, Kyoto 606-8501 (Japan); Graduate School of Pharmaceutical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582 (Japan); Arano, Yasushi [Graduate School of Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba 260-8675 (Japan); Otaka, Akira [Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida Shimoadachi-cho, Sakyo-ku, Kyoto 606-8501 (Japan); Ueda, Masashi [Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida Shimoadachi-cho, Sakyo-ku, Kyoto 606-8501 (Japan); Uehara, Tomoya [Graduate School of Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba 260-8675 (Japan); Magata, Yasuhiro [Photon Medical Research Center, Hamamatsu University School of Medicine, Hamamatsu 431-3192 (Japan); Hashimoto, Kazuyuki [Japan Atomic Energy Research Institute, Tokai-mura, Ibaraki 319-1195 (Japan); Saji, Hideo [Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida Shimoadachi-cho, Sakyo-ku, Kyoto 606-8501 (Japan)]. E-mail: hsaji@pharm.kyoto-u.ac.jp

    2006-05-15

    To develop a radiopharmaceutical for the palliation of painful bone metastases based on the concept of bifunctional radiopharmaceuticals, we synthesized a bisphosphonate derivative labeled with rhenium-186 ({sup 186}Re) that contains a hydroxyl group at the central carbon of its bisphosphonate structure, we attached a stable {sup 186}Re-MAMA chelate to the amino group of a 4-amino butylidene-bisphosphonate derivative [N-[2-[[4-[(4-hydroxy-4,4-diphosphonobutyl)amino]-4-oxobutyl] -2-thioethylamino]acetyl]-2-aminoethanethiolate] oxorhenium (V) ({sup 186}Re-MAMA-HBP) and we investigated the effect of a hydroxyl group at the central carbon of its bisphosphonate structure on affinity for hydroxyapatite and on biodistribution by conducting a comparative study with [N-[2-[[3-(3,3-diphosphonopropylcarbamoyl)propyl]-2-thioethylamino]acetyl] -2-a minoethanethiolate] oxorhenium (V) ({sup 186}Re-MAMA-BP). The precursor of {sup 186}Re-MAMA-HBP, trityl (Tr)-MAMA-HBP, was obtained by coupling a Tr-MAMA derivative to 4-amino-1-hydroxybutylidene-1,1-bisphosphonate. {sup 186}Re-MAMA-HBP was prepared by a reaction with {sup 186}ReO{sub 4} {sup -} and SnCl{sub 2} in citrate buffer after the deprotection of the Tr groups of Tr-MAMA-HBP. After reversed-phase high-performance liquid chromatography, {sup 186}Re-MAMA-HBP had a radiochemical purity of over 95%. Compared with {sup 186}Re-MAMA-BP, {sup 186}Re-MAMA-HBP showed a greater affinity for hydroxyapatite beads in vitro and accumulated a significantly higher level in the femur in vivo. Thus, the introduction of a hydroxyl group into {sup 186}Re complex-conjugated bisphosphonates would be effective in enhancing accumulation in bones. These findings provide useful information on the design of bone-seeking therapeutic radiopharmaceuticals.

  8. New bisphosphonate labeled with Iodine-131 for the palliative therapy for bone metastases pain

    International Nuclear Information System (INIS)

    Prats Capote, Anaís; Perera Pintado, Alejandro; León, Mariela; Hernández González, Ignacio; Leyva Montaña, René; Mocelo Castell, Raúl; O'Reilly, Beatriz; Calderón, Osmar; Griffith Pérez, Yoel; García Batle, Marisé; Rodríguez Tanty, Chryslaine

    2016-01-01

    The aim of this work was to obtain new bisphosphonate marked with 131I suitable for palliative treatment of bone metastases pain characteristics. Materials and Methods: It started with aromatic amino acids and the synthesis consisted of three stages: 1) Protection of amino groups by acetylation; 2) phosphonation protected amino acids with a mixture of phosphorous acid and phosphorus pentachloride; 3) Lack of protection of the amino groups by basic hydrolysis. The compounds obtained were characterized by IR, 1H NMR, RMN13-C mass. Los spectrometry bisphosphonic acids obtained were labeled with 131I using chloramine T and iodogen as oxidants. Stability of labeled compounds in aqueous solution was studied serum. 3 mg of 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1-bisphosphonic acid labeled of 131I were administered to male wistar rats (170-190 g) through a lateral tail vein. The scintigraphic study was conducted at 2, 6 and 12 hours. Results: The yield of the reactions of the amino group protection four compounds ranged from 75 to 80%, while the phosphonation was between 50 and 60%. The radiochemical purity of 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1- bisphosphonic acid labeled with 131I was (91.5 ± 1.4)% and its stability was satisfactory for 72h. Scintigraphic images suggest excretion by the kidneys of the compound and from 12 h post-administration begin to visualize bone structures of the animal, suggesting that the compound exhibits affinity for these tissues. Conclusions: A novel synthesis method with modifications that yielded the sodium salts of bisphosphonic acids starting from the respective aromatic amino acids was developed. 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1-bisphosphonic acid 131I labeled was stable up to 72h and showed affinity for bone tissue. (author)

  9. The effects of the CORE programme on pain at rest, movement-induced and secondary pain, active range of motion, and proprioception in female office workers with chronic low back pain: a randomized controlled trial.

    Science.gov (United States)

    Kim, Tae Hoon; Kim, Eun-Hye; Cho, Hwi-young

    2015-07-01

    To investigate the effects of the CORE programme on pain at rest, movement-induced pain, secondary pain, active range of motion, and proprioception deficits in female office workers with chronic low back pain. Randomized controlled trial. Rehabilitation clinics. A total of 53 participants with chronic low back pain were randomized into the CORE group and the control group. CORE group participants underwent the 30-minute CORE programme, five times per week, for eight weeks, with additional use of hot-packs and transcutaneous electrical nerve stimulation, while the control group used only hot-packs and transcutaneous electrical nerve stimulation. Participants were evaluated pretest, posttest, and two months after the intervention period to measure resting and movement-induced pain, pressure pain as secondary pain, active range of pain-free motion, and trunk proprioception. Pain intensity at rest (35.6 ±5.9 mm) and during movement (39.4 ±9.1 mm) was significantly decreased in the CORE group following intervention compared with the control group. There were significant improvements in pressure pain thresholds (quadratus lumborum: 2.2 ±0.7 kg/cm(2); sacroiliac joint: 2.0 ±0.7 kg/cm(2)), active range of motion (flexion: 30.8 ±14.3°; extension: 6.6 ±2.5°), and proprioception (20° flexion: 4.3 ±2.4°; 10° extension: 3.1 ±2.0°) in the CORE group following intervention (all p proprioception in female office workers with chronic low back pain. © The Author(s) 2014.

  10. Phase II study of concurrent capecitabine and external beam radiotherapy for pain control of bone metastases of breast cancer origin.

    Directory of Open Access Journals (Sweden)

    Yulia Kundel

    Full Text Available Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer.Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m(2 twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial at 12 weeks was 86%. Side effects were of mild intensity (grade I or II and included nausea (38% of patients, weakness (24%, diarrhea (24%, mucositis (10%, and hand and foot syndrome (7%.External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted.ClinicalTrials.gov NCT01784393NCT01784393.

  11. Up-regulation of brain-derived neurotrophic factor in the dorsal root ganglion of the rat bone cancer pain model

    Directory of Open Access Journals (Sweden)

    Tomotsuka N

    2014-07-01

    Full Text Available Naoto Tomotsuka,1 Ryuji Kaku,1 Norihiko Obata,1 Yoshikazu Matsuoka,1 Hirotaka Kanzaki,2 Arata Taniguchi,1 Noriko Muto,1 Hiroki Omiya,1 Yoshitaro Itano,1 Tadasu Sato,3 Hiroyuki Ichikawa,3 Satoshi Mizobuchi,1 Hiroshi Morimatsu1 1Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; 2Department of Pharmacy, Okayama University Hospital, Okayama, Japan; 3Department of Oral and Craniofacial Anatomy, Tohoku University Graduate School of Dentistry, Sendai, Japan Abstract: Metastatic bone cancer causes severe pain, but current treatments often provide insufficient pain relief. One of the reasons is that mechanisms underlying bone cancer pain are not solved completely. Our previous studies have shown that brain-derived neurotrophic factor (BDNF, known as a member of the neurotrophic family, is an important molecule in the pathological pain state in some pain models. We hypothesized that expression changes of BDNF may be one of the factors related to bone cancer pain; in this study, we investigated changes of BDNF expression in dorsal root ganglia in a rat bone cancer pain model. As we expected, BDNF mRNA (messenger ribonucleic acid and protein were significantly increased in L3 dorsal root ganglia after intra-tibial inoculation of MRMT-1 rat breast cancer cells. Among the eleven splice-variants of BDNF mRNA, exon 1–9 variant increased predominantly. Interestingly, the up-regulation of BDNF is localized in small neurons (mostly nociceptive neurons but not in medium or large neurons (non-nociceptive neurons. Further, expression of nerve growth factor (NGF, which is known as a specific promoter of BDNF exon 1–9 variant, was significantly increased in tibial bone marrow. Our findings suggest that BDNF is a key molecule in bone cancer pain, and NGF-BDNF cascade possibly develops bone cancer pain. Keywords: BDNF, bone cancer pain, chronic pain, nerve growth

  12. Bone scintigraphy in bone stress. A technical consideration and correlation of the findings to clinical symptoms especially to the pain

    International Nuclear Information System (INIS)

    Kuusela, T.; Vorne, M.; Vahatalo, S.

    1983-01-01

    The purpose of this investigation was to find out a reliable scintigraphic method to investigate different fatigue phenomena in bone and to correlate the scintigraphic findings to the development of clinical symptoms. The gamma-imaging after the injection of bone seeking tracers is recommended to be performed after a period of 1-3 hours. The experiments indicate that in active bone tissue, might it be a healing fracture or a remodeling bone, the tracer uptake still increases after 1-3 hours. The delayed gamma-imaging can therefore be useful, especially if it is important to investigate faint physiological changes in bone tissue. It seems, that the capacity of emission energy in the diagnosis of bone affections is superior to the radiology because of its excellent histo-functional resolution especially in detecting and localizing bone affections

  13. Optimal Timing of Bisphosphonate Administration in Combination with Samarium-153 Oxabifore in the Treatment of Painful Metastatic Bone Disease

    International Nuclear Information System (INIS)

    Rasulova, Nigora; Lyubshin, Vladimir; Arybzhanov, Dauranbek; Sagdullaev, Sh.; Krylov, Valery; Khodjibekov, Marat

    2013-01-01

    While bisphosphonates are indicated for prevention of skeletal-related events, radionuclide therapy is widely used for treatment of painful bone metastases. Combined radionuclide therapy with bisphosphonates has demonstrated improved effectiveness in achieving bone pain palliation in comparison to mono therapy with radionuclides or bisphosphonates alone. However, there are conflicting reports as to whether bisphosphonates adversely influence skeletal uptake of the bone-seeking radiotracers used for therapy. Recent studies analyzing influence of Zoledronic acid on total bone uptake of Samarium-153 EDTMP (Sm-153 EDTMP) by measuring cumulative urinary activity of Sm-153 on baseline study, as well as in combination with bisphosphonates (administrated 48 hours prior to Sm-153) did not provide any statistically significant difference in urinary excretion of Sm-153 between the two groups. It may be noted that the exact temporal sequence of bisphosphonate administration vis a vis radionuclide therapy has not yet been studied. One of the side effects of bisphosphonates is transient flare effect on bone pain. Radionuclide therapy may also have similar side effect. Keeping in view the above the current study was designed with the main objective of determining the exact timing of bisphosphonate administration in patients receiving combined therapy so as to achieve optimal efficacy of bone pain palliation. Ninety-three patients suffering from metastatic bone pain who received combination therapy with Sm-153 oxabifore (an analog of Sm-153 EDTMP) and Zoledronic acid were divided into three groups according to the timing of Zoledronic acid administration: Group I: 39 patients who received Zoledronic acid 7 or more days prior to Sm-153 oxabifore treatment; Group II: 32 patients who received Zoledronic acid 48-72 hours prior to Sm-153 oxabifore treatment and Group III: 22 patients who received Zoledronic acid 7 days after Sm-153 oxabifore treatment. Sm-153 oxabifore was administered

  14. Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: a meta-analysis.

    Science.gov (United States)

    Mehta, Swati; McIntyre, Amanda; Dijkers, Marcel; Loh, Eldon; Teasell, Robert W

    2014-11-01

    To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI). A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013. Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with ≥3 subjects and ≥50% of study population with SCI, were included. Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted. Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at pain with gabapentin (SMD=1.20±.16; 95% CI, .88-1.52; Ppain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Antinociceptive Effect of Intrathecal Injection of Genetically Engineered Human Bone Marrow Stem Cells Expressing the Human Proenkephalin Gene in a Rat Model of Bone Cancer Pain

    Directory of Open Access Journals (Sweden)

    Yi Sun

    2017-01-01

    Full Text Available Background. This study aimed to investigate the use of human bone marrow mesenchymal stem cells (hBMSCs genetically engineered with the human proenkephalin (hPPE gene to treat bone cancer pain (BCP in a rat model. Methods. Primary cultured hBMSCs were passaged and modified with hPPE, and the cell suspensions (6 × 106 were then intrathecally injected into a rat model of BCP. Paw mechanical withdrawal threshold (PMWT was measured before and after BCP. The effects of hPPE gene transfer on hBMSC bioactivity were analyzed in vitro and in vivo. Results. No changes were observed in the surface phenotypes and differentiation of hBMSCs after gene transfer. The hPPE-hBMSC group showed improved PMWT values on the ipsilateral side of rats with BCP from day 12 postoperatively, and the analgesic effect was reversed by naloxone. The levels of proinflammatory cytokines such as IL-1β and IL-6 were ameliorated, and leucine-enkephalin (L-EK secretion was augmented, in the hPPE-engineered hBMSC group. Conclusion. The intrathecal administration of BMSCs modified with the hPPE gene can effectively relieve pain caused by bone cancer in rats and might be a potentially therapeutic tool for cancer-related pain in humans.

  16. Preliminary Results for the Treatment of a Pain-Causing Osteoporotic Vertebral Compression Fracture with a Sky Bone Expander

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jin Bo; Tang, Xue Ming; Xu, Nan Wei; Bao, Hong Tao [Changzhou No 2. Hospital, Changzhou (China)

    2008-10-15

    Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 {+-} 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 {+-} 5.0 mL) was injected per vertebra. The average anterior height was 18.4 {+-} 5.1 mm preoperatively and 20.5 {+-} 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 {+-} 5.2 mm preoperatively and 18.9 {+-} 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 {+-} 8.2 degrees preoperatively to 9.2 {+-} 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 {+-} 1.8 points preoperatively to 3.1 {+-} 2.0, 2.9 {+-} 1.7, 2.6 {+-} 1.5 and 2.9 {+-} 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander

  17. Clinical characteristics of patients with suspected cardiac chest pain and angiographically normal coronary arteries in a secondary care hospital

    NARCIS (Netherlands)

    de Lange, T. S.; Tijssen, R. Y. G.; Damman, P.; van Bergen, P. F. M. M.

    2017-01-01

    Background An important number of patients with suspected cardiac chest pain have non-obstructive coronary artery disease. Our purpose was to describe the clinical characteristics of patients with normal or near-normal coronary arteries in routine cardiological practice in a secondary care hospital.

  18. Cleft Patient-Reported Postoperative Donor Site Pain Following Alveolar Autologous Iliac Crest Bone Grafting: Comparing Two Minimally Invasive Harvesting Techniques.

    Science.gov (United States)

    Raposo-Amaral, Cesar Augusto; Denadai, Rafael; Chammas, Danilo Zanardo; Marques, Frederico Figueiredo; Pinho, André Silveira; Roberto, Wellington Matheus; Buzzo, Celso Luiz; Raposo-Amaral, Cassio Eduardo

    2015-10-01

    Autologous bone grafting is still considered the standard method for alveolar cleft repair. However, donor site morbidities remain a relevant problem in cleft care. Thus, the authors assessed postoperative donor site pain in cleft patients who underwent alveolar cleft repair by iliac crest bone graft transferring through a prospective randomized study comparing 2 minimally invasive harvesting techniques. Fifty-six consecutive patients with cleft lip and palate who underwent iliac crest bone grafting for alveolar cleft repair were randomly divided into 2 groups: bone graft harvested by minimally invasive techniques without (group 1) and with (group 2) periosteum elevation. Postoperative donor site pain was evaluated using a unidimensional numerical pain intensity rating scale (0, "no pain;" 10, "worst pain imaginable") at 1, 3, 6, 9, and 12 hours after the procedures and on the 3rd, 7th, 14th, 21st, and 28th days after surgeries. Intergroup comparisons were performed. The mean measurements of donor site pain revealed no significant differences (all P > 0.05) in any of the evaluated postoperative period comparisons between groups 1 and 2. There was a greater number (P < 0.05) of group 1 patients who reported "no pain" in the donor site compared with group 2, suggesting that periosteum elevation may play a role in pain intensity measurement. This prospective randomized study showed no difference in pain intensity among cleft patients who had postoperative pain. However, a greater number of patients in group 1 reported "no pain" in comparison to patients in group 2.

  19. Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity

    DEFF Research Database (Denmark)

    Jensen, Lone Donbæk; Maribo, Thomas; Schiøttz-Christensen, Berit

    2012-01-01

    OBJECTIVE: To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. METHODS: Randomised controlled trial in the secondary...... healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP...... addressing both workplace barriers and leisure-time physical activity. A workplace visit was performed if required. Pain, function and duration of sick leave due to LBP were primary outcomes. RESULTS: A reduction in bodily pain and improvement in physical function both measured by the 36-item short...

  20. Calculation of the Dose of Samarium-153-Ethylene Diamine Tetramethylene Phosphonate (153Sm-EDTMP as a Radiopharmaceutical for Pain Relief of bone Metastasis

    Directory of Open Access Journals (Sweden)

    Fatemeh Razghandi

    2016-04-01

    Full Text Available Introduction One of the important applications of nuclear physics in medicine is the use of radioactive elements as radiopharmaceuticals. Metastatic bone disease is the most common form of malignant bone tumors. Samarium-153-ethylene diamine tetramethylene phosphonate (153Sm-EDTMP as a radiopharmaceutical is used for pain palliation. This radiopharmaceutical usually emits beta particles, which have a high uptake in bone tissues. The purpose of this study was to calculate the radiation dose distribution of 153Sm-EDTMP in bone and other tissues, using MCNPX Monte Carlo code in the particle transport model. Materials and Methods Dose delivery to the bone was simulated by seeking radiopharmaceuticals on the bone surface. The phantom model had a simple cylindrical geometry and included bone, bone marrow, and soft tissue. Results The simulation results showed that a significant amount of radiation dose was delivered to the bone by the use of this radiopharmaceutical. Conclusion Thebone acted as a fine protective shield against rays for the bone marrow. Therefore, the trivial absorbed dose by the bone marrow caused less damage to bone-making cells. Also, the high absorbed dose of the bone could destroy cancer cells and relieve the pain in the bone.

  1. Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study

    International Nuclear Information System (INIS)

    Westhoff, Paulien G.; Verdam, Mathilde G.E.; Oort, Frans J.; Jobsen, Jan J.; Vulpen, Marco van; Leer, Jan Willem H.; Marijnen, Corrie A.M.; Graeff, Alexander de; Linden, Yvette M. van der

    2016-01-01

    Purpose: To study the course of quality of life (QoL) after radiation therapy for painful bone metastases. Patients and Methods: The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics. Results: In general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (−0.11 to −0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions. Conclusion: Although radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.

  2. Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Department of Radiotherapy, Radboud University Medical Center, Nijmegen (Netherlands); Verdam, Mathilde G.E. [Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Oort, Frans J. [Research Institute of Child Development and Education, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Jobsen, Jan J. [Department of Radiotherapy, Medisch Spectrum Twente, Enschede (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, Radboud University Medical Center, Nijmegen (Netherlands); Marijnen, Corrie A.M. [Department of Radiotherapy, Leiden University Medical Center, Leiden (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Linden, Yvette M. van der [Department of Radiotherapy, Leiden University Medical Center, Leiden (Netherlands)

    2016-08-01

    Purpose: To study the course of quality of life (QoL) after radiation therapy for painful bone metastases. Patients and Methods: The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics. Results: In general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (−0.11 to −0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions. Conclusion: Although radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.

  3. Comparison of single versus multiple fractions for palliative treatment of painful bone metastasis: First study from north west India

    Directory of Open Access Journals (Sweden)

    Akhil Kapoor

    2015-01-01

    Full Text Available Background: Bone metastasis is a usual cause of pain in advanced cancer. Conventional radiation schedules require larger hospital stay and thus are not suitable for patients with poor general condition. This prospective observational study aims to compare the pain-relieving efficacy of different radiation fractionation schedules, i.e., 8 Gy administered in a single fraction versus 30 Gy administered in 10 fractions. Materials and Methods: Two hundred and fifty consecutive patients of bone metastasis were evaluated for the study, with 63 patients being excluded due to non-fulfillment of the inclusion criteria. The response to radiotherapy leading to pain relief as per the Visual Analog Scale was recorded at the end of treatment, 8 days, 15 days and 1 month during the follow-up visits. Results: Sixty-two percent of the patients received a single fraction while the remaining received 10 fractions. In the 10-fraction group, overall response was present in 60% of the patients. Stable pain was present in 23% of the patients while 9% patients had progressive pain. At 1 month of completion of treatment, 9% patients were lost to follow-up. In the single-fraction arm, overall response was seen in 58%, stable pain in 27% and progressive pain in 7% of the patients. Six percent of the patients were lost to follow-up. Conclusions: Single-fraction treatment for bony metastasis is as effective as multiple fractions to relieve bony pain and provides treatment convenience to both the patient and the caregiver.

  4. Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: Usefulness of 99mTc-pyrophosphate bone scintigraphy

    International Nuclear Information System (INIS)

    Kinnaert, P.; Van Hooff, I.; Schoutens, A.

    1989-01-01

    Forty-one patients in chronic end-stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia (AL O). Thirty-eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1 +/- 0.3) was significantly higher than in all other categories (5.9 +/- 0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients, p less than 0.01). Patients with massive aluminum accumulation in bone (greater than 75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism. 99m Tc-pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients

  5. Does increased local bone resorption secondary to breast and prostate cancer result in increased cartilage degradation?

    DEFF Research Database (Denmark)

    Leeming, Diana J; Byrjalsen, Inger; Qvist, Per

    2008-01-01

    BACKGROUND: Breast and prostate cancer patients often develop lesions of locally high bone turnover, when the primary tumor metastasizes to the bone causing an abnormal high bone resorption at this site. The objective of the present study was to determine whether local increased bone turnover in ...... experiments revealed that osteoclasts released CTXI fragments but not CTXII from bone specimens. The same was observed for cathepsin K. CONCLUSION: Data suggest that an uncoupling between bone resorption and cartilage degradation occurs in breast and lung cancer patient....

  6. Reinforcing the Mucoperiosteal Pocket with the Scarpa Fascia Graft in Secondary Alveolar Bone Grafting: A Retrospective Controlled Outcome Study.

    Science.gov (United States)

    Lonic, Daniel; Yamaguchi, Kazuaki; Chien-Jung Pai, Betty; Lo, Lun-Jou

    2017-10-01

    Secondary alveolar bone grafting is the gold standard for the treatment of alveolar clefts in cleft lip and palate patients. The authors present a modified method using a Scarpa fascia graft that is placed deep into the mucoperiosteal pocket for watertight sealing of the bone graft chamber and limiting the graft position to the alveolar region for bony stability and tooth support. The outcome was assessed for clinical success in terms of bone graft stability and infection rate. Seventy-four unilateral complete cleft lip and palate patients were enrolled in this retrospective study consisting of equal-size Scarpa fascia and control groups of consecutive unilateral complete cleft lip and palate patients undergoing secondary alveolar bone grafting. Occlusal radiographs of the alveolar cleft taken at least 1 year postoperatively were evaluated for Spearman correlated Bergland and Witherow scales. Statistical evaluation was conducted using t test, chi-square test, and odds ratio. The clinical success rate (Bergland types I and II) of the Scarpa fascia procedure was significantly higher (67.6 versus 94.6 percent, respectively), with a significantly lower infection rate (16.2 versus 2.7 percent, respectively) and a high correlation of Bergland and Witherow scales (0.964; p fascia group. The authors' new method of alveolar bone grafting with the Scarpa fascia graft is safe and effective, and has one of the highest documented success rates. Therapeutic, III.

  7. Use of 5% lidocaine medicated plaster to treat localized neuropathic pain secondary to traumatic injury of peripheral nerves

    Directory of Open Access Journals (Sweden)

    Correa-Illanes G

    2012-07-01

    Full Text Available Gerardo Correa-Illanes,1 Ricardo Roa,2 José Luis Piñeros,2 Wilfredo Calderón31Rehabilitation Department, 2Burns and Plastic Surgery Department, Hospital del Trabajador, 3Plastic Surgery Department, Hospital del Salvador, Santiago, ChileObjective: The efficacy of 5% lidocaine medicated plaster (LMP has previously been demonstrated in post-traumatic localized neuropathic pain. This study evaluated the use of LMP in localized neuropathic pain secondary to traumatic peripheral nerve injury.Patients and methods: This prospective observational study enrolled patients with traumatic injuries to peripheral nerves that were accompanied by localized neuropathic pain of more than 3 months duration. Demographic variables, pain intensity (measured using the numeric rating scale; NRS, answers to the Douleur Neuropathique 4 (DN4 questionnaire, and the size of the painful area were recorded.Results: Nineteen patients were included, aged (mean ± standard deviation 41.4 ± 15.7 years. Nerve injuries affected the upper (eight patients or lower (11 patients limbs. The mean duration of pain before starting treatment with LMP was 22.6 ± 43.5 months (median 8 months. Mean baseline values included: NRS 6.7 ± 1.6, painful area 17.8 ± 10.4 cm2 (median 18 cm2, and DN4 score 6.7 ± 1.4. The mean duration of treatment with LMP was 19.5 ± 10.0 weeks (median 17.4 weeks. Mean values after treatment were: NRS 2.8 ± 1.5 (≥3 point reduction in 79% of patients, ≥50% reduction in 57.9% of patients and painful area 2.1 ± 2.3 cm2 (median 1 cm2, ≥50% reduction in 94.7% of patients. Functional improvement after treatment was observed in 14/19 patients (73.7%.Conclusion: LMP effectively treated traumatic injuries of peripheral nerves which presented with chronic localized neuropathic pain, reducing both pain intensity and the size of the painful area.Keywords: chronic post-surgical pain, chronic post-traumatic pain, 5% lidocaine medicated plaster, neuropathic pain

  8. {sup 177}Lu-EDTMP for palliation of pain from bone metastases in patients with prostate and breast cancer: a phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Krishan Kant; Singla, Suhas; Arora, Geetanjali; Bal, Chandrasekhar [All India Institute of Medical Sciences, Department of Nuclear Medicine, Ansari Nagar, New Delhi (India)

    2015-01-15

    The purpose of this study was to evaluate the efficacy and safety of {sup 177}Lu-EDTMP for pain palliation in patients with bone metastases from castration-resistant prostate and breast cancer. The secondary objective was to compare low-dose and high-dose {sup 177}Lu-EDTMP in bone pain palliation. Included in the study were 44 patients with documented breast carcinoma (12 patients; age 47 ± 13 years) or castration-resistant prostate carcinoma (32 patients; age 66 ± 9 years) and skeletal metastases. Patients were randomized into two equal groups treated with {sup 177}Lu-EDTMP intravenously at a dose of 1,295 MBq (group A) or 2,590 MBq (group B). Pain palliation was evaluated using a visual analogue score (VAS), analgesic score (AS) and Karnofsky performance score (KPS) up to 16 weeks. Toxicity was assessed in terms of haematological and renal parameters. The overall response rate (in all 44 patients) was 86 %. Complete, partial and minimal responses were seen in 6 patients (13 %), 21 patients (48 %) and 11 patients (25 %), respectively. A favourable response was seen in 27 patients (84 %) with prostate cancer and in 11 patients (92 %) with breast cancer. There was a progressive decrease in the VAS from baseline up to 4 weeks (p < 0.05). Also, AS decreased significantly from 1.8 ± 0.7 to 1.2 ± 0.9 (p < 0.0001). There was an improvement in quality of life of the patients as reflected by an increase in mean KPS from 56 ± 5 to 75 ± 7 (p < 0.0001). The overall response rate in group A was 77 % compared to 95 % in group B (p = 0.188). There was a significant decrease in VAS and AS accompanied by an increase in KPS in both groups. Nonserious haematological toxicity (grade I/II) was observed in 15 patients (34 %) and serious toxicity (grade III/IV) occurred in 10 patients (23 %). There was no statistically significant difference in haematological toxicity between the groups. {sup 177}Lu-EDTMP was found to be a safe and effective radiopharmaceutical for bone pain

  9. "HISTOLOGIC STRUCTURE AND MINERAL COMPONENTS OF SECONDARY DENTIN FORMED BY ENDOCHONDRAL BONE MATRIX GELATIN IMPLANTATION IN RABBIT PULP CAVITY"

    Directory of Open Access Journals (Sweden)

    A. G. Sobhani

    2005-04-01

    Full Text Available Many investigators use bone matrix gelatin for bone induction but it is used rarely for repair of teeth defects. This study was designed to evaluate secondary dentin formation by endochondral bone matrix gelatin (E-BMG in rabbit. E-BMG was prepared from tibia and femur of 4 Deutsche-Poland rabbits with average ages of 4-6 months. The prepared E-BMG was implanted in right incisor teeth pulps of 8 rabbits as experimental groups and left incisor teeth pulps selected as control groups. The light and scanning electron microscopic studies were performed on days 28 and 60 after operation. Also, new secreted matrix was analyzed on experimental, control and normal groups. The histological results showed secondary dentin and osteodentin formation in experimental group on day 28 after operation. The scanning electron microscopic observation on day 60 after operation in experimental group showed mineralized mass on site of E-BMG implantation. In contrast, in control group no mineralized mass was shown. Analyzing of new secreted matrix in experimental group showed the high deposition of calcium and phosphate on E-BMG implantation site. Results of present investigation indicate that implantation of E-BMG in pulp cavity could induce secondary dentin and osteodentin formation in rabbit. E-BMG could be a suitable biomaterial for secondary dentin formation in pulp cavity.

  10. Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity.

    Science.gov (United States)

    Jensen, Lone Donbæk; Maribo, Thomas; Schiøttz-Christensen, Berit; Madsen, Finn Hjorth; Gonge, Bigitte; Christensen, Michael; Frost, Poul

    2012-01-01

    To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. Randomised controlled trial in the secondary healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP addressing both workplace barriers and leisure-time physical activity. A workplace visit was performed if required. Pain, function and duration of sick leave due to LBP were primary outcomes. A reduction in bodily pain and improvement in physical function both measured by the 36-item short-form health survey questionnaire in favour of the intervention group was found. The change in pain score was found to be clinically relevant. The risk of sick leave for at least 8 weeks due to LBP was significantly reduced in the intervention group. Two secondary outcomes, Fear Avoidance Beliefs about physical activity and maximum oxygen uptake, supported compliance and adherence to the part of the intervention focusing on enhanced physical activity. Two short counselling sessions by an OP combining advice on meeting workplace barriers and enhancing physical activity had a substantial effect on important prognostic factors for LBP patients with moderate to severe symptoms diagnosed in outpatient rheumatological clinics. Current Controlled Trials ISRCTN13071157.

  11. Long-term results of secondary alveolar bone grafting using a technique to harvest pure calvarial cancellous bone: Evaluation based on plain radiography and computed tomography.

    Science.gov (United States)

    Han, Kihwan; Jeong, Woonhyeok; Yeo, Hyeonjung; Choi, Jaehoon; Kim, Junhyung; Son, Daegu; Oh, Sangho; Kim, Changhyun

    2017-03-01

    We introduce a method to extract the maximum amount of cancellous bone from the calvarium and analyze the outcomes using plain radiography and computed tomography. We retrospectively analyzed the medical records of patients who underwent secondary alveolar bone grafts using a maximal harvesting technique for calvarial cancellous bone. Bone survival was determined based on Enemark's grading system using plain radiographs. Alveolar thickness and height were analyzed by computed tomography and compared with radiographic measurements. Our study enrolled 27 patients, 22 unilateral and 5 bilateral, for a total of 32 alveolar clefts. The mean age at surgery was 9.04 ± 0.41 years (range: 6-12 years). Donor sites were successfully recovered without complications, such as hematomas, seromas, infections, or tears in the dura mater. The mean follow-up duration for obtaining plain radiographs was 6.90 ± 0.61 years (range: 2.0-18.50 years). The mean follow-up duration for computed tomography was 6.51 ± 0.99 years (range: 2.0-14.83 years). A canine tooth erupted in 30 cases. Success (Enemark's grades I or II) was achieved in 26 cases. Alveolar height was strongly correlated with the Enemark scale results (γ = 0.878, p technique resulted in successful graft survival without serious complications, including dural or brain injuries. Although the ilium is widely accepted as the optimal donor site for secondary alveolar bone grafting, the calvarium could be an alternative donor site that results in equivalent outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. {sup 99m}Tc-MDP bone uptake in secondary hyperparathyroidism: comparison among mandible, cranium, radius and femur

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    Boasquevisque, Edson; Silva, Jorge Wagner Esteves da; Bernardo, Vanessa V. de Albuquerque; Macedo, Sara Mello Santana de; Boasquevisque, Camila S.

    2008-07-01

    Full text: Objective: Evaluating bone involvement in secondary hyperparathyroidism (SHPT) by {sup 99m}Tc-MDP uptake in the mandible, cranium, radius and femur and with data correlation with PTHi serum (Intact Parathyroid Hormone). Materials and Methods: In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi, concentration and positive {sup 99m}Tc-MDP bone scintigraphy. Bone uptake measurements were carried out drawing regions-of-interest (ROI) on the mandible, posterior cranium, distal radius and proximal femur. Additionally, soft tissue uptake was measured with one region-of-interest on the internal tight soft tissue (BG). The ROI-BG ratio used as the index of normalized bone uptake. Results: The uptake differences from SHPT and control groups mainly for mandible (p = 0,001) and cranium (p = 0,002) were statistically significant, even when the SHPT groups were separated according to serum PTHi levels. There was increased bone uptake with the increased levels of PTHi serum. All of the mandibles of the SHPT patients were abnormal with 33% having focal lesions. Conclusions: The bone uptake in SHPT group was abnormal in all areas evaluated, with high uptake of {sup 99m}Tc-MDP correlated to the increase of PTHi serum concentration. (author)

  13. 99mTc-MDP bone uptake in secondary hyperparathyroidism: comparison among mandible, cranium, radius and femur

    International Nuclear Information System (INIS)

    Boasquevisque, Edson; Silva, Jorge Wagner Esteves da; Bernardo, Vanessa V. de Albuquerque; Macedo, Sara Mello Santana de; Boasquevisque, Camila S.

    2008-01-01

    Full text: Objective: Evaluating bone involvement in secondary hyperparathyroidism (SHPT) by 99m Tc-MDP uptake in the mandible, cranium, radius and femur and with data correlation with PTHi serum (Intact Parathyroid Hormone). Materials and Methods: In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi, concentration and positive 99m Tc-MDP bone scintigraphy. Bone uptake measurements were carried out drawing regions-of-interest (ROI) on the mandible, posterior cranium, distal radius and proximal femur. Additionally, soft tissue uptake was measured with one region-of-interest on the internal tight soft tissue (BG). The ROI-BG ratio used as the index of normalized bone uptake. Results: The uptake differences from SHPT and control groups mainly for mandible (p = 0,001) and cranium (p = 0,002) were statistically significant, even when the SHPT groups were separated according to serum PTHi levels. There was increased bone uptake with the increased levels of PTHi serum. All of the mandibles of the SHPT patients were abnormal with 33% having focal lesions. Conclusions: The bone uptake in SHPT group was abnormal in all areas evaluated, with high uptake of 99m Tc-MDP correlated to the increase of PTHi serum concentration. (author)

  14. 99mTc-MDP bone uptake in secondary hyperparathyroidism. Comparison of the mandible, cranium, radius, and femur

    International Nuclear Information System (INIS)

    Boasquevisque, Edson; Mandarim-de-Lacerda, Carlos A.; Silva, Jorge Wagner Esteves da; Albuquerque Bernardo, V.V. de; Macedo, S. Mello Santana de; Oliveira, Andre Ribeiro Nogueira de; Pires Kasai, Erika Tami; Boasquevisque, Camila S.

    2008-01-01

    The objective of this study to evaluate the bone involvement of the mandible, cranium, radius, and femur in secondary hyperparathyroidism (SHPT) using 99m Tc-methylene diphosphonate sodium (MDP) uptake correlated with the serum intact parathyroid hormone (PTHi). In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi and 99m Tc-MDP bone scintigraphy. Bone uptake was measured in regions of interest (ROIs) in the mandible posterior cranium, distal radius, and proximal femur. In addition, soft tissue uptake was measured in one ROI in the soft tissues of the medial thigh (BG). The ROI-BG ratio was used as an index of the normalized bone uptake. The uptake differences in the SHPT and control groups were statistically significant for the mandible (P=0.001) and cranium (P=0.002). When the SHPT group was subclassified according to serum PTHi levels, the bone uptake increased with the serum PTHi level. All mandibles of the patients with SHPT were abnormal, and 33% had focal lesions. The bone uptake in the SHPT group was abnormal in all areas evaluated, and a high uptake of 99m Tc-MDP was correlated with an increased serum PTHi. (author)

  15. Association of non-traumatic complex regional pain syndrome with adenocarcinoma lung on 99mTc-MDP bone scan

    Science.gov (United States)

    Damle, Nishikant A; Tripathi, Madhavi; Singhal, Abhinav; Bal, Chandrasekhar; Kumar, Praveen; Kandasamy, Devasenathipathi; Jana, Manisha

    2012-01-01

    Complex regional pain syndrome (CRPS) is usually associated with trauma. Rarely, it may be seen in association with malignancies. We present here the bone scan and X-ray findings in the case of a 56-year-male-patient with adenocarcinoma lung who also had non-traumatic CRPS without involvement of the stellate ganglion. The case highlights the fact that spontaneous development of reflex sympathetic dystrophy may be associated with a neoplastic etiology. PMID:24019656

  16. Association of non-traumatic complex regional pain syndrome with adenocarcinoma lung on 99mTc-MDP bone scan

    International Nuclear Information System (INIS)

    Damle, Nishikant A.; Tripathi, Madhavi; Singhal, Abhinav; Bal, Chandrasekhar; Praveen Kumar; Kandasamy, Devasenathipathi; Jana, Manisha

    2012-01-01

    Complex regional pain syndrome (CRPS) is usually associated with trauma. Rarely, it may be seen in association with malignancies. We present here the bone scan and X-ray findings in the case of a 56-year-male-patient with adenocarcinoma lung who also had non-traumatic CRPS without involvement of the stellate ganglion. The case highlights the fact that spontaneous development of reflex sympathetic dystrophy may be associated with a neoplastic etiology. (author)

  17. Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

    Science.gov (United States)

    Namba, Hirofumi; Kawasaki, Motohiro; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro; Koizumi, Norihiro

    2017-03-01

    It has been reported that MRgFUS has pain palliative effects on the local pain in patients with bone metastasis. In general, a severity of pain has been evaluated using only subjective method with numerical rating scale (NRS) or visual analogue scale (VAS). It is important to evaluate local pain-palliative effects of MRgFUS treatment with objective and quantitative method. The aim of this study is to investigate changes in the severity of local pain of bone metastasis before and after MRgFUS treatments, measuring pressure pain threshold (PPT) using pressure algometer, and pain intensity using electrical stimulation device (the Pain Vision system) at most painful site of bone metastasis. We have conducted MRgFUS for pain palliation of bone metastasis for 8 patients, and evaluated the local tenderness quantitatively for 8 patients, and evaluated local pain intensity for 7 patients. Before the treatments, PPTs were 106.3kPa [40.0-431.5] at metastatic site and 344.8 kPa [206.0-667.0] at normal control site, which showed a significant difference. The PPTs at metastatic site shows a significant increase from 106.3 kPa [40.0-431.5] at the baseline to 270.5 kPa [93.5-533.5] at 3 months after the treatment. The NRS score shows a significant decrease from 6.0 [4-8] at baseline to 1 [0-3] at 3 months after the treatment. Similarly, the pain intensity shows a significant decrease 245 [96.3-888.7] at baseline to 55.9 [2.8-292] at 3 months after the treatment. The results of our study illustrate the pain-relieving effects of MRgFUS for the treatment of painful bone metastasis. PPT might be a useful parameter not only for assessing a treatment's effect, but also for the decision of the painful area to treat with MRgFUS. Pain Vision seems to be useful for quantitative and objective evaluation of local pain of painful bone metastasis.

  18. Reactive oxygen species scavengers ameliorate mechanical allodynia in a rat model of cancer-induced bone pain

    Directory of Open Access Journals (Sweden)

    Ya-Qun Zhou

    2018-04-01

    Full Text Available Cancer-induced bone pain (CIBP is a frequent complication in patients suffering from bone metastases. Previous studies have demonstrated a pivotal role of reactive oxygen species (ROS in inflammatory and neuropathic pain, and ROS scavengers exhibited potent antinociceptive effect. However, the role of spinal ROS remains unclear. In this study, we investigated the analgesic effect of two ROS scavengers in a well-established CIBP model. Our results found that intraperitoneal injection of N-tert-Butyl-α-phenylnitrone (PBN, 50 and 100 mg/kg and 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (Tempol, 100 and 200 mg/kg significantly suppressed the established mechanical allodynia in CIBP rats. Moreover, repeated injection of PBN and Tempol showed cumulative analgesic effect without tolerance. However, early treatment with PBN and Tempol failed to prevent the development of CIBP. Naive rats received repetitive injection of PBN and Tempol showed no significant change regarding the nociceptive responses. Finally, PBN and Tempol treatment notably suppressed the activation of spinal microglia in CIBP rats. In conclusion, ROS scavengers attenuated established CIBP by suppressing the activation of microglia in the spinal cord. Keywords: Cancer-induced bone pain, Reactive oxygen species, PBN, Tempol

  19. Conditional TNF-α Overexpression in the Tooth and Alveolar Bone Results in Painful Pulpitis and Osteitis.

    Science.gov (United States)

    Hall, B E; Zhang, L; Sun, Z J; Utreras, E; Prochazkova, M; Cho, A; Terse, A; Arany, P; Dolan, J C; Schmidt, B L; Kulkarni, A B

    2016-02-01

    Tumor necrosis factor-α (TNF-α) is a proalgesic cytokine that is commonly expressed following tissue injury. TNF-α expression not only promotes inflammation but can also lead to pain hypersensitivity in nociceptors. With the established link between TNF-α and inflammatory pain, we identified its increased expression in the teeth of patients affected with caries and pulpitis. We generated a transgenic mouse model (TNF-α(glo)) that could be used to conditionally overexpress TNF-α. These mice were bred with a dentin matrix protein 1 (DMP1)-Cre line for overexpression of TNF-α in both the tooth pulp and bone to study oral pain that would result from subsequent development of pulpitis and bone loss. The resulting DMP1/TNF-α(glo) mice show inflammation in the tooth pulp that resembles pulpitis while also displaying periodontal bone loss. Inflammatory infiltrates and enlarged blood vessels were observed in the tooth pulp. Pulpitis and osteitis affected the nociceptive neurons innervating the orofacial region by causing increased expression of inflammatory cytokines within the trigeminal ganglia. With this new mouse model morphologically mimicking pulpitis and osteitis, we tested it for signs of oral pain with an oral function assay (dolognawmeter). This assay/device records the time required by a mouse to complete a discrete gnawing task. The duration of gnawing required by the DMP1/TNF-α(glo) mice to complete the task was greater than that for the controls; extended gnaw time in a dolognawmeter indicates reduced orofacial function. With the DMP1/TNF-α(glo) mice, we have shown that TNF-α expression alone can produce inflammation similar to pulpitis and osteitis and that this mouse model can be used to study dental inflammatory pain. © International & American Associations for Dental Research 2015.

  20. Does increased local bone resorption secondary to breast and prostate cancer result in increased cartilage degradation?

    Directory of Open Access Journals (Sweden)

    Fregerslev Michael

    2008-06-01

    Full Text Available Abstract Background Breast and prostate cancer patients often develop lesions of locally high bone turnover, when the primary tumor metastasizes to the bone causing an abnormal high bone resorption at this site. The objective of the present study was to determine whether local increased bone turnover in breast and prostate cancer patients is associated with an increase in cartilage degradation and to test in vitro whether osteoclasts or cathepsin K alone generate CTXII from human bone. Methods The study included 132 breast and prostate cancer patient, where presence of bone metastases was graded according to the Soloway score. Total bone resorption (CTXItotal and cartilage degradation (CTXII were determined. Results Breast and prostate cancer patients with bone metastases revealed significant increased levels of CTXItotal at Soloway scores 1 and higher compared to patients without bone metastases (p total significantly decreased at score 3 and 4 (p total, CTXII and CTXII/CTXItotal changed +900%, +130%, and -90%, respectively at Soloway score 4 compared to score 0. The in vitro experiments revealed that osteoclasts released CTXI fragments but not CTXII from bone specimens. The same was observed for cathepsin K. Conclusion Data suggest that an uncoupling between bone resorption and cartilage degradation occurs in breast and lung cancer patient.

  1. Fractionated Wide-Field Radiation Therapy Followed by Fractionated Local-Field Irradiation for Treating Widespread Painful Bone Metastasis

    International Nuclear Information System (INIS)

    Ki, Yongkan; Kim, Wontaek; Nam, Jiho; Kim, Donghyun; Jeon, Hosang; Park, Dahl; Kim, Dongwon

    2011-01-01

    Purpose: Wide-field radiation therapy (WFRT) is an effective treatment for widespread bone metastasis. We evaluated local-field irradiation (LFI) after fractionated WFRT (f-WFRT) for treating the patients with multiple painful bone lesions. Methods and Materials: From 1998 to 2007, 32 patients with multiple bone metastases were treated with fractionated LFI (f-LFI) after f-WFRT. All patients initially received 15 Gy in 5 fractions to a wide field, followed by LFI (9-15 Gy in 3 Gy fractions). Response was assessed by evaluating the degree of pain relief using a visual analog scale before radiotherapy, after f-WFRT, and after f-LFI. Results: Fractionated LFI following f-WFRT yielded an overall relief rate of 93.8% and a complete relief rate of 43.8%. The rate of the appearance of new disease was 6.3% for the patients with complete relief, 20.5% for the patients with a partial relief, and 50% for the patients with no relief. Conclusion: Fractionated LFI after f-WFRT is a well-tolerated and effective treatment for multiple metastatic bone disease.

  2. Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment

    International Nuclear Information System (INIS)

    Bedard, Gillian; Hoskin, Peter; Chow, Edward

    2014-01-01

    Introduction: Radiation therapy has been shown to successfully palliate bone metastases. A number of systematic reviews and large clinical trials have reported response rates for initial treatment and retreatment. Objective: To determine overall response rates of patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment. Methods: Intent-to-treat and evaluable patient statistics from a systematic review of palliative radiotherapy trials for initial treatment of bone metastases and a randomized clinical trial of retreatment were pooled and analyzed to determine the overall response rates for patients receiving initial treatment and retreatment. Results: In the intent-to-treat calculation, 71–73% of patients had an overall response to radiation treatment and in the evaluable patient population; 85–87% of patients did so. Response rates varied slightly whether patients underwent single or multiple fractions in initial treatment or retreatment. Conclusions: Single and multiple fraction radiation treatment yielded very similar overall response rates. Patients treated with a single fraction for both initial and repeat radiation experience almost identical overall response to those patients treated with multiple fraction treatment. It is therefore recommended that patients with uncomplicated painful bone metastases be treated with a single 8 Gy fraction of radiation at both the initial treatment and retreatment

  3. Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease.

    Science.gov (United States)

    Coluzzi, Flaminia; Raffa, Robert B; Pergolizzi, Joseph; Rocco, Alessandra; Locarini, Pamela; Cenfra, Natalia; Cimino, Giuseppe; Mattia, Consalvo

    2015-01-01

    Myeloma bone disease (MBD) is a devastating complication of multiple myeloma that leads to severe pain. The aim of this study was to evaluate the efficacy and tolerability of tapentadol prolonged release (PR) in the management of patients with MBD suffering from moderate-to-severe cancer pain. A 12-week prospective study was carried out in 25 opioid-naïve MBD patients. Patients initially received twice-daily doses of tapentadol PR 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity. The following parameters were recorded at weekly intervals for 4 weeks, and then at weeks 8 and 12: pain, opioid-related adverse effects, use of other analgesics, DN4 (Douleur Neuropathique 4) score. Quality of life (SF-36 [36-item short-form health survey]) was measured at baseline and at final evaluation. Of 25 patients, 22 completed the study. Pain intensity significantly decreased from baseline to all the week intervals (Popioid-naïve MBD patients with moderate-to-severe pain. Tapentadol PR can be considered a first-choice opioid in cancer patients suffering from mixed pain with a neuropathic component.

  4. Involvement of chemokine CXCL11 in the development of morphine tolerance in rats with cancer-induced bone pain.

    Science.gov (United States)

    Guo, Genhua; Peng, Yawen; Xiong, Bingrui; Liu, Daiqiang; Bu, Huilian; Tian, Xuebi; Yang, Hui; Wu, Zhen; Cao, Fei; Gao, Feng

    2017-05-01

    Morphine is viewed as one of the classical treatments for intractable pain, but its role is limited by side effects, including analgesic tolerance. A few chemokines have been reported to be engaged in the mechanisms of morphine tolerance. However, the exact roles of CXC chemokine 11 (CXCL11) in chronic morphine tolerance remain unknown. In this study, Walker 256 mammary gland carcinoma cells were inoculated into the tibia of rats to provoke cancer-induced bone pain. Then, morphine was intrathecally administered twice daily for seven consecutive days to induce drug tolerance. We found that the level of CXCL11 in lumbar spinal cord was increased during the development of morphine tolerance in cancer-induced bone pain rats. Meanwhile, CXCL11 was co-localized with markers of astrocytes and neurons in the spinal cord. Inhibition of CXCL11 by neutralizing antibodies could remarkably attenuate the degree of morphine tolerance and decrease the activation of astrocytes. Moreover, blocking astrocyte activation by d, l-Fluorocitric acid could distinctly alleviate morphine tolerance and reduce the expression of CXCL11. Finally, morphine stimulation could induce the release of CXCL11 by cultured astrocytes and neurons in vitro. In summary, our results provide evidence that spinal CXCL11 plays a powerful modulatory role in the development of morphine tolerance through cross-talking between astrocytes and neurons. Read the Review series "Pain". © 2016 International Society for Neurochemistry.

  5. Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus.

    Directory of Open Access Journals (Sweden)

    Hiroki eNakata

    2014-12-01

    Full Text Available Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging (fMRI, and neurophysiological methods, such as magnetoencephalography (MEG and electroencephalography (EEG, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation’. In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation.

  6. Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus

    Science.gov (United States)

    Nakata, Hiroki; Sakamoto, Kiwako; Kakigi, Ryusuke

    2014-01-01

    Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging, and neurophysiological methods, such as magnetoencephalography and electroencephalography, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC) and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation.’ In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation. PMID:25566158

  7. The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?

    OpenAIRE

    Lange Fredrik; Lövgren Peter W; Jørgensen Kristian; Halasz Laszlo; Eklund Andreas; Jensen Irene B; Axén Iben; Rosenbaum Annika; Leboeuf-Yde Charlotte

    2009-01-01

    Abstract Background Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (L...

  8. Canine Eruption After Secondary Alveolar Bone Graft in Unilateral Cleft Lip and Palate Patients.

    Science.gov (United States)

    Vellone, Valentino; Cirignaco, Giulio; Cavarretta, Bruno; Cascone, Piero

    2017-07-01

    The aim of this article is to analyze dental abnormalities in unilateral cleft lip and palate patients by focusing on the role of the secondary alveolar bone graft (SABG) surgery and its outcomes on canine eruption/inclusion. A sample of 24 patients with unilateral cleft lip and palate were selected.Dental anomalies, canine eruption based on the existence of supernumeraries, agenesis elements, inclination of the major canine axis before and after surgery, distance from the occlusal plane before and after surgery, and sector classification were analyzed. Out of the 24 patients, 87.5% presented a canine spontaneously erupted in the dental arch while 12.5% needed surgical-orthodontic traction.There is also no proof that inclination of the canine significantly influenced the eruption before (P = 0.5889) and after (P = 0.4029) surgery. Also, there is no any correlation between the 2 sides (P = 0.1257).The SABG surgery showed a significant correlation with canine eruption (P = 0.009242); moreover, SABG shows a positive relationship with the radicular development of the canine (P = 0.005163).Lateral incisive (P = 0.8493) and second premolar agenesis (P = 1) are not statistically correlated with the eruption of the canine. This does not happen with supernumerary elements that are correlated with the surgical-orthodontic traction (P = 0.0004464). Agenesis does not play any role in the process of canine eruption while supernumeraries do. There is no relationship between the inclination and eruption of the canine.The SABG surgery has a key role because it contributes to create an appropriate support for the erupting canine, the nasal base and the anterior maxilla.

  9. Preventing painful age-related bone fractures: Anti-sclerostin therapy builds cortical bone and increases the proliferation of osteogenic cells in the periosteum of the geriatric mouse femur.

    Science.gov (United States)

    Thompson, Michelle L; Chartier, Stephane R; Mitchell, Stefanie A; Mantyh, Patrick W

    2016-01-01

    Age-related bone fractures are usually painful and have highly negative effects on a geriatric patient's functional status, quality of life, and survival. Currently, there are few analgesic therapies that fully control bone fracture pain in the elderly without significant unwanted side effects. However, another way of controlling age-related fracture pain would be to preemptively administer an osteo-anabolic agent to geriatric patients with high risk of fracture, so as to build new cortical bone and prevent the fracture from occurring. A major question, however, is whether an osteo-anabolic agent can stimulate the proliferation of osteogenic cells and build significant amounts of new cortical bone in light of the decreased number and responsiveness of osteogenic cells in aging bone. To explore this question, geriatric and young mice, 20 and 4 months old, respectively, received either vehicle or a monoclonal antibody that sequesters sclerostin (anti-sclerostin) for 28 days. From days 21 to 28, animals also received sustained administration of the thymidine analog, bromodeoxyuridine (BrdU), which labels the DNA of dividing cells. Animals were then euthanized at day 28 and the femurs were examined for cortical bone formation, bone mineral density, and newly borne BrdU+ cells in the periosteum which is a tissue that is pivotally involved in the formation of new cortical bone. In both the geriatric and young mice, anti-sclerostin induced a significant increase in the thickness of the cortical bone, bone mineral density, and the proliferation of newly borne BrdU+ cells in the periosteum. These results suggest that even in geriatric animals, anti-sclerostin therapy can build new cortical bone and increase the proliferation of osteogenic cells and thus reduce the likelihood of painful age-related bone fractures. © The Author(s) 2016.

  10. Validity of a health-related quality-of-life scale for dogs with signs of pain secondary to cancer.

    Science.gov (United States)

    Yazbek, Karina V B; Fantoni, Denise T

    2005-04-15

    To develop and validate a health-related quality-of-life scale for dogs with pain secondary to cancer. Questionnaire development. 40 healthy dogs with no history or signs of pain, 20 dogs with dermatologic disease but no signs of pain other than mild pruritus, and 20 dogs with cancer. Owners of all dogs completed a questionnaire containing 12 questions with 4 options for each question, and a quality-of-life score ranging from 0 to 36 was calculated. Scores for dogs with cancer were compared with scores for healthy dogs and dogs with dermatologic disease. All owners indicated that the questionnaire was easy to complete. Scores for healthy dogs were significantly different from scores for dogs with cancer and scores for dogs with dermatologic disease. Scores for dogs with dermatologic disease were significantly different from scores for dogs with cancer. Results suggested that a simple questionnaire may be useful in assessing health-related quality of life in dogs with pain secondary to cancer, in that dogs with cancer had significantly lower scores than did healthy dogs and dogs with dermatologic disease.

  11. Development and Internal Validation of a Clinical Risk Score to Predict Pain Response After Palliative Radiation Therapy in Patients With Bone Metastases

    NARCIS (Netherlands)

    van der Velden, JM; Peters, Max; Verlaan, Jorrit Jan; Versteeg, Anne L.; Zhang, Liying; Tsao, May; Danjoux, Cyril; Barnes, Elizabeth; van Vulpen, Marco; Chow, Edward; Verkooijen, Helena M.

    2017-01-01

    Purpose To investigate the relationship between patient and tumor characteristics and pain response in patients with metastatic bone disease, and construct and internally validate a clinical prediction model for pain response to guide individualized treatment decision making. Material and Methods A

  12. Effectiveness of traditional bone setting in treating chronic low back pain: a randomised pilot trial.

    Science.gov (United States)

    Zaproudina, N; Hietikko, T; Hänninen, O O P; Airaksinen, O

    2009-01-01

    The aim of this trial was to establish the effectiveness of traditional bone setting (TBS) compared with conventional physical and exercise therapy (PhT) in treating chronic low back pain (cLBP). Randomised clinical trial. Working-aged cLBP patients (n=131, age range 29-51 years) were randomised into two treatment groups: TBS and PhT. Follow-up assessments took place 1, 6 and 12 months after treatment. TBS is a popular traditional manual mobilisation therapy for musculoskeletal disorders in Finland. Conventional PhT was used as the reference treatment. LBP intensity (Visual Analog Scale 0-100, VAS), the Oswestry Disability Index (ODI), the global assessment score (scale -1 to +10), a health-related quality of life (HRQoL) assessment and spine mobility measurements were used as measures. 118 patients (95.9%, 59 men and 59 women) completed the treatment program. Both treatments reduced the VAS and ODI levels after 1 month. Changes in VAS did not differ between the two treatment groups (mean -0.2, CI -11.3 to 10.9). The improvement in ODI (mean 2.4, CI -1.2 to 6.0, p=0.069, repeated measurements ANOVA) and quality of life scores (mean -0.03, CI -0.06 to 0, p=0.056) tended to be greater after TBS. Additionally, global assessment scores were better for TBS-treated patients (Mann-Whitney test, p=0.001). There were no differences between the spine mobility test results of the two groups. Changes in both VAS (mean -2.4, CI -15.5 to 10.6) and ODI (mean 1.0, CI -3.0 to 5.1) measures did not, however, differ between the groups at the 1-year follow-up stage. Most cLBP patients found the treatments to be beneficial. Although the long-term dynamics of pain and disability did not differ between the groups, the subjective benefits appeared to be more significant after TBS.

  13. Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease

    Directory of Open Access Journals (Sweden)

    Coluzzi F

    2015-05-01

    Full Text Available Flaminia Coluzzi,1,2 Robert B Raffa,3 Joseph Pergolizzi,4 Alessandra Rocco,1 Pamela Locarini,1 Natalia Cenfra,5 Giuseppe Cimino,5 Consalvo Mattia1,2 1Department of Medical and Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Unit of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Polo Pontino, Sapienza University of Rome, Latina, Italy; 2SIAARTI Study Group on Acute and Chronic Pain, Rome, Italy; 3Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA; 4Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 5Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy Context: Myeloma bone disease (MBD is a devastating complication of multiple myeloma that leads to severe pain. Objectives: The aim of this study was to evaluate the efficacy and tolerability of tapentadol prolonged release (PR in the management of patients with MBD suffering from moderate-to-severe cancer pain. Methods: A 12-week prospective study was carried out in 25 opioid-naïve MBD patients. Patients initially received twice-daily doses of tapentadol PR 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity. The following parameters were recorded at weekly intervals for 4 weeks, and then at weeks 8 and 12: pain, opioid-related adverse effects, use of other analgesics, DN4 (Douleur Neuropathique 4 score. Quality of life (SF-36 [36-item short-form health survey] was measured at baseline and at final evaluation. Results: Of 25 patients, 22 completed the study. Pain intensity significantly decreased from baseline to all the week intervals (P<0.01. Quality of life significantly improved with respect to all SF-36 subscale parameters (P<0.01, and so did both the physical and mental status (P<0.01. Tapentadol PR significantly reduced DN4 mean value (P<0.01 and the number of patients with neuropathic component

  14. Gender differences in pain and patient reported outcomes: a secondary analysis of the NCIC CTG SC. 23 randomized trial.

    Science.gov (United States)

    Chow, Selina; Ding, Keyue; Wan, Bo Angela; Brundage, Michael; Meyer, Ralph M; Nabid, Abdenour; Chabot, Pierre; Coulombe, Genevievev; Ahmed, Shahida; Kuk, Joda; Dar, A Rashid; Mahmud, Aamer; Fairchild, Alysa; Wilson, Carolyn F; Wu, Jackson S Y; Dennis, Kristopher; DeAngelis, Carlo; Wong, Rebecca K S; Zhu, Liting; Chow, Edward

    2017-12-01

    Gender differences may contribute to variations in disease presentations and health outcomes. To explore the gender difference in pain and patient reported outcomes in cancer patients with bone metastases undergoing palliative radiotherapy on the National Cancer Institute of Canada (NCIC) SC.23 randomized trial. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life (QOL) bone metastases module (QLQ-BM22) and EORTC QOL Core-15-Palliative (QLQ-C15-PAL) before treatment and at days 10 and 42 after a single 8 Gy radiation treatment. Patient demographics, performance status, analgesic consumption, BM22 and C15 were compared between males and females using the 2-sample t-test for continuous variables or the Chi-squared test for categorical variables. Multiple linear regression models were used to check the difference between gender groups adjusting for the baseline demographics and primary disease sites. There were 298 patients (170 male, 128 female) with median age of 69 years. The most common primary cancer sites were lung, prostate and breast. At baseline, there were no differences in BM22 and C15 scores, except a worse nausea and vomiting score (P=0.03) in females on the C15. In patients with moderate baseline worst pain scores (WPS), females reported worse scores in painful sites of BM22. At day 42, there was no significant difference in response to radiotherapy. Among the responders, females reported better improvement in emotional aspect. In cancer patients with bone metastases undergoing palliative radiotherapy, the majority of symptom presentations, patient reported outcomes, and response to radiation was not significantly different between genders. NCT01248585.

  15. A pain in the neck: a rare case of isolated hyoid bone trauma

    Science.gov (United States)

    Iacovou, E; Nayar, M; Fleming, J; Lew-Gor, S

    2011-01-01

    We report the first case of dislocation of the symphysis between the great cornu and the body of the hyoid bone following strangulation in survivors. The present paper presents a rare case of injury to the hyoid bone and reviews the current knowledge on hyoid bone injuries in survivors. PMID:24950041

  16. The selective Cox-2 inhibitor Celecoxib suppresses angiogenesis and growth of secondary bone tumors: An intravital microscopy study in mice

    International Nuclear Information System (INIS)

    Klenke, Frank Michael; Gebhard, Martha-Maria; Ewerbeck, Volker; Abdollahi, Amir; Huber, Peter E; Sckell, Axel

    2006-01-01

    The inhibition of angiogenesis is a promising strategy for the treatment of malignant primary and secondary tumors in addition to established therapies such as surgery, chemotherapy, and radiation. There is strong experimental evidence in primary tumors that Cyclooxygenase-2 (Cox-2) inhibition is a potent mechanism to reduce angiogenesis. For bone metastases which occur in up to 85% of the most frequent malignant primary tumors, the effects of Cox-2 inhibition on angiogenesis and tumor growth remain still unclear. Therefore, the aim of this study was to investigate the effects of Celecoxib, a selective Cox-2 inhibitor, on angiogenesis, microcirculation and growth of secondary bone tumors. In 10 male severe combined immunodeficient (SCID) mice, pieces of A549 lung carcinomas were implanted into a newly developed cranial window preparation where the calvaria serves as the site for orthotopic implantation of the tumors. From day 8 after tumor implantation, five animals (Celecoxib) were treated daily with Celecoxib (30 mg/kg body weight, s.c.), and five animals (Control) with the equivalent amount of the CMC-based vehicle. Angiogenesis, microcirculation, and growth of A549 tumors were analyzed by means of intravital microscopy. Apoptosis was quantified using the TUNEL assay. Treatment with Celecoxib reduced both microvessel density and tumor growth. TUNEL reaction showed an increase in apoptotic cell death of tumor cells after treatment with Celecoxib as compared to Controls. Celecoxib is a potent inhibitor of tumor growth of secondary bone tumors in vivo which can be explained by its anti-angiogenic and pro-apoptotic effects. The results indicate that a combination of established therapy regimes with Cox-2 inhibition represents a possible application for the treatment of bone metastases

  17. A health information system in radiotherapy to support health personnel in evaluation of standard pain in patients with bone metastases

    International Nuclear Information System (INIS)

    Santos, Maria E.M.; Vieira, Jose W.; Melo, Jonathan A.; Lima, Fernando R.A.

    2013-01-01

    Radiation therapy is a medical specialty that uses ionizing radiation sources, and can be applied to relieve the pain. The Numerical Dosimetry Group (GDN) of Recife-PE, Brazil presented in June 2012 the SISRAD (Health information system in radiotherapy), developed to organize information about data of patients with bone metastasis, aiming to evaluate patterns of pain after radiation treatment. They have since been carried out interviews with this type of patient and the answers have been added to a data file of the software. Were developed some graphical visualization tools as well as data sheets. The current version of SISRAD reads the data file and displays graphics and numerical results, with options to save them or print them. In this paper is presented a roadmap for the health care professional use with efficiency the SISRAD to form quantitative profiles of intensity of pain that their patients, on their responsibility, feel after the radiation treatment. A hypothesis used in SISRAD consists of organizing the responses of the patients supposing them free from other effects other than those arising from the permanence of the pain he felt before treatment or modification by the treatment. So the way the information is handled in the SISRAD enable the trader can discern patterns of pain and, consequently, improve the quality of treatment. In this sense the computational tool here presented can be classified as educational software for health professionals

  18. Balancing spinal stability and future mobility in the cervical spine: surgical treatment of a case of osteoblastoma with secondary aneurysmal bone cyst.

    Science.gov (United States)

    Ramme, Austin J; Smucker, Joseph D

    2011-05-01

    The combination of osteoblastoma and aneurysmal bone cyst (ABC) in the cervical spine is a relatively rare occurrence in the general population. The diagnosis and surgical management of osteoblastoma and ABCs have been previously described in a small number of case reports/series and orthopedic texts. Lesions of the cervical spine pose challenges to surgeons that require preoperative planning and intraoperative decisions to ensure an appropriate patient outcome. Complete resection has been shown to be the most effective method for preventing recurrence; however, balancing spinal stability, future mobility, and complete resection is especially important in active young patients. We describe a modern approach to the surgical management of osteoblastoma with secondary ABC of the cervical spine with 4-year clinical and radiographic follow-up. Included in this report is a comprehensive review of the literature related to osteoblastoma, ABCs, and surgical issues pertinent to them. An independent retrospective case review combined with a review of current literature was performed. A single patient with a combination of osteoblastoma and secondary ABC is presented. During 4 years of follow-up, the patient has been evaluated with plain radiographs for subluxation or rotation of the cervical spine. Postoperative assessments for pain and range of motion were also collected. The medical, pathologic, and radiographic records of a case of osteoblastoma with secondary aneursymal bone cyst of the cervical spine were reviewed. A computer-based literature search of the PubMed database was used to compile a comprehensive review of the topic. The diagnosis and surgical treatment of osteoblastoma with secondary ABC in the cervical spine are discussed in the context of a literature review. The surgical management of this lesion was dictated by the size and location of the mass as well as the impact of the surgical resection on surrounding structures in terms of spinal stability and

  19. Psychological and behavioral differences between low back pain populations: a comparative analysis of chiropractic, primary and secondary care patients.

    Science.gov (United States)

    Eklund, Andreas; Bergström, Gunnar; Bodin, Lennart; Axén, Iben

    2015-10-19

    Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics. In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared. A: Four hundred eighty subjects from chiropractic primary care clinics. B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity). C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic. D: Two hundred thirty-five subjects from secondary care clinics. The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed). The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D. The chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on our findings from the MPI-S instrument the 4 samples may be considered statistically and clinically different. Sample A comes from an ongoing trial registered at clinical trials.gov; NCT01539863 , February 22, 2012.

  20. Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care

    DEFF Research Database (Denmark)

    Søndergård, S; Vaegter, H B; Erlangsen, A

    2018-01-01

    compared with the Danish general population. METHODS: Patients (n = 7197) consulted in the interdisciplinary Pain Clinic South at Odense University Hospital, Denmark, from 2005 to 2015 were included. Data from the Pain Clinic were linked to the Danish National Patient Register-Psychiatry and the Danish...

  1. Knee Pain and Driving Duration: A Secondary Analysis of the Taxi Drivers’ Health Study

    Science.gov (United States)

    Chen, Jiu-Chiaun; Dennerlein, Jack T.; Shih, Tung-Sheng; Chen, Chiou-Jong; Cheng, Yawen; Chang, Wushou P.; Ryan, Louise M.; Christiani, David C.

    2004-01-01

    Objectives. We explored a postulated association between daily driving time and knee pain. Methods. We used data from the Taxi Drivers’ Health Study to estimate 1-year prevalence of knee pain as assessed by the Nordic musculoskeletal questionnaire. Results. Among 1242 drivers, the prevalence of knee pain, stratified by duration of daily driving (≤ 6, > 6 through 8, > 8 through 10, and > 10 hours), was 11%, 17%, 19%, and 22%, respectively. Compared with driving 6 or fewer hours per day, the odds ratio of knee pain prevalence for driving more than 6 hours per day was 2.52 (95% confidence interval = 1.36, 4.65) after we adjusted for socioeconomic, work-related, and personal factors in the multiple logistic regression. Conclusions. The dose-related association between driving duration and knee pain raises concerns about work-related knee joint disorders among professional drivers. PMID:15054008

  2. Groin pain secondary to Femoral Acetabular Impingement Syndrome - A case of mistaken identity

    Directory of Open Access Journals (Sweden)

    Elizabeth Tan

    2018-02-01

    Full Text Available Groin pain is a common presentation usually associated with inguinal hernias, thus a clinician will rarely consider hip pathology. We present the case of a 51-year-old man with right groin pain and imaging-confirmed right inguinal hernia. His atypical symptoms and signs however led to us pursuing other differentials; he was subsequently diagnosed with a Cam-type femoral acetabular impingement (FAI syndrome. Through this case study and literature review, we aim to increase awareness amongst general surgeons regarding this uncommon differential of FAI syndrome- a painful condition associated with morphological characteristics of the proximal femur and/or acetabulum. A thorough history and examination in patients with groin pain is essential in the diagnostic algorithm to accurately diagnose FAI syndrome. This will facilitate orthopaedic referral, appropriately manage pain symptoms, as well as prevent unnecessary hernioplasties and possible complications

  3. Study on correlation between bone marrow edema, stage of necrosis and area ratio of necrosis with the hip pain grading in nontraumatic osteonecrosis of the femoral head

    Directory of Open Access Journals (Sweden)

    Jianchuan Wang

    2015-01-01

    Full Text Available The objective of this study was to explore the correlation between bone marrow edema, stage of necrosis, and area ratio of necrosis with the hip pain grading in non-traumatic osteonecrosis of the femoral head. Bone marrow edema grading at all levels and the hip pain grade differences were statistically significant (P < 0.001. Bone marrow edema grading increased by levels of 0, 1, and 2, whereas average pain rating increased as well to 40.73, 104.66 and 143.49. I ~ III period stage of necrosis and the hip pain grade difference was statistically significant (P < 0.001, with the average grade progress pain stage by the death of a rank gradually increased, I period, II period, III period was 57.00, 88.58 and 120.62, respectively. Area ratio of necrosis between 0 ~ 3 were positively correlated with pain, compared the two was statistically significant (P < 0.001, and with the degree of pathological changes is aggravating, increase the average rank of levels of pain. 0, 1, 2 and 3 are 36.88, 98.03, 123.87 and 151.93 respectively. We can choose the treatment method and evaluate treatment effect by considering a patients’ degree of bone marrow edema, stage of necrosis and area ratio of necrosis.

  4. Evaluation of secondary alveolar bone grafting outcomes performed after canine eruption in complete unilateral cleft lip and palate.

    Science.gov (United States)

    Lorenzoni, Diego Coelho; Janson, Guilherme; Bastos, Juliana Cunha; Carvalho, Roberta Martinelli; Bastos, José Carlos; de Cássia Moura Carvalho Lauris, Rita; Henriques, José Fernando Castanha; Ozawa, Terumi Okada

    2017-01-01

    Evaluate the results of secondary alveolar bone grafting (SABG) in patients with complete unilateral cleft lip and palate (UCLP), operated after permanent canine eruption (CE). Seventy-four periapical radiographs from patients with complete UCLP (mean age 14 years) submitted to SABG were retrospectively analyzed for the amount of bone in the cleft site through the Bergland and Chelsea scales. Of the cases, 47.3 % was classified as Bergland type I and Chelsea type A, 35.2 % as type II/C, 6.7 % as type III/D, and 10.8 % as type IV/failure. When the canine was moved into the grafted area, the success rate (type I/A) was 56.8 %; for cases in which the space was maintained for an implant or prosthetic finishing, the index was 45.8 %; however, this difference was not statistically significant. Even in advanced ages, after permanent canine eruption, SABG can be considered a highly successful procedure. This research shows good results of secondary alveolar bone grafting performed in patients with unilateral complete cleft lip and palate, even when it was performed after eruption of the permanent canine in the cleft area.

  5. Influence of simulated bone-implant contact and implant diameter on secondary stability: a resonance frequency in vitro study.

    Science.gov (United States)

    Veltri, Mario; González-Martín, Oscar; Belser, Urs C

    2014-08-01

    This study tested the hypothesis of no differences in resonance frequency for standardized amounts of simulated bone-implant contact around implants with different diameters. In addition, it was evaluated if resonance frequency is able to detect a difference between stable and rotation mobile ("spinning") implants. Implants with diameters of 3.3, 4.1 and 4.8 mm were placed in a purposely designed metal mould where liquid polyurethane resin was then poured to obtain a simulated bone-implant specimen. By regulating the mould, it was possible to create the following simulated bone-implant contact groups: 3.3 mm (198.6 mm(2)); 4.1 mm (198.8 mm(2)); 4.8 mm (200.2 mm(2)); 4.8 mm (231.7 mm(2)); 4.8 mm (294.7 mm(2)). Each group included 10 specimens. After resin setting, resonance frequency was measured. On the last group, measurements were repeated after establishing implant rotational mobility. One-way ANOVA tests with post hoc comparisons, a Pearson's correlation coefficient and a t-test for repeated measurements were used to evaluate statistically significant differences. Implants with different diameters but with the same amount of simulated osseointegration revealed no differences in resonance frequency. On the contrary, an increase of simulated bone-implant contact resulted in significantly higher resonance frequency. A clear direct linear correlation resulted between resonance frequency and simulated bone-implant contact. Furthermore, a significant difference resulted between resonance frequency measured before and after creation of rotational mobility. Within the conditions of this study, the secondary stability was correlated with the simulated bone-implant contact. In addition, resonance frequency was able to discern between stable and rotation mobile implants. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    Energy Technology Data Exchange (ETDEWEB)

    Zeng Liang [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Chow, Edward, E-mail: edward.chow@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Bedard, Gillian; Zhang, Liying [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Fairchild, Alysa [Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta (Canada); Vassiliou, Vassilios [Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia (Cyprus); Alm El-Din, Mohamed A. [Department of Clinical Oncology, Tanta University Hospital, Tanta Faculty of Medicine, Tanta (Egypt); Jesus-Garcia, Reynaldo [Department of Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo (Brazil); Kumar, Aswin [Division of Gynaecology and Genitourinary Oncology, Department of Radiation Oncology, Regional Cancer Center, Trivandrum (India); Forges, Fabien [Inserm CIE3, Saint Etienne University Hospital, Saint-Etienne (France); Unit of Clinical Research, Innovation, and Pharmacology, Saint Etienne University Hospital, Saint-Etienne (France); Tseng, Ling-Ming [Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (China); Hou, Ming-Feng [Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (China); Chie, Wei-Chu [Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan (China); Bottomley, Andrew [European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels (Belgium)

    2012-11-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  7. Gender differences in pain and secondary hyperalgesia after heat/capsaicin sensitization in healthy volunteers

    DEFF Research Database (Denmark)

    Jensen, Magnus Thorsten; Petersen, Karin Lottrup

    2006-01-01

    In most published studies women are more sensitive to experimental pain than men. Enhanced central pain processing in women has been suggested, but psychosocial factors might also have affected the findings. Data from five completed healthy volunteer studies were analyzed to investigate gender...... can be explained by enhanced central sensitization in women. PERSPECTIVE: Our findings suggest that gender differences in nociceptive transmission and neuronal sensitization are small and provide only limited support to the hypothesis that gender differences in acute and chronic pain syndromes can...... be explained by enhanced central sensitization in women....

  8. Radiofrequency-Induced Intradiscal Nucleoplasty Chronic Low Back Pain Secondary To Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    DW Lee

    2013-07-01

    Full Text Available We set out to assess the efficacy of radiofrequency-induced intradiscal nucleoplasty in reducing pain in symptomatic patients with MRI-defined lumbar disc herniation and their satisfaction with the procedure. We compared the patients’ pain intensity and severity of disability scores before and after undergoing the procedure in a retrospective questionnaire. These patients reported statistically significant reduction of pain intensity and disability level after the procedure. We conclude that radio frequency induced intradiscal nucleoplasty is an acceptable alternative minimally invasive procedure in relieving the symptoms of patients with lumbar disc herniation.

  9. Complexes of low energy beta emitters {sup 47}Sc and {sup 177}Lu with zoledronic acid for bone pain therapy

    Energy Technology Data Exchange (ETDEWEB)

    Majkowska, Agnieszka [Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195 Warsaw (Poland)], E-mail: a.majkowska@ichtj.waw.pl; Neves, Maria; Antunes, Ines [Instituto Tecnologico e Nuclear, Estrada Nacional 10, 2686-953 Sacavem (Portugal); Bilewicz, Aleksander [Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195 Warsaw (Poland)

    2009-01-15

    Targeted radiopharmaceuticals have been mostly developed to visualize and/or treat oncologic diseases. In targeted radiotherapy radionuclide selection is a key issue, because the radionuclide should provide the appropriate radiation absorbed dose, matching the desirable biologic effect, but at the same time it should preclude irradiation of surrounding healthy tissues. Among the last generation of bisphosphonates with cyclic side chains, zoledronic acid is the most potent bisphosphonate, described till now, which inhibits bone resorption. In this paper, we describe the synthesis, properties and hydroxyapatite binding of zoledronic acid labeled with two low energy beta emitters, {sup 47}Sc and {sup 177}Lu. Radiochemicals labeled with low energy electron emitters are preferred, because they deliver both a therapeutic dose to the bone and spare the bone marrow. Hydroxyapatite adsorption experiments have shown that the binding values obtained with complexes of zoledronic acid labeled with {sup 46}Sc and {sup 177}Lu are much higher than those of bisphosphonates labeled with {sup 153}Sm and {sup 166}Ho. Hence, complexes of zoledronic acid with either {sup 46}Sc or {sup 177}Lu seems to be a promising radiopharmaceutical for bone pain therapy.

  10. Comparable effects of exercise and analgesics for pain secondary to knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Hansen, Julie B; Klokker, Louise

    2016-01-01

    AIM: Evidence of comparative effectiveness of different treatment approaches is important for clinical decision-making, yet absent for most recommended treatments of knee osteoarthritis pain. The objective of this study was to estimate the comparative effectiveness of exercise versus orally...... administered analgesics for pain in patients with knee osteoarthritis. METHODS: The Cochrane Database of systematic reviews was searched for meta-analyses of randomized controlled studies comparing exercise or analgesics with a control group (placebo or usual care) and with pain as an outcome. Individual study...... estimates were identified and effect sizes were calculated from group differences. We combined study-level effects on pain with a random effects meta-analysis and compared effect sizes between exercise trials and trials with analgesic interventions. RESULTS: We included six Cochrane reviews (four...

  11. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    Directory of Open Access Journals (Sweden)

    Bezjak Andrea

    2004-10-01

    Full Text Available Abstract Background This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. Methods A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Results Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%. Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. Conclusion For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and

  12. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    International Nuclear Information System (INIS)

    Wu, Jackson Sai-Yiu; Wong, Rebecca KS; Lloyd, Nancy S; Johnston, Mary; Bezjak, Andrea; Whelan, Timothy

    2004-01-01

    This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently

  13. The value of 99mTc-MDP bone SPECT/CT in evaluation of patients with painful knee prosthesis.

    Science.gov (United States)

    Mandegaran, Ramin; Agrawal, Kanhaiyalal; Vijayanathan, Sanjay; Gnanasegaran, Gopinath

    2018-03-16

    The purpose of this study was to assess the incremental value of technetium-99m-methyl diphosphonate (Tc-MDP) single-photon emission computed tomography/computed tomography (SPECT/CT) over Tc-MDP two-phase bone scan (TPBS) in the assessment of the patients with pain following knee arthroplasty. Tc-MDP TPBS and Tc-MDP SPECT/CT were performed in 49 patients with knee pain after knee arthroplasty. The scans were reviewed by two readers (nuclear medicine physician and musculoskeletal radiologist). Tc-MDP SPECT/CT studies were interpreted in conjunction with TPBS in this retrospective study to identify the pain generator in painful knee prosthesis. The final diagnosis was established based on a combination of histopathological/cytological findings, other imaging findings (e.g. MRI, radiolabelled white scan), clinical decisions, and management outcomes (including subsequent intraoperative findings). In diagnosing infection or aseptic loosening, a definitive outcome regarding the presence/absence of aseptic loosening or periprosthetic infection was obtained in 41 patients. (a) Sensitivity of Tc-MDP SPECT/CT [100%; 95% confidence interval (CI): 66.4-100%] was higher than Tc-MDP TPBS (88.9%; 95% CI: 51.8-99.7%). (b) Specificity of Tc-MDP SPECT/CT (75%; 95% CI: 53.3-90.2%) was considerably higher than Tc-MDP TPBS (30%; 95% CI: 11.9-54.3%). Alternative diagnoses were identified in 21/49 (43%) patients on Tc-MDP SPECT/CT, which could not be ascertained on Tc-MDP TPBS alone. Tc-MDP SPECT/CT has better sensitivity and specificity compared with Tc-MDP TPBS in diagnosis of aseptic loosening and periprosthestic infection in patients with painful knee arthroplasty. Tc-MDP SPECT/CT identified alternative causes of pain in 43% of patients, which was not identified by Tc-MDP TPBS.

  14. The clinical application of 89Sr in the treatment of metastatic bone pain

    International Nuclear Information System (INIS)

    Jin Zhikui; Zhou Daqing; Zeng Qin; Zhang Qiang; Chen Shaoping

    2001-01-01

    Clinical application of 80 patients treated with 89 Sr for metastatic bony pain was reported the toxic effect and dosage was also evaluated. Of the 17 cases with complete blood sample examination, 7 cases with the dosage of 1.11 - 1.48 MBq/kg showed no changes in leukocyte and platelet count. 10 cases with the dosage of 1.48 - 2.22 MBq/kg showed slight decline 14% and 23% respectively in leukocyte and platelet count, 5 - 6 weeks after 89 Sr treatment. As to the pain relief 25 cases 31.25% complete pain free (grade 4), 34 (42.5%) are of significant pain decrease (grade 3), 13 (16.25%) are of slight pain decrease (grade 2), 8 (10.0%) are of no change or even pain aggravated (grade 1), the total efficacy of 89 Sr was 90.0% and the significant efficacy (complete pain free + significant pain relief) was 73.75%. The optimal dose of authors' study was within the range of 1.11 - 1.48 MBq/kg. Thereby, it was concluded 89 Sr was effective for relief of the metastatic bony pain

  15. Acute Renal Infarction Presenting with Acute Abdominal Pain Secondary to Newly Discovered Atrial Fibrillation: A Case Report and Literature Review

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    Sherif Ali Eltawansy

    2014-01-01

    Full Text Available We report an 85-year-old female with known history of recurrent diverticulitis presented with abdominal pain. It was believed that the patient again needed to be treated for another diverticulitis and was started on the routine treatment. The initial CT scan of abdomen showed renal infarcts bilaterally that were confirmed by a CT with and without intravenous contrast secondary to unknown cause. An ECG found accidentally that the patient was in atrial fibrillation, which was the attributed factor to the renal infarctions. Subsequently, the patient was started on the appropriate anticoagulation and discharged.

  16. Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia.

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    E N Zamri

    Full Text Available Musculoskeletal pain is common among teachers. Work-related psychosocial factors are found to be associated with the development of musculoskeletal pain, however psychological distress may also play an important role.To assess the prevalence of self-reported low back pain (LBP, and neck and/or shoulder pain (NSP among secondary school teachers; and to evaluate the association of LBP and NSP with psychological distress and work-related psychosocial factors.This was a cross-sectional study conducted among teachers in the state of Penang, Malaysia. The participants were recruited via a two stage sampling method. Information on demographic, psychological distress, work-related psychosocial factors, and musculoskeletal pain (LBP and NSP in the past 12 months was collected using a self-administered questionnaire. Poisson regression was used to estimate the prevalence ratio (PR for the associations between psychological distress and work-related psychosocial factors with LBP and NSP.The prevalence of self-reported LBP and NSP among 1482 teachers in the past 12 months was 48.0% (95% Confidence Interval (CI 45.2%, 50.9% and 60.1% (95% CI 57.4%, 62.9% respectively. From the multivariate analysis, self-reported LBP was associated with teachers who reported severe to extremely severe depression (PR: 1.71, 95% CI 1.25, 2.32, severe to extremely severe anxiety (1.46, 95% CI 1.22, 1.75, high psychological job demand (1.29, 95% CI 1.06, 1.57, low skill discretion (1.28, 95% CI 1.13, 1.47 and poorer mental health (0.98, 95% CI 0.97, 0.99. Self-reported NSP was associated with mild to moderate anxiety (1.18, 95% CI 1.06, 1.33, severe to extremely severe anxiety (1.25, 95% CI 1.09, 1.43, low supervisory support (1.13, 95% CI 1.03, 1.25 and poorer mental health (0.98, 95% CI 0.97, 0.99.Self-reported LBP and NSP were common among secondary school teachers. Interventions targeting psychological distress and work-related psychosocial characteristics may reduce

  17. Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia.

    Science.gov (United States)

    Zamri, E N; Moy, F M; Hoe, V C W

    2017-01-01

    Musculoskeletal pain is common among teachers. Work-related psychosocial factors are found to be associated with the development of musculoskeletal pain, however psychological distress may also play an important role. To assess the prevalence of self-reported low back pain (LBP), and neck and/or shoulder pain (NSP) among secondary school teachers; and to evaluate the association of LBP and NSP with psychological distress and work-related psychosocial factors. This was a cross-sectional study conducted among teachers in the state of Penang, Malaysia. The participants were recruited via a two stage sampling method. Information on demographic, psychological distress, work-related psychosocial factors, and musculoskeletal pain (LBP and NSP) in the past 12 months was collected using a self-administered questionnaire. Poisson regression was used to estimate the prevalence ratio (PR) for the associations between psychological distress and work-related psychosocial factors with LBP and NSP. The prevalence of self-reported LBP and NSP among 1482 teachers in the past 12 months was 48.0% (95% Confidence Interval (CI) 45.2%, 50.9%) and 60.1% (95% CI 57.4%, 62.9%) respectively. From the multivariate analysis, self-reported LBP was associated with teachers who reported severe to extremely severe depression (PR: 1.71, 95% CI 1.25, 2.32), severe to extremely severe anxiety (1.46, 95% CI 1.22, 1.75), high psychological job demand (1.29, 95% CI 1.06, 1.57), low skill discretion (1.28, 95% CI 1.13, 1.47) and poorer mental health (0.98, 95% CI 0.97, 0.99). Self-reported NSP was associated with mild to moderate anxiety (1.18, 95% CI 1.06, 1.33), severe to extremely severe anxiety (1.25, 95% CI 1.09, 1.43), low supervisory support (1.13, 95% CI 1.03, 1.25) and poorer mental health (0.98, 95% CI 0.97, 0.99). Self-reported LBP and NSP were common among secondary school teachers. Interventions targeting psychological distress and work-related psychosocial characteristics may reduce

  18. Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures

    Energy Technology Data Exchange (ETDEWEB)

    Andresen, R.; Luedtke, C.W.; Kamusella, P.; Wissgott, C. [Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide (Germany). Inst. of Diagnostic and Interventional Radiology/Neuroradiology; Radmer, S. [Center of Orthopedics, Berlin (Germany). Orthopedic Surgery and Traumatology; Schober, H.C. [Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock (Germany). Dept. of Internal Medicine

    2014-09-15

    Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6+/-1.78 (4-10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3+/-0.67 (8-10) pre-operatively to 2.7+/-1.28 (1-5) on the 2nd postoperative day and 2.9+/-0.81 (2-5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned. Conclusion: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain. (orig.)

  19. Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures

    International Nuclear Information System (INIS)

    Andresen, R.; Luedtke, C.W.; Kamusella, P.; Wissgott, C.; Radmer, S.; Schober, H.C.

    2014-01-01

    Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6+/-1.78 (4-10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3+/-0.67 (8-10) pre-operatively to 2.7+/-1.28 (1-5) on the 2nd postoperative day and 2.9+/-0.81 (2-5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned. Conclusion: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain. (orig.)

  20. Prevention and management of osteonecrosis of the jaw secondary to bone-targeted therapy in patients with kidney cancer.

    Science.gov (United States)

    Ripamonti, Carla I; Lucchesi, Maurizio; Giusti, Raffaele

    2016-09-01

    The aim of this revision is prevention and management of osteonecrosis of the jaw (ONJ) secondary to bone-targeted therapy in patients with kidney cancer. Patients with kidney cancer treated with zoledronate suffered from ONJ earlier compared with patients with breast cancer or multiple myeloma; among men, ONJ occurred at 24 months of zoledronic acid treatment in more than 80% of the patients and much earlier, in respect to patients with prostate cancer or multiple myeloma. Protective factors against an ONJ can be sequential prescription of different bisphosphonates and female sex. Less data are available on ONJ secondary to denosumab administration in patients with kidney cancer. Bone metastases, developing in about 30% of the patients with metastatic renal cell carcinoma, are typically osteolytic on imaging and cause significant morbidity and poor quality of life. Incidence of skeletal-related events has been reported to reach 3.38 per year in such patients. To decrease the incidence of ONJ, a maxillofacial examination must be performed in all patients before treatment with bisphosphonates, in particular in patients with metastatic renal cell carcinoma treated with sunitinib alone or in association with zoledronate. The management of ONJ consider a conservative approach.

  1. The role of single nucleotide polymorphism of IL-6 and IL-10 cytokine on pain severity and pain relief after radiotherapy in multiple myeloma patients with painful bone destructions

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    Rudzianskiene Milda

    2014-01-01

    Full Text Available Multiple myeloma (MM cells interact with bone marrow stromal cells stimulating transcription and secretion of cytokines like IL-6 and IL-10, which are implicated in the progression and dissemination of MM. Regulation of cytokines secretion is under genetic control through genetic polymorphisms in their coding and promoter sequences. It seems that single nucleotide polymorphism (SNP in the promoter region of various genes may regulate the plasma concentrations of cytokines. Cytokines could be also hypothesized to function as pain modulators as peripheral nociceptors are sensitized by cytokines. The aim was to determine if the SNP of IL-6 and IL-10 cytokines could influence the analgesic response of radiotherapy in the treatment of painful bone destructions in MM patients. 30 patients (19 women and 11 men, median age: 67 years with MM and painful bone destructions were treated with palliative radiotherapy. Pain was evaluated according to the visual analogue scale and analgesics intake. Pain scores and analgesics use were measured prior to radiotherapy as well as 4, 12 and 24 weeks afterward. Opioid analgesics were converted to the morphine-equivalent daily dose (MEDD. Genomic DNA was extracted from peripheral blood leukocytes and IL-6 and IL-10 gene promoter polymorphisms were analysed with polymerase chain reaction. 60% of patients reported severe pain prior to radiotherapy, which decreased to 13% at the first follow-up visit (p <0.001. The MEDD on admission to the hospital was 75 mg/day which decreased to 46 mg/day at the first follow-up visit (p = 0.033. A significant parameter in pain relief was: age < 65 years (p=0.029. We analysed 6 SNPs in the gene promoter region of IL-6 (-597 G/A, -572 G/C, -174 G/C and IL-10 (-592 A/C, -819 C/T, -1082 A/G as well as their relation with pain severity and analgesic consumption. Patients who are IL-10 -1082 A/G carriers are prone to respond better to radiotherapy than other patients (p<0.05. A borderline

  2. Preliminary Results of Multiple Epiphyseal Drilling and Autologous Bone Marrow Implantation for Osteonecrosis of the Femoral Head Secondary to Sickle Cell Disease in Children.

    Science.gov (United States)

    Novais, Eduardo N; Sankar, Wudbhav N; Wells, Lawrence; Carry, Patrick M; Kim, Young-Jo

    2015-12-01

    Sickle cell disease (SCD) is the most common cause of osteonecrosis of the femoral head (ONFH) during childhood. The natural history of ONFH in SCD is poor with progression to femoral head collapse and deformity that ultimately may lead to hip osteoarthritis. Multiple epiphyseal drilling with autologous bone marrow implantation may enhance the mechanism of osteogenic repair. The purpose of this study was to describe early clinical and radiographic outcomes in pediatric patients with ONFH secondary to SCD after multiple epiphyseal drilling and AMBI. Nine boys and 2 girls (14 hips) with a mean age of 12.7 years (range, 9.7-18 y) at the time of surgery were evaluated. All patients were followed for at least 1 year after surgery and the mean duration of follow-up was 25 months (range, 12-47 mo). Clinical outcome was assessed by the pain domain from the Children's Hospital Oakland Hip Evaluation Scale and by hip range of motion. The extent of femoral head involvement was assessed by measuring the arc of necrosis and the amount of collapse on anteroposterior and frog lateral radiographs. The University of Pennsylvania system was used to assess the osteonecrosis stage. Wilcoxon signed-rank tests were used to compare radiographic and clinical variables. Compared with preoperative measures, multiple epiphyseal drilling with AMBI resulted in significant improvement in pain (P=0.0010), internal hip rotation (P=0.0005), external hip rotation (P=0.0010), and flexion (P=0.0015). The amount of lateral collapse (P=0.4609), anterior collapse (P=0.4258), and the arc of necrosis (P=0.2251) were not significant after surgery. The majority of the hips had either improvement in the Steinberg stage of disease (4/14 hips) or no further progression (7/14 hips) at the latest follow-up. There were no surgical complications. Multiple epiphyseal drilling with autologous bone marrow cell implantation allows for short-term clinical improvement and limits radiographic progression of ONFH

  3. The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?

    Science.gov (United States)

    Axén, Iben; Jensen, Irene B; Eklund, Andreas; Halasz, Laszlo; Jørgensen, Kristian; Lange, Fredrik; Lövgren, Peter W; Rosenbaum, Annika; Leboeuf-Yde, Charlotte

    2009-01-22

    Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP). Structured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA) were invited to participate in the discussions and in the questionnaire survey. Thirty-six (22%) of SCA members participated in the group discussions and 129 (77%) returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50-69% of the respondents, namely duration (over the past year and of the present attack), treatment (effect and durability), lifestyle, work conditions, and psychosocial factors (including attitude). The vast majority of our respondents believe

  4. The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?

    Directory of Open Access Journals (Sweden)

    Lange Fredrik

    2009-01-01

    Full Text Available Abstract Background Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP. Method Structured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA were invited to participate in the discussions and in the questionnaire survey. Results Thirty-six (22% of SCA members participated in the group discussions and 129 (77% returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50–69% of the respondents, namely duration (over the past year and of the present attack, treatment (effect and durability, lifestyle, work conditions, and psychosocial factors (including

  5. Preparation, Biological Evaluation and Dosimetry Studies of 175Yb-Bis-Phosphonates for Palliative Treatment of Bone Pain

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    Ashraf Fakhari

    2015-10-01

    Full Text Available Objective: Optimized production and quality control of ytterbium-175 (Yb-175 labeled pamidronate and alendronate complexes as efficient agents for bone pain palliation has been presented. Methods: Yb-175 labeled pamidronate and alendronate (175Yb-PMD and 175Yb-ALN complexes were prepared successfully at optimized conditions with acceptable radiochemical purity, stability and significant hydroxyapatite absorption. The biodistribution of complexes were evaluated up to 48 h, which demonstrated significant bone uptake ratios for 175Yb-PAM at all-time intervals. It was also detected that 175Yb-PAM mostly washed out and excreted through the kidneys. Results: The performance of 175Yb-PAM in an animal model was better or comparable to other 175Yb-bone seeking complexes previously reported. Conclusion: Based on calculations, the total body dose for 175Yb-ALN is 40% higher as compared to 175Yb-PAM (especially kidneys indicating that 175Yb-PAM is probably a safer agent than 175Yb-ALN.

  6. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Hubert Y.; Allen, Pamela K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin S. [Department of Symptom Research, University of Texas MD Anderson Cancer, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Department of Radiation Oncology, USC Norris Cancer Center, Los Angeles, California (United States); Rhines, Laurence D.; Tatsui, Claudio E. [Department of Neurosurgery, University of Texas MD Anderson Cancer, Houston, Texas (United States); Amini, Behrang [Department of Diagnostic Radiology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin A. [Department of Radiation Physics, University of Texas MD Anderson Cancer, Houston, Texas (United States); Tannir, Nizar M. [Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Ghia, Amol J., E-mail: AJGhia@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States)

    2014-11-15

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

  7. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    International Nuclear Information System (INIS)

    Pan, Hubert Y.; Allen, Pamela K.; Wang, Xin S.; Chang, Eric L.; Rhines, Laurence D.; Tatsui, Claudio E.; Amini, Behrang; Wang, Xin A.; Tannir, Nizar M.; Brown, Paul D.; Ghia, Amol J.

    2014-01-01

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred

  8. Optimization and In Vivo Profiling of a Refined Rat Model of Walker 256 Breast Cancer Cell-Induced Bone Pain Using Behavioral, Radiological, Histological, Immunohistochemical and Pharmacological Methods

    Directory of Open Access Journals (Sweden)

    Priyank Shenoy

    2017-07-01

    Full Text Available In the majority of patients with advanced breast cancer, there is metastatic spread to bones resulting in pain. Clinically available drug treatments for alleviation of breast cancer-induced bone pain (BCIBP often produce inadequate pain relief due to dose-limiting side-effects. A major impediment to the discovery of novel well-tolerated analgesic agents for the relief of pain due to bony metastases is the fact that most cancer-induced bone pain models in rodents relied on the systemic injection of cancer cells, causing widespread formation of cancer metastases and poor general animal health. Herein, we have established an optimized, clinically relevant Wistar Han female rat model of breast cancer induced bone pain which was characterized using behavioral assessments, radiology, histology, immunohistochemistry and pharmacological methods. In this model that is based on unilateral intra-tibial injection (ITI of Walker 256 carcinoma cells, animals maintained good health for at least 66 days post-ITI. The temporal development of hindpaw hypersensitivity depended on the initial number of Walker 256 cells inoculated in the tibiae. Hindpaw hypersensitivity resolved after approximately 25 days, in the continued presence of bone tumors as evidenced by ex vivo histology, micro-computed tomography scans and immunohistochemical assessments of tibiae. A possible role for the endogenous opioid system as an internal factor mediating the self-resolving nature of BCIBP was identified based upon the observation that naloxone, a non-selective opioid antagonist, caused the re-emergence of hindpaw hypersensitivity. Bolus dose injections of morphine, gabapentin, amitriptyline and meloxicam all alleviated hindpaw hypersensitivity in a dose-dependent manner. This is a first systematic pharmacological profiling of this model by testing standard analgesic drugs from four important diverse classes, which are used to treat cancer induced bone pain in the clinical setting

  9. Human bone marrow-derived and umbilical cord-derived mesenchymal stem cells for alleviating neuropathic pain in a spinal cord injury model

    OpenAIRE

    Yousefifard, Mahmoud; Nasirinezhad, Farinaz; Shardi Manaheji, Homa; Janzadeh, Atousa; Hosseini, Mostafa; Keshavarz, Mansoor

    2016-01-01

    Background Stem cell therapy can be used for alleviating the neuropathic pain induced by spinal cord injuries (SCIs). However, survival and differentiation of stem cells following their transplantation vary depending on the host and intrinsic factors of the cell. Therefore, the present study aimed to determine the effect of stem cells derived from bone marrow (BM-MSC) and umbilical cord (UC-MSC) on neuropathic pain relief. Methods A compression model was used to induce SCI in a rat model. A w...

  10. Fluorodeoxyglucose Uptake on Positron Emission Tomography Is a Useful Predictor of Long-Term Pain Control After Palliative Radiation Therapy in Patients With Painful Bone Metastases: Results of a Single-Institute Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Tahara, Takatoshi, E-mail: taka.t-may7@med.Tottori-u.ac.jp [Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago (Japan); Fujii, Shinya; Ogawa, Toshihide; Michimoto, Koichi; Fukunaga, Takeru; Tanino, Tomohiko; Uchida, Nobue [Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago (Japan); Matsuki, Tsutomu; Sakamoto, Hiroaki [Division of Radiology, Tottori Municipal Hospital, Tottori (Japan)

    2016-02-01

    Purpose: To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) before and after palliative radiation therapy (RT) can predict long-term pain control in patients with painful bone metastases. Methods and Materials: Thirty-one patients with bone metastases who received RT were prospectively included. Forty painful metastatic treatment fields were evaluated. All patients had undergone pre-RT and post-RT PET/CT scanning. We evaluated the relationships between the pre-RT, post-RT, and changes in maximum standardized uptake value (SUV{sub max}) and the pain response, and between SUV{sub max} and pain relapse of the bone metastases in the treatment field. In addition, we compared the SUV{sub max} according to the length of time from the completion of RT to pain relapse of the bone metastases. Results: Regarding the pain response at 4 weeks after the completion of RT, there were 36 lesions of 27 patients in the responder group and 4 lesions of 4 patients in the nonresponder group. Changes in the SUV{sub max} differed significantly between the responder and nonresponder groups in both the early and delayed phases (P=.0292 and P=.0139, respectively), but no relationship was observed between the pre-RT and post-RT SUV{sub max} relative to the pain response. The responder group was evaluated for the rate of relapse. Thirty-five lesions of 26 patients in the responder group were evaluated, because 1 patient died of acute renal failure at 2 months after RT. Twelve lesions (34%) showed pain relapse, and 23 lesions (66%) did not. There were significant differences between the relapse and nonrelapse patients in terms of the pre-RT (early/delayed phases: P<.0001/P<.0001), post-RT (P=.0199/P=.0261), and changes in SUV{sub max} (P=.0004/P=.004). Conclusions: FDG-PET may help predict the outcome of pain control in the treatment field after palliative RT for painful bone metastases.

  11. How does pain experience relate to the need for pain relief? A secondary exploratory analysis in a large sample of cancer patients.

    Science.gov (United States)

    Johnsen, Anna Thit; Petersen, Morten A; Snyder, Claire F; Pedersen, Lise; Groenvold, Mogens

    2016-10-01

    To explore (1) the information obtained from related but conceptually different approaches to pain assessment and (2) the extent to which the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) can be used as a screening tool to predict patient-reported need for pain relief. Cancer patients randomly sampled from 56 hospital departments were included. Questionnaire items assessed patients' (a) pain experience using the EORTC QLQ-C30 pain scale and its two pain items separately (pain intensity and pain interference) and (b) pain burden and (c) need for pain relief using the Three-Levels-of-Needs Questionnaire (3LNQ). Of the 2364 patients contacted by mail, 1447 (61 %) completed the questionnaires. Among these, 51 % reported at least "a little" pain on the pain intensity item. The number of patients reporting pain to be a burden was similar, and pain experience and pain burden were highly correlated (correlation coefficients ranged from 0.85 to 0.91). Pain experience and pain burden were moderately correlated with the need for pain relief. A receiver-operating characteristic (ROC) curve analysis showed that the EORTC QLQ-C30 discriminated between patients with and without a need for pain relief to an acceptable degree (area under the curve (AUC) 0.73-0.77). The cut-point a little gave a sensitivity of 84 % and specificity of 59 % for the item "Have you had pain?" and a sensitivity of 72 % and a specificity of 72 % for the pain scale. The majority of patients who experienced pain felt it to be a problem. Pain experience and pain burden were substantially related to need for pain relief, and the latter could be predicted from the EORTC QLQ-C30.

  12. Increased technetium-99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism

    DEFF Research Database (Denmark)

    Enevoldsen, Lotte Hahn; Heaf, James Goya; Højgaard, Liselotte

    2017-01-01

    patients diagnosed with secondary hyperparathyroidism admitted for Tc-99 m-HDP bone scan. Baseline characteristics and mean concentrations of biochemical markers (including P-calcium and P-phosphate) taken 0-3 months prior to the bone scans were collected. Soft tissue uptake was detected on bone scans...... of the 36 patients without myocardial uptake. In conclusion, dialysis-treated CKD patients with secondary hyperparathyroidism have a high incidence of soft tissue uptake, and this finding is strongly correlated with elevated phosphate, but not calcium values.......In bone scan patients with dialysis-treated chronic kidney disease (CKD) and hyperparathyroidism, soft tissue accumulation of technetium-99 m hydroxy/methylene diphosphonate (Tc-99 m-HDP/MDP) has been reported primarily in case reports and usually explained by hypercalcaemia and...

  13. Effects of low-dose capecitabine on Samarium-153-EDTMP therapy for painful bone metastases

    International Nuclear Information System (INIS)

    Barai, Sukanta; Gambhir, Sanjay; Rastogi, Neeraj; Mandani, Anil; Siddegowda, Murthy

    2015-01-01

    Samarium-153 (Sm-153)-EDTMP is routinely used for pain palliation in skeletal metastasis, however most patients report partial response. Many strategies have been contemplated to make radiation therapy for pain more effective, one of them being the use of radiosensitizers. Capecitabine is a chemotherapeutic drug and is routinely combined with external beam radiation to make the target more radio-sensitive. Aim of the study was to evaluate whether combining capecitabine in radiosensitizing dose with Sm-153-EDTMP produces superior analgesia compared to Sm alone. Forty-four patients with skeletal metastases from various primaries were randomized into two groups: The study group received 1 mCi/kg Sm-153-EDTMP plus capecitabine (1,650 mg/m 2 ) orally for 8 days (equivalent to four t ½ of 153 Sm-EDTMP) and the control arm received 1 mCi/kg Sm-153-EDTMP plus placebo for the 8 days. After treatment, the patients were followed up for 12 weeks to evaluate the degree and duration of pain palliation and hematologic toxicity. All 44 patients reported different degrees of pain relief with none reporting complete pain relief for the entire duration of 12 weeks posttherapy observation period. However the level of pain relief obtained in study arm was significantly better than the control arm with mean posttherapy pain score being 1.29 ± 1.05 and 3.59 ± 2.77 respectively with P of 0.001. Transient and mild hematologic toxicity, as determined by World Health Organization criteria, was apparent in both arms without significant differences. The addition of a low-dose of capecitabine significantly enhances the analgesic effect of Sm-153 without any additional side effects

  14. [Aseptic loosening of total ankle replacement : Two-stage revision with bone augmentation of osseous defects and secondary prosthesis implantation].

    Science.gov (United States)

    Barg, A; Wiewiorski, M; Valderrabano, V

    2017-06-01

    To remove loosened ankle prosthesis components, perform osseous defect augmentation, and reimplant definitive prosthesis components to preserve ankle range of motion. Aseptic loosening of the tibial and/or talar ankle prosthesis components with substantial bone defect. General surgical/anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy, substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, noncompliance, primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patients' expectations, high activity in sports. Exposure of the ankle joint using the previous incision. Mobilization and removal of loosened prosthesis components. Debridement of bone stock. Assessment and measurement of osseous defects. Harvesting of iliac crest autograft. Screw fixation of iliac crest autograft. Placement of polyethylene inlay as a spacer. Wound closure in layers at the ankle and the iliac crest. Implantation of definitive prosthesis components. A soft wound dressing. Thromboprophylaxis recommended. Mobilization on postoperative day 1 using a stabilizing walking boot/cast for 6 weeks (sole contact but no weight bearing). Clinical and radiographic follow-up 3 months postoperatively including computed tomography to assess osseous consolidation. After the second surgery, patient mobilization on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot/cast for 6 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually. From January 2007 to December 2012, a two-stage revision TAR was performed in 5 patients (46.8 and 71.4 years). The time between the initial TAR and revision was 2.4-11.5 years. No intra

  15. Mas-Related Gene (Mrg C Activation Attenuates Bone Cancer Pain via Modulating Gi and NR2B.

    Directory of Open Access Journals (Sweden)

    Yu'e Sun

    Full Text Available This study is to investigate the role of Mas-related gene (Mrg C in the pathogenesis and treatment of bone cancer pain (BCP.BCP mouse model was established by osteosarcoma cell inoculation. Pain-related behaviors were assessed with the spontaneous lifting behavior test and mechanical allodynia test. Expression levels of MrgC, Gi, and NR2B in the spinal cord were detected with Western blot analysis and immunohistochemistry.Pain-related behavior tests showed significantly increased spontaneous flinches (NSF and decreased paw withdrawal mechanical threshold (PWMT in mouse models of BCP. Western blot analysis showed that, compared with the control group and before modeling, all the expression levels of MrgC, Gi, and NR2B in the spinal cord of BCP mice were dramatically elevated, which were especially increased at day 7 after operation and thereafter, in a time-dependent manner. Moreover, the treatment of MrgC agonist BAM8-22 significantly up-regulated Gi and down-regulated NR2B expression levels, in the spinal cord of BCP mice, in a time-dependent manner. On the other hand, anti-MrgC significantly down-regulated Gi expression, while dramatically up-regulated NR2B expression, in the BCP mice. Similar results were obtained from the immunohistochemical detection. Importantly, BAM8-22 significantly attenuated the nociceptive behaviors in the BCP mice.Our results indicated the MrgC-mediated Gi and NR2B expression alterations in the BCP mice, which might contribute to the pain hypersensitivity. These findings may provide a novel strategy for the treatment of BCP in clinic.

  16. Utility of the dimercapto succinic acid pentavalent (99m Tc- DMSA V) in the diagnostic of secondary bone leisure at metastasis of diverse primary tumours. Preliminary study

    International Nuclear Information System (INIS)

    Ortega L, N.; Pichardo R, P.A.; Marquez H, A.

    2005-01-01

    The more used method in the diagnosis of secondary bone lesions to become cancerous it is by means of having derived of phosphates like it is the 99m Tc- MDP. The reason of acquiring searching with the radiopharmaceutical 99m Tc- DMSA V is with the purpose to find other bone lesions that are not visualized with the gammagraphy with diphosphonate and therefore to increase the specificity of the study. (Author)

  17. Multispecies animal investigation on biodistribution, pharmacokinetics and toxicity of 177Lu-EDTMP, a potential bone pain palliation agent

    International Nuclear Information System (INIS)

    Mathe, Domokos; Balogh, Lajos; Polyak, Andras; Kiraly, Reka; Marian, Terez; Pawlak, Dariusz; Zaknun, John J.; Pillai, Maroor R.A.; Janoki, Gyozo A.

    2010-01-01

    Introduction: Radionuclide therapy (RNT) is an effective method for bone pain palliation in patients suffering from bone metastasis. Due to the long half-life, easy production and relatively low β- energy, 177 Lu [T 1/2 =6.73 days, E βmax =497 keV, E γ =113 keV (6.4%), 208 keV (11%)]-based radiopharmaceuticals offer logistical advantage for wider use. This paper reports the results of a multispecies biodistribution and toxicity studies of 177 Lu-EDTMP to collect preclinical data for starting human clinical trials. Methods: 177 Lu-EDTMP with radiochemical purity greater than 99% was formulated by using a lyophilized kit of EDTMP (35 mg of EDTMP, 5.72 g of CaO and 14.1 mg of NaOH). Biodistribution studies were conducted in mice and rabbits. Small animal imaging was performed using NanoSPECT/CT (Mediso, Ltd., Hungary) and digital autoradiography. Gamma camera imaging was done in rabbits and dogs. Four levels of activity (9.25 through 37 MBq/kg body weight) of 177 Lu-EDTMP were injected in four groups of three dogs each to study the toxicological effects. Results: 177 Lu-EDTMP accumulated almost exclusively in the skeletal system (peak ca. 41% of the injected activity in bone with terminal elimination half-life of 2130 and 1870 h in mice and rabbits, respectively) with a peak uptake during 1-3 h. Excretion of the radiopharmaceutical was through the urinary system. Imaging studies showed that all species (mouse, rat, rabbit and dog) take up the compound in regions of remodeling bone, while kidney retention is not visible after 1 day postinjection (pi). In dogs, the highest applied activity (37 MBq/kg body weight) led to a moderate decrease in platelet concentration (mean, 160 g/L) at 1 week pi with no toxicity. Conclusion: The protracted effective half-life of 177 Lu-EDTMP in bone supports that modifying the EDTMP molecule by introducing 177 Lu does not alter its biological behaviour as a specific bone-seeking tracer. Species-specific pharmacokinetic behavior

  18. Multispecies animal investigation on biodistribution, pharmacokinetics and toxicity of {sup 177}Lu-EDTMP, a potential bone pain palliation agent

    Energy Technology Data Exchange (ETDEWEB)

    Mathe, Domokos [Department of Applied Radioisotopes and Animal Experimentation, National ' Frederic Joliot-Curie' Institute of Radiobiology and Radiohygiene, H-1221 Budapest (Hungary)], E-mail: mdomokos@hp.osski.hu; Balogh, Lajos; Polyak, Andras; Kiraly, Reka [Department of Applied Radioisotopes and Animal Experimentation, National ' Frederic Joliot-Curie' Institute of Radiobiology and Radiohygiene, H-1221 Budapest (Hungary); Marian, Terez [Institute of Nuclear Medicine, Debrecen University, Debrecen (Hungary); Pawlak, Dariusz [Institute of Atomic Energy, Radioisotope Centre POLATOM, Swierk-Otwock (Poland); Zaknun, John J.; Pillai, Maroor R.A. [International Atomic Energy Agency (IAEA), Vienna (Austria); Janoki, Gyozo A. [Department of Applied Radioisotopes and Animal Experimentation, National ' Frederic Joliot-Curie' Institute of Radiobiology and Radiohygiene, H-1221 Budapest (Hungary)

    2010-02-15

    Introduction: Radionuclide therapy (RNT) is an effective method for bone pain palliation in patients suffering from bone metastasis. Due to the long half-life, easy production and relatively low {beta}- energy, {sup 177}Lu [T{sub 1/2}=6.73 days, E{sub {beta}}{sub max}=497 keV, E{sub {gamma}}=113 keV (6.4%), 208 keV (11%)]-based radiopharmaceuticals offer logistical advantage for wider use. This paper reports the results of a multispecies biodistribution and toxicity studies of {sup 177}Lu-EDTMP to collect preclinical data for starting human clinical trials. Methods: {sup 177}Lu-EDTMP with radiochemical purity greater than 99% was formulated by using a lyophilized kit of EDTMP (35 mg of EDTMP, 5.72 g of CaO and 14.1 mg of NaOH). Biodistribution studies were conducted in mice and rabbits. Small animal imaging was performed using NanoSPECT/CT (Mediso, Ltd., Hungary) and digital autoradiography. Gamma camera imaging was done in rabbits and dogs. Four levels of activity (9.25 through 37 MBq/kg body weight) of {sup 177}Lu-EDTMP were injected in four groups of three dogs each to study the toxicological effects. Results: {sup 177}Lu-EDTMP accumulated almost exclusively in the skeletal system (peak ca. 41% of the injected activity in bone with terminal elimination half-life of 2130 and 1870 h in mice and rabbits, respectively) with a peak uptake during 1-3 h. Excretion of the radiopharmaceutical was through the urinary system. Imaging studies showed that all species (mouse, rat, rabbit and dog) take up the compound in regions of remodeling bone, while kidney retention is not visible after 1 day postinjection (pi). In dogs, the highest applied activity (37 MBq/kg body weight) led to a moderate decrease in platelet concentration (mean, 160 g/L) at 1 week pi with no toxicity. Conclusion: The protracted effective half-life of {sup 177}Lu-EDTMP in bone supports that modifying the EDTMP molecule by introducing {sup 177}Lu does not alter its biological behaviour as a specific bone

  19. Development and Internal Validation of a Clinical Risk Score to Predict Pain Response After Palliative Radiation Therapy in Patients With Bone Metastases.

    Science.gov (United States)

    van der Velden, Joanne M; Peters, Max; Verlaan, Jorrit-Jan; Versteeg, Anne L; Zhang, Liying; Tsao, May; Danjoux, Cyril; Barnes, Elizabeth; van Vulpen, Marco; Chow, Edward; Verkooijen, Helena M

    2017-11-15

    To investigate the relationship between patient and tumor characteristics and pain response in patients with metastatic bone disease, and construct and internally validate a clinical prediction model for pain response to guide individualized treatment decision making. A total of 965 patients with painful bone metastases undergoing palliative radiation therapy at a tertiary referral center between 1999 and 2007 were identified. Pain scores were measured at 1, 2, and 3 months after radiation therapy. Pain response was defined as at least a 2-point decrease on a pain score scale of 0-10, without increase in analgesics, or an analgesic decrease of at least 25% without an increase in pain score. Thirteen candidate predictors were identified from the literature and expert experience. After multiple imputation, final predictors were selected using stepwise regression and collapsed into a prediction model. Model performance was evaluated by calibration and discrimination and corrected for optimism. Overall 462 patients (47.9%) showed a response. Primary tumor site, performance status, and baseline pain score were predictive for pain response, with a corrected c-statistic of 0.63. The predicted response rates after radiation therapy increased from 37.5% for patients with the highest risk score to 79.8% for patients with the lowest risk score and were in good agreement with the observed response rates. A prediction score for pain response after palliative radiation therapy was developed. The model performance was moderate, showing that prediction of pain response is difficult. New biomarkers and predictors may lead to improved identification of the large group of patients who are unlikely to respond and who may benefit from other or innovative treatment options. Copyright © 2017. Published by Elsevier Inc.

  20. Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration

    International Nuclear Information System (INIS)

    Arcangeli, Giorgio; Giovinazzo, Giuseppe; Saracino, Biancamaria; D'Angelo, Luciano; Giannarelli, Diana; Arcangeli, Giancarlo; Micheli, Adriana

    1998-01-01

    Purpose: In order to better define variables and factors that may influence the pain response to radiation, and to look for a radiation regimen that can assure the highest percentage and the longest duration of pain relief, we performed a prospective, although not randomized, study on patients with bone metastases from various primary sites. Methods and Materials: From December 1988 to March 1994, 205 patients with a total of 255 solitary or multiple bone metastases from several primary tumors were treated in our radiotherapy center with palliative intent. Irradiation fields were treated with three main fractionation schedules: (1) Conventional fractionation: 40-46 Gy/20-23 fractions in 5-5.5 weeks; (2) Short course: 30-36 Gy/10-12 fractions in 2-2.3 weeks; (3) Fast course: 8-28 Gy/1-4 consecutive fractions. Pain intensity was self-assessed by patients using a visual analogic scale graduated from 0 (no pain) to 10 (the strongest pain one can experience). Analgesic requirement was assessed by using a five-point scale, scoring both analgesic strength and frequency (0 = no drug or occasional nonopioids; 1 = Nonopioids once daily; 2 = Nonopioids more than once daily; 3 = Mild opioids (oral codeine, pentazocine, etc.), once daily; 4 = Mild opioids more than once daily; 5 = Strong opioids (morphine, meperidine, etc.). Complete pain relief meant the achievement of a score ≤ 2 in the pain scale or 0 in the analgesic requirement scale. Partial pain relief indicated a score of 3 to 4 or of 1 to 2 on the former and latter scale, respectively. Results: Total pain relief (complete + partial) was observed in 195 (76%) sites, in 158 of which (62%) a complete response was obtained. Metastases from NSC lung tumors appeared to be the least responsive among all primary tumors, with 46% complete pain relief in comparison to 65% and 83% complete relief in breast (p = 0.04) and in prostate metastases (p 0.002), respectively. A significant difference in pain relief was detected among

  1. Controlled release pharmaceutical composition useful for the treatment of diseases and conditions affecting metabolism and/or structural integrity of cartilage and/or bone in male comprises strontium salt

    DEFF Research Database (Denmark)

    2004-01-01

    ); such as osteoporosis (also including secondary osteoporosis induced by e.g. endocrine diseases, metabolic causes, nutritional conditions, drug substances and/or disorders of the collagen metabolism), osteoarthritis, osteopectoris, osteopenia, Paget's disease, hypercalcemia of malignancy, periodontal disease......, hyperparathyroidism, periarticular erosions in rheumatoid arthritis, osteodystrophy, myositis ossificans, Bechterew's disease, osteolytic lesions produced by bone metastasis, bone pain due to bone metastasis, bone loss due to sex steroid hormone deficiency, bone abnormalities due to steroid hormone treatment, bone...

  2. Effect of paricalcitol on mineral bone metabolism in kidney transplant recipients with secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Francisco José Borrego Utiel

    2015-07-01

    Conclusions: Paricalcitol is an effective therapy for secondary hyperparathyroidism in kidney transplant recipients. Overall, no significant changes were observed in calcium and phosphorus levels or urinary excretion. Patients having previously received calcitriol required higher paricalcitol doses. When used in patients receiving cinacalcet, paricalcitol results in a significant PTH fall, with paricalcitol doses being similar to those used in patients not receiving cinacalcet.

  3. Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain: A Study Supported by Differential Diagnostic Local Anesthetic Blocks.

    Science.gov (United States)

    Jain, Anuj; Jain, Suruchi; Agarwal, Anil; Gambhir, Sanjay; Shamshery, Chetna; Agarwal, Amita

    2015-12-01

    Conventional radiologic modalities provide details only about the anatomic aspect of the various structures of the spine. Frequently the structures that show abnormal morphology may not be the cause of low back pain (LBP). Functional imaging in the form of bone scan along with single photon emission computerized tomography (SPECT/CT) may be helpful in identifying structures causing pain, whether morphologically normal or not. The objective of this study is to evaluate the role of bone scan with SPECT/CT in management of patients with LBP. This is randomized double-blinded controlled study performed on 80 patients with LBP aged 20 to 80 years, ASA physical status I to III. Patients were randomized into bone scan and control groups consisting of 40 patients each. On the basis of the clinical features and radiologic findings a clinical diagnosis was made. After making a clinical diagnosis, the patients in bone scan group were subjected to bone scan with SPECT/CT. On the basis of the finding of the bone scan and SPECT/CT, a new working diagnosis was made and intervention was performed according to the new working diagnosis. Diagnostic blocks in the control group were given based on clinical diagnosis. Controlled comparative diagnostic blocks were performed with local anesthetic. The pain score just after the diagnostic block and at the time of discharge (approximately 4 h later) was recorded; the pain relief was recorded in percentage. In both the groups, sacroilitis was the most common diagnosis followed by facet joint arthropathy. The number of patients obtaining pain relief of >50% was significantly higher in the bone scan-positive group as compared with the control group. Three new clinical conditions were identified in the bone scan group. These conditions were multiple myeloma, avascular necrosis of the femoral head, and ankylosing spondylitis. Bone scan with SPECT/CT was found to complement the clinical workup of patients with LBP. Inclusion of bone scan with

  4. Mice with cancer-induced bone pain show a marked decline in day/night activity

    Directory of Open Access Journals (Sweden)

    Lisa A. Majuta

    2017-10-01

    Conclusion:. Even when the tumor is confined to a single load-bearing bone, CIBP drives a significant loss of activity, which increases with disease progression. Understanding the mechanisms that drive this reduction in activity may allow the development of therapies that allow CIBP patients to better maintain their activity and functional status.

  5. Single fraction versus multiple fraction radiotherapy for palliation of painful vertebral bone metastases: A prospective study

    Directory of Open Access Journals (Sweden)

    Dipanjan Majumder

    2012-01-01

    Conclusions: Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.

  6. Value of inflammation scintigraphy and bone scan in differential diagnosis of painful affections of small joints

    International Nuclear Information System (INIS)

    Warchol, O.; Dworak, E.; Koenig, B.; Koehn, H.; Dunky, A.; Mostbeck, A.

    1998-01-01

    It was the aim of this study to evaluate different markers of inflammation such as 99m-Tc-labelled human immunoglobulin G and 99m-Tc-nanocolloid with respect to their ability to detect inflammatory or degenerative affections of small joints of hand and fingers. While conventional bone scanning reveals good agreement with clinical findings it is not well suited for screening of inflammatory processes due to its poor specificity. In small joints conventional three-phase bone scan with information of perfusion, blood pool and accumulation is not suitable due to the small ROI, low count rate with high statistics. Therefore we used inflammatory markers to overcome this problem. Immunoglobulin G was true positive in case of inflammatory lesions in 69%, and false positive in case of degenerative lesions in 24%, while nanocolloid was true positive in 72% and false positive in 14%, respectively. Significant differences were found between markers of inflammation and the bone scanning agent while both inflammatory markers, immunoglobulin G and nanocolloid demonstrated significant correlation. While bone scanning tracers detect all kinds of joint affections, immunoglobulin G and nanocolloid accumulate preferentially in inflammatory joints and therefore might be useful to differentiate between inflammatory and degenerative lesions. (author)

  7. Effects of different loading protocols on the secondary stability and peri-implant bone density of the single implants in the posterior maxilla.

    Science.gov (United States)

    Akoğlan, Mücahide; Tatli, Ufuk; Kurtoğlu, Cem; Salimov, Fariz; Kürkçü, Mehmet

    2017-08-01

    Immediate or early loading of dental implants becomes a clinically feasible concept. The aim was to evaluate the effects of different loading protocols (immediate, early, and delayed) on secondary stability and peri-implant bone density of single implants in the posterior maxilla. Thirty-nine implants (Dentium, South-Korea) were placed in 39 patients. After placement, implant stability values (ISQ) and baseline peri-implant bone density values derived from cone-beam computed tomography were recorded. Thirteen implants were included randomly in each loading groups. The secondary ISQ values were recorded during follow-up visits. Peri-implant bone density values were measured 1 year after placement again. Data was statistically analyzed. Immediate-loaded group showed the lowest ISQ values, 1 month after placement. During the next follow-up visits, delayed-loaded group showed the lowest ISQ values while other groups showed comparable results. Early loading increased the peri-implant bone density greater than the other groups. The peri-implant bone of early-loaded implants was significantly denser than that of immediate- and delayed-loaded implants, 1 year after placement. Density increment can be judged as the radiological findings of loaded-bone, which may also reduce the need for histomorphometric analysis of human biopsy to evaluate the bone reaction around the implants. © 2017 Wiley Periodicals, Inc.

  8. Does transcutaneous electrical nerve stimulation (TENS) alleviate the pain experienced during bone marrow sampling in addition to standard techniques? A randomised, double-blinded, controlled trial.

    Science.gov (United States)

    Tucker, David L; Rockett, Mark; Hasan, Mehedi; Poplar, Sarah; Rule, Simon A

    2015-06-01

    Bone marrow aspiration and trephine (BMAT) biopsies remain important tests in haematology. However, the procedures can be moderately to severely painful despite standard methods of pain relief. To test the efficacy of transcutaneous electrical nerve stimulation (TENS) in alleviating the pain from BMAT in addition to standard analgesia using a numerical pain rating scale (NRS). 70 patients requiring BMAT were randomised (1:1) in a double-blind, placebo-controlled trial. -35 patients received TENS impulses at a strong but comfortable amplitude (intervention group) and 35 patients received TENS impulses just above the sensory threshold (control group) (median pulse amplitude 20 and 7 mA, respectively). Patients and operators were blinded to group allocation. Pain assessments were made using a numerical pain scale completed after the procedure. No significant difference in NRS pain recalled after the procedure was detected (median pain score 5.7 (95% CI 4.8 to 6.6) in control vs 5.6 (95% CI 4.8 to 6.4) in the intervention group). However, 100% of patients who had previous experience of BMAT and >94% of participants overall felt they benefited from using TENS and would recommend it to others for this procedure. There were no side effects from the TENS device, and it was well tolerated. TENS is a safe, non-invasive adjunct to analgesia for reducing pain during bone marrow biopsy and provides a subjective benefit to most users; however, no objective difference in pain scores was detected when using TENS in this randomised controlled study. NCT02005354. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Directory of Open Access Journals (Sweden)

    Vincent Ochieng

    2016-01-01

    Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.

  10. Radionuclide therapy of painful bone metastases--a comparative study between consecutive radionuclide infusions, combination with chemotherapy, and radionuclide infusions alone: an in vivo comparison of their effectiveness.

    Science.gov (United States)

    Sideras, Panagiotis A; Stavraka, Anastasia; Gouliamos, Athanasios; Limouris, Georgios S

    2013-12-01

    Radionuclides have been long used for the palliation of skeletal-related metastatic pain. They are almost invariably used as the last resource for pain palliation. Their use as single agents with dose escalations, in combination with biphosphonates or chemotherapy is well known in the peer-reviewed literature; however, little is known about the combination between different agents. In our study, we used consecutive administration of 2 different radionuclides such as (186)Re-1,1-hydroxyethylidenediphosphonate ((186)Re-HEDP) and (89)Strontium Chloride ((89)Sr-Cl) separated by adequate period of time to allow bone marrow recovery in patients with high chance of bone pain relapse and compared it with (89)Sr-Cl and chemotherapy group and (186)Re-HEDP with bisphosphonates. The end result was that treatment with consecutive radionuclides was much more effective and safe than the other 2 groups.

  11. MHC-I promotes apoptosis of GABAergic interneurons in the spinal dorsal horn and contributes to cancer induced bone pain.

    Science.gov (United States)

    Fu, Qiaochu; Shi, Dai; Zhou, Yaqun; Zheng, Hua; Xiang, Hongbing; Tian, Xuebi; Gao, Feng; Manyande, Anne; Cao, Fei; Tian, Yuke; Ye, Dawei

    2016-12-01

    Cancer induced bone pain (CIBP) remains one of the most intractable clinical problems due to poor understanding of its underlying mechanisms. Recent studies demonstrate the decline of inhibitory interneurons, especially GABAergic interneurons in the spinal cord, can evoke generation of chronic pain. It has also been reported that neuronal MHC-I expression renders neurons vulnerable to cytotoxic CD8 + T cells and finally lead to neurons apoptosis in a variety neurological disorders. However, whether MHC-I could induce the apoptosis of GABAergic interneurons in spinal cord and contribute to the development of CIBP remains unknown. In this study, we investigated roles of MHC-I and underlying mechanisms in CIBP on a rat model. Our results showed that increased MHC-I expression on GABAergic interneurons could deplete GABAergic interneurons by inducing their apoptosis in the spinal dorsal horn of tumor-bearing rats. Pretreatment of MHC-I RNAi-lentivirus could prevent the apoptosis of GABAergic interneurons and therefore alleviated mechanical allodynia induced by tumor cells intratibial injection. Additionally, we also found that CD8 + T cells were colocalized with MHC-I and GABAergic neurons and presented a significant and persistent increase in the spinal cord of tumor-bearing rats. Taken together, these findings indicated that MHC-I could evoke CIBP by promoting apoptosis of GABAergic interneurons in the dorsal horn, and this apoptosis was closely related to local CD8 + T cells. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Acute Abdominal Pain Secondary to Retroperitoneal Bleeding From a Giant Adrenal Lipoma With Review of Literature

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    Reyaz M. Singaporewalla

    2009-07-01

    Full Text Available Adrenal lipomas are rare, non-functioning benign tumours, which are primarily detected during autopsy or imaging, as asymptomatic incidentalomas. Occasionally, they can present with abdominal pain due to their large size. Imaging studies help to determine the origin, volume, composition of the lesion and presence of bleeding. Histopathology, however, is necessary to differentiate an adrenal lipoma from other fatty tumours such as myelolipoma, angiomyolipomas, teratomas and liposarcomas. We report a case of spontaneous bleeding from a giant adrenal lipoma that presented as an acute abdomen, and was initially mistaken on imaging for the more common myelolipoma. The literature is reviewed to discuss the clinical, pathological and radiological features, and the optimum therapeutic management.

  13. Pain

    OpenAIRE

    H.W. Snyman

    1980-01-01

    The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  14. Pain

    Directory of Open Access Journals (Sweden)

    H.W. Snyman

    1980-09-01

    Full Text Available The medical profession has always been under pressure to supply public explanations of the diseases with which it deals. On the other hand, it is an old characteristic of the profession to devise comprehensive and unifying theories on all sorts of medical problems. Both these statements apply to pain - one of the most important and clinically striking phenomena and expressions of man since his origin in the mists of time.

  15. Efficacy of SPECT over planar bone scan in the diagnosis of solitary vertebral lesions in patients with low back pain

    International Nuclear Information System (INIS)

    Sudhakar, Pushpalatha; Bhushan, Shanti M.; Ranadhir, G.; Prabhakar Rao, V.V.S.; Sharma, Anshu Rajnish; Narsimuhulu, G.

    2010-01-01

    The purpose of our study has been to evaluate the efficacy of single photon emission computed tomography (SPECT) over planar bone scan in identifying solitary vertebral lesions in patients with low backache and its ability to differentiate various pathologies according to the uptake pattern. Materials and Methods: The study included twenty patients out of whom six patients presented with known carcinoma and fourteen patients with low back pain. SPECT was done in all following planar skeletal survey. Benign and malignant lesions were identified according to the uptake pattern in vertebral elements, based on Gary F. Gates observations. Final diagnosis was obtained by means of biopsy or correlation with radiograph or computed tomography (CT) or magnetic resonance imaging (MRI), and/or follow up. Results: SPECT detected additional 30% of solitary vertebral lesions that were obscured on planar scan. Seven out of twenty were localized in anterior vertebral body and were diagnosed as benign ostophytes in six and osteoma in one substantiating the previous observations. Out of six cases of known carcinoma, three were having solitary metastases and showed posterior vertebral body uptake with pedicle involvement. SPECT could localize specific lesions as source of pain in eleven patients with low back pain (78%) and identified various etiologies including benign tumors (osteoid osteoma and osteoma), facet arthritis, discitis, transverse process fractures and spondylolysis. Conclusion: Our study highlighted the higher diagnostic value of SPECT over planar skeletal scintigraphy in localizing solitary vertebral lesions in low backache patients. Based on SPECT pattern, malignant and benign lesions could be differentiated in the given clinical context. (author)

  16. Experience of bone pain palliation therapy at SGPGIMS, Lucknow (Uttar Pradesh)

    International Nuclear Information System (INIS)

    Ora, M.; Madhusudhanan, P.; Jain, S.; Arya, A.; Barai, S.; Pradhan, P.K.; Gambhir, S.

    2010-01-01

    Full text: Radionuclide pain palliation therapy was done in 156 patients (1995-2007). Total 176 therapy were done. Mean age at the time of presentation was 56 yrs (13-81) with 114 patients were male. Most common referral diagnosis was Carcinoma prostate (86 patients) followed by Breast (38), lung (6) and other malignancies. Earlier oral Phosphorus-32 was used in a mean dose 3.15 mCi (2.5-4 mCi) in 20 patients, intravenous Phosphorus-32 6.7 mCi (4.5-7 mCi) in 138 pts and Samarium-153 52.8 mCi (45-95 mCi) in 14 patients. Most of the patients were referred at very advanced stage so follow up rate was low 25∼30% (40 patients only). Mean follow up duration was 3.75 months. Out of 40 patients significant pain relief was noted in 33 patients while no change was noted in 7 patients. Pre-treatment pain score and narcotic score were 7.6 and 4.5. Average hemoglobin, white blood cell and platelet count was 10.8, 7,800 and 2,05,000 respectively. After administration of radionuclide therapy there was a predictive fall in platelet count only. It decreased to 1,43,000 at around 4-5 weeks. Post-treatment pain score and narcotic score were 5 and 3.5 (P<0.005 as compared with pretreatment level). No serious toxicity was noted in any patient. Despite of most of the patient being in very advance stage of cancer significant relief was noted in 83% patients. Radionuclide therapy is a safe option even in advanced cancer with minimal toxicity

  17. Radionuclide re-therapy is a practical option in bone pain palliation therapy

    International Nuclear Information System (INIS)

    Ora, M.; Jain, S.; Madhusudhanan, P.; Barai, S.; Pradhan, P.K.; Arya, A.; Tiwari, D.K.; Gambhir, S.

    2010-01-01

    Full text: After giving first dose of radionuclide pain palliation therapy in 20 patients, re-therapy was considered again in these patients. 2nd therapy was done in 20 patients followed by 3rd therapy in 11 of them which was subsequently followed by 4th therapy in 4 patients (total 35 re-therapy doses). Phosphorus-32 was used in a mean dose 6.15 mCi (4.5-7 mCi) in 15 pts. and Samarium-153, 60 mCi (45-95 mCi) in 20 therapies. Strict follow up data was available in all patients. Mean follow up duration was 13.75 months (6 month - 20 months). Re-therapy was done after an interval of 4.7 months on an average. Pre-treatment pain score and narcotic score were 6.8 and 3.5. Average Hemoglobin, white blood cell and platelet count was 11.2, 8,600 and 1,89,000 respectively. After administration of radionuclide therapy there was a predictive but fully recovered fall in platelet counts only. It decreased to a mean 1,63,000 at around 4-5 weeks. Post-treatment pain score and narcotic score were 4.1 and 2.5 (P<0.005 as compared with pretreatment level). No serious toxicity was noted in any patient. Radionuclide pain palliation remains a very safe and effective option. Retherapy can be done very easily will equally good effects. No hematological toxicity was seen in any of the patient

  18. Determination of the painful level in osteoporotic vertebral fractures--Retrospective comparison between plain film, bone scan, and magnetic resonance imaging.

    Science.gov (United States)

    Lin, Hsi-Hsien; Chou, Po-Hsin; Wang, Shih-Tien; Yu, Jung-Kuang; Chang, Ming-Chau; Liu, Chien-Lin

    2015-12-01

    Determining the actual painful vertebral level is difficult when evaluating osteoporotic vertebral fracture, especially when there are acute and chronic fractures simultaneously. In this study, we retrospectively evaluated and compared the findings between plain film, bone scan, and magnetic resonance imaging (MRI) in the diagnosis of new fracture in osteoporotic vertebral fractures. This is a retrospective clinical study of patients who were diagnosed with osteoporotic vertebral fractures using plain film, bone scan, and MRI within a 1-month interval between February 2008 and December 2012. The findings in plain film, the extent of increased uptake in bone scan, and signal change in MRI were compared to evaluate the actual level of pain. All patients received percutaneous vertebroplasty according to MR finding. Pain scores (visual analog scale) of the study patients were compared prior to and after the procedure. A total of 52 patients with a mean age of 79.1 years (range 59-92 years) were enrolled in this study, and were treated by vertebroplasty confirmed by MRI. It was observed that patient pain score (visual analog scale) improved from 7.6 to 2.8. Plain film examination revealed 79 vertebrae that were suspected to be compression fractures. Among the suspected vertebrae, 62 showed increased uptake in bone scan, and MRI showed bony edema change in 58 vertebrae. The consistency between bone scan and MRI was 96.9% in patients with single-level suspected fracture on plain film. There was moderate agreement (kappa was 0.56) in patients where multiple levels were noted. Fifteen vertebrae with vacuum cleft sign on plain film showed total concordance in both bone scan and MRI. For patients with single-level compression fracture, the painful level in osteoporotic vertebral fractures can be determined by plain film and bone scan testing. Vacuum cleft sign noted on plain film may be enough to localize the level of pain. However, MRI testing is further needed in multiple

  19. Chondroblastoma of the patella with aneurysmal bone cyst.

    Science.gov (United States)

    Tan, Honglue; Yan, Mengning; Yue, Bing; Zeng, Yiming; Wang, You

    2014-01-01

    Chondroblastoma of the patella is rare. Aneurysmal bone cysts, which develop from a prior lesion such as a chondroblastoma, are seldom seen in the patella. The authors report a case of a 36-year-old man who presented with 2 years of right knee pain without calor, erythema, pain on palpation, or abnormal range of motion. Radiological studies suggested aneurysmal bone cyst. The lesion was excised with curettage and the residual cavity filled with autogenous bone graft. Histopathology revealed chondroblastoma associated with a secondary aneurysmal bone cyst. In the follow-up period, the patient demonstrated normal joint activities with no pain. Normal configuration of the patella and bone union were shown on plain radiographs. The authors present a review of the literature of all cases of patellar chondroblastoma with aneurysmal bone cyst. This case is the 14th report of aneurysmal bone cyst arising in a chondroblastoma of the patella. According to the literature, computed tomography and magnetic resonance imaging are useful in the study of these lesions. The pathologic diagnosis is based on the presence of chondroblastoma and aneurysmal bone cyst. Treatment of this lesion includes patellectomy, curettage alone, and curettage with bone grafting. Despite the risk of recurrence of this lesion in the patella, the authors first recommend curettage followed by filling the cavity with bone graft. To protect the anterior tension of the patella intraoperatively, the bone window should be made at the medial edge of the patella to perform the curettage and bone grafting.

  20. Bilateral downregulation of Nav1.8 in dorsal root ganglia of rats with bone cancer pain induced by inoculation with Walker 256 breast tumor cells

    International Nuclear Information System (INIS)

    Miao, Xue-Rong; Gao, Xiao-Fei; Wu, Jing-Xiang; Lu, Zhi-Jie; Huang, Zhang-Xiang; Li, Xiao-Qing; He, Cheng; Yu, Wei-Feng

    2010-01-01

    Rapid and effective treatment of cancer-induced bone pain remains a clinical challenge and patients with bone metastasis are more likely to experience severe pain. The voltage-gated sodium channel Nav1.8 plays a critical role in many aspects of nociceptor function. Therefore, we characterized a rat model of cancer pain and investigated the potential role of Nav1.8. Adult female Wistar rats were used for the study. Cancer pain was induced by inoculation of Walker 256 breast carcinosarcoma cells into the tibia. After surgery, mechanical and thermal hyperalgesia and ambulation scores were evaluated to identify pain-related behavior. We used real-time RT-PCR to determine Nav1.8 mRNA expression in bilateral L4/L5 dorsal root ganglia (DRG) at 16-19 days after surgery. Western blotting and immunofluorescence were used to compare the expression and distribution of Nav1.8 in L4/L5 DRG between tumor-bearing and sham rats. Antisense oligodeoxynucleotides (ODNs) against Nav1.8 were administered intrathecally at 14-16 days after surgery to knock down Nav1.8 protein expression and changes in pain-related behavior were observed. Tumor-bearing rats exhibited mechanical hyperalgesia and ambulatory-evoked pain from day 7 after inoculation of Walker 256 cells. In the advanced stage of cancer pain (days 16-19 after surgery), normalized Nav1.8 mRNA levels assessed by real-time RT-PCR were significantly lower in ipsilateral L4/L5 DRG of tumor-bearing rats compared with the sham group. Western-blot showed that the total expression of Nav1.8 protein significantly decreased bilaterally in DRG of tumor-bearing rats. Furthermore, as revealed by immunofluorescence, only the expression of Nav1.8 protein in small neurons down regulated significantly in bilateral DRG of cancer pain rats. After administration of antisense ODNs against Nav1.8, Nav1.8 protein expression decreased significantly and tumor-bearing rats showed alleviated mechanical hyperalgesia and ambulatory-evoked pain. These

  1. Exuberant sprouting of sensory and sympathetic nerve fibers in nonhealed bone fractures and the generation and maintenance of chronic skeletal pain.

    Science.gov (United States)

    Chartier, Stephane R; Thompson, Michelle L; Longo, Geraldine; Fealk, Michelle N; Majuta, Lisa A; Mantyh, Patrick W

    2014-11-01

    Skeletal injury is a leading cause of chronic pain and long-term disability worldwide. While most acute skeletal pain can be effectively managed with nonsteroidal anti-inflammatory drugs and opiates, chronic skeletal pain is more difficult to control using these same therapy regimens. One possibility as to why chronic skeletal pain is more difficult to manage over time is that there may be nerve sprouting in nonhealed areas of the skeleton that normally receive little (mineralized bone) to no (articular cartilage) innervation. If such ectopic sprouting did occur, it could result in normally nonnoxious loading of the skeleton being perceived as noxious and/or the generation of a neuropathic pain state. To explore this possibility, a mouse model of skeletal pain was generated by inducing a closed fracture of the femur. Examined animals had comminuted fractures and did not fully heal even at 90+days post fracture. In all mice with nonhealed fractures, exuberant sensory and sympathetic nerve sprouting, an increase in the density of nerve fibers, and the formation of neuroma-like structures near the fracture site were observed. Additionally, all of these animals exhibited significant pain behaviors upon palpation of the nonhealed fracture site. In contrast, sprouting of sensory and sympathetic nerve fibers or significant palpation-induced pain behaviors was never observed in naïve animals. Understanding what drives this ectopic nerve sprouting and the role it plays in skeletal pain may allow a better understanding and treatment of this currently difficult-to-control pain state. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  2. High-fat diet exacerbates pain-like behaviors and periarticular bone loss in mice with CFA-induced knee arthritis.

    Science.gov (United States)

    Loredo-Pérez, Aleyda A; Montalvo-Blanco, Carlos E; Hernández-González, Luis I; Anaya-Reyes, Maricruz; Fernández Del Valle-Laisequilla, Cecilia; Reyes-García, Juan G; Acosta-González, Rosa I; Martínez-Martínez, Arisai; Villarreal-Salcido, Jaira C; Vargas-Muñoz, Virginia M; Muñoz-Islas, Enriqueta; Ramírez-Rosas, Martha B; Jiménez-Andrade, Juan M

    2016-05-01

    Our aim was to quantify nociceptive spontaneous behaviors, knee edema, proinflammatory cytokines, bone density, and microarchitecture in high-fat diet (HFD)-fed mice with unilateral knee arthritis. ICR male mice were fed either standard diet (SD) or HFD starting at 3 weeks old. At 17 weeks, HFD and SD mice received intra-articular injections either with Complete Freund's Adjuvant (CFA) or saline into the right knee joint every 7 days for 4 weeks. Spontaneous pain-like behaviors and knee edema were assessed for 26 days. At day 26 post-first CFA injection, serum levels of IL-1β, IL-6, and RANKL were measured by ELISA, and microcomputed tomography analysis of knee joints was performed. HFD-fed mice injected with CFA showed greater spontaneous pain-like behaviors of the affected extremity as well as a decrease in the weight-bearing index compared to SD-fed mice injected with CFA. Knee edema was not significantly different between diets. HFD significantly exacerbated arthritis-induced bone loss at the distal femoral metaphysis but had no effect on femoral diaphyseal cortical bone. HFD did not modify serum levels of proinflammatory cytokines. HFD exacerbates pain-like behaviors and significantly increases the magnitude of periarticular trabecular bone loss in a murine model of unilateral arthritis. © 2016 The Obesity Society.

  3. Predictive implications of bone turnover markers after palliative treatment with 186Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases

    International Nuclear Information System (INIS)

    Zafeirakis, Athanasios; Papatheodorou, Georgios; Arhontakis, Athanasios; Gouliamos, Athanasios; Vlahos, Lambros; Limouris, Georgios S.

    2010-01-01

    To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with 186 Re-1,1-hydroxyethylidene diphosphonate ( 186 Re-HEDP). Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with 186 Re-HEDP. None had received any treatment that would have interfered with bone metabolism before 186 Re-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment. Pain response was correlated only with pretreatment ΝΤx/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p=0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to 186 Re-HEDP treatment were a posttreatment decrease in NTx of ≥20% (RR=3.44, p=0.0005) and a pretreatment NTx/PINP ratio of ≥1.2 (RR=3.04, p=0.036) NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with 186 Re-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response. (orig.)

  4. Cancer-induced bone pain sequentially activates the ERK/MAPK pathway in different cell types in the rat spinal cord

    Directory of Open Access Journals (Sweden)

    Cheng Hao

    2011-07-01

    Full Text Available Abstract Background Previous studies have demonstrates that, after nerve injury, extracellular signal-regulated protein kinase (ERK activation in the spinal cord-initially in neurons, then microglia, and finally astrocytes. In addition, phosphorylation of ERK (p-ERK contributes to nociceptive responses following inflammation and/or nerve injury. However, the role of spinal cells and the ERK/MAPK pathway in cancer-induced bone pain (CIBP remains poorly understood. The present study analyzed activation of spinal cells and the ERK/MAPK pathway in a rat model of bone cancer pain. Results A Sprague Dawley rat model of bone cancer pain was established and the model was evaluated by a series of tests. Moreover, fluorocitrate (reversible glial metabolic inhibitor and U0126 (a MEK inhibitor was administered intrathecally. Western blots and double immunofluorescence were used to detect the expression and location of phosphorylation of ERK (p-ERK. Our studies on pain behavior show that the time between day 6 and day 18 is a reasonable period ("time window" as the remaining stages to investigate bone cancer pain mechanisms and to research analgesic drugs. Double-labeling immunofluorescence revealed that p-ERK was sequentially expressed in neurons, microglia, and astrocytes in the L4-5 superficial spinal cord following inoculation of Walker 256 cells. Phosphorylation of ERK (p-ERK and the transcription factor cAMP response element-binding protein (p-CREB increased in the spinal cord of CIBP rats, which was attenuated by intrathecal injection of fluorocitrate or U0126. Conclusions The ERK inhibitors could have a useful role in CIBP management, because the same target is expressed in various cells at different times.

  5. Cancer-induced bone pain sequentially activates the ERK/MAPK pathway in different cell types in the rat spinal cord.

    Science.gov (United States)

    Wang, Li-na; Yao, Ming; Yang, Jian-ping; Peng, Jun; Peng, Yan; Li, Cai-fang; Zhang, Yan-bing; Ji, Fu-hai; Cheng, Hao; Xu, Qi-nian; Wang, Xiu-yun; Zuo, Jian-ling

    2011-07-01

    Previous studies have demonstrates that, after nerve injury, extracellular signal-regulated protein kinase (ERK) activation in the spinal cord-initially in neurons, then microglia, and finally astrocytes. In addition, phosphorylation of ERK (p-ERK) contributes to nociceptive responses following inflammation and/or nerve injury. However, the role of spinal cells and the ERK/MAPK pathway in cancer-induced bone pain (CIBP) remains poorly understood. The present study analyzed activation of spinal cells and the ERK/MAPK pathway in a rat model of bone cancer pain. A Sprague Dawley rat model of bone cancer pain was established and the model was evaluated by a series of tests. Moreover, fluorocitrate (reversible glial metabolic inhibitor) and U0126 (a MEK inhibitor) was administered intrathecally. Western blots and double immunofluorescence were used to detect the expression and location of phosphorylation of ERK (p-ERK). Our studies on pain behavior show that the time between day 6 and day 18 is a reasonable period ("time window" as the remaining stages) to investigate bone cancer pain mechanisms and to research analgesic drugs. Double-labeling immunofluorescence revealed that p-ERK was sequentially expressed in neurons, microglia, and astrocytes in the L4-5 superficial spinal cord following inoculation of Walker 256 cells. Phosphorylation of ERK (p-ERK) and the transcription factor cAMP response element-binding protein (p-CREB) increased in the spinal cord of CIBP rats, which was attenuated by intrathecal injection of fluorocitrate or U0126. The ERK inhibitors could have a useful role in CIBP management, because the same target is expressed in various cells at different times.

  6. Percutaneous bone tumor management.

    Science.gov (United States)

    Gangi, Afshin; Buy, Xavier

    2010-06-01

    Interventional radiology plays a major role in the management of bone tumors. Many different percutaneous techniques are available. Some aim to treat pain and consolidate a pathological bone (cementoplasty); others aim to ablate tumor or reduce its volume (sclerotherapy, thermal ablation). In this article, image-guided techniques of primary and secondary bone tumors with vertebroplasty, ethanol injection, radiofrequency ablation, laser photocoagulation, cryoablation, and radiofrequency ionization (coblation) will be reviewed. For each modality, the principles, the indications, and the results will be presented. The technical choice depends on the therapeutic intent-curative or palliative-and the need for consolidation, but also on the general status of the patient and the other therapeutic options. For the most complex cases, combined treatments can be required. However, the less disabling technique should always be considered first.

  7. Hybrid Bone SPECT/CT Imaging in Evaluation of Chronic Low Back Pain: Correlation with Facet Joint Arthropathy.

    Science.gov (United States)

    Russo, Vittorio M; Dhawan, Ranju T; Baudracco, Irene; Dharmarajah, Nishanth; Lazzarino, Antonio I; Casey, Adrian T

    2017-11-01

    Evidence to support the use of bone hydroxydiphosphonate (HDP) single photon emission computed tomography (SPECT/CT) in patients with facetogenic low back pain (LBP) is still limited. In this study we compared the scintigraphic patterns on bone SPECT/CT with the degree of structural facet joint (FJ) degeneration on CT in patients with LBP. Ninety-nine consecutive patients with LBP were prospectively evaluated. Patients with known or suspected malignancy, trauma, infectious processes, chronic inflammatory diseases, and previous surgery were excluded. The effect of LBP on the daily quality of life was assessed with the Oswestry disability index (ODI). The Pathria grading system was used to score FJ degeneration on CT scans. The correlation between the degree of FJ degeneration and osteoblastic activity on SPECT/CT was analyzed with Kappa statistics. Ninety-nine patients were included (59 female, mean age 56.2 years). The mean ODI score was 38.5% (range, 8% to 72%). In all, 792 FJ (L2-3 to L5-S1) were examined. Of the FJs, 49.6% were Pathria grade 0-1 (normal to mild degeneration) on CT, 35% were grade 2 (moderate degeneration), and 16% were grade 3 (severe degeneration). Sixty-seven percent of the patients had scintigraphically active FJs on SPECT/CT. Sixty-nine percent of Pathria grade 3 FJs were scintigraphically active; 5.5% and 16.8% of Pathria grade 0-1 and Pathria grade 2, respectively, were active. Of the metabolically active FJs, 71.4% were at the L4-5/L5-S1 levels. The ability of SPECT/CT to precisely localize scintigraphically active FJs may provide significant improvement in the diagnosis and treatment of patients with LBP. In this study we demonstrate that in >40% of FJs, the scintigraphic patterns on SPECT/CT did not correlate with the degree of degeneration on CT. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Powered bone marrow biopsy procedures produce larger core specimens, with less pain, in less time than with standard manual devices

    Directory of Open Access Journals (Sweden)

    Larry J. Miller

    2011-07-01

    Full Text Available Bone marrow sampling remains essential in the evaluation of hematopoietic and many non-hematopoietic disorders. One common limitation to these procedures is the discomfort experienced by patients. To address whether a Powered biopsy system could reduce discomfort while providing equivalent or better results, we performed a randomized trial in adult volunteers. Twenty-six subjects underwent bilateral biopsies with each device. Core samples were obtained in 66.7% of Manual insertions; 100% of Powered insertions (P=0.002. Initial mean biopsy core lengths were 11.1±4.5 mm for the Manual device; 17.0±6.8 mm for the Powered device (P<0.005. Pathology assessment for the Manual device showed a mean length of 6.1±5.6 mm, width of 1.0±0.7 mm, and volume of 11.0±10.8 mm3. Powered device measurements were mean length of 15.3±6.1 mm, width of 2.0±0.3 mm, and volume of 49.1±21.5 mm3 (P<0.001. The mean time to core ejection was 86 seconds for Manual device; 47 seconds for the Powered device (P<0.001. The mean second look overall pain score was 33.3 for the Manual device; 20.9 for the Powered (P=0.039. We conclude that the Powered biopsy device produces superior sized specimens, with less overall pain, in less time.

  9. Quality assurance experience with the randomized neuropathic bone pain trial (Trans-Tasman Radiation Oncology Group, 96.05)

    International Nuclear Information System (INIS)

    Roos, Daniel E.; Davis, Sidney R.; Turner, Sandra L.; O'Brien, Peter C.; Spry, Nigel A.; Burmeister, Bryan H.; Hoskin, Peter J.; Ball, David L.

    2003-01-01

    Background and purpose: Trans-Tasman Radiation Oncology Group 96.05 is a prospective randomized controlled trial comparing a single 8 Gy with 20 Gy in five fractions of radiotherapy (RT) for neuropathic pain due to bone metastases. This paper summarizes the quality assurance (QA) activities for the first 234 patients (accrual target 270). Materials and methods: Independent audits to assess compliance with eligibility/exclusion criteria and appropriateness of treatment of the index site were conducted after each cohort of approximately 45 consecutive patients. Reported serious adverse events (SAEs) in the form of cord/cauda equina compression or pathological fracture developing at the index site were investigated and presented in batches to the Independent Data Monitoring Committee. Finally, source data verification of the RT prescription page and treatment records was undertaken for each of the first 234 patients to assess compliance with the protocol. Results: Only one patient was found conclusively not to have genuine neuropathic pain, and there were no detected 'geographical misses' with RT fields. The overall rate of detected infringements for other eligibility criteria over five audits (225 patients) was 8% with a dramatic improvement after the first audit. There has at no stage been a statistically significant difference in SAEs by randomization arm. There was a 22% rate of RT protocol variations involving ten of the 14 contributing centres, although the rate of major dose violations (more than ±10% from protocol dose) was only 6% with no statistically significant difference by randomization arm (P=0.44). Conclusions: QA auditing is an essential but time-consuming component of RT trials, including those assessing palliative endpoints. Our experience confirms that all aspects should commence soon after study activation

  10. rhBMP-2 with a demineralized bone matrix scaffold versus autologous iliac crest bone graft for alveolar cleft reconstruction.

    Science.gov (United States)

    Francis, Cameron S; Mobin, Sheila S Nazarian; Lypka, Michael A; Rommer, Elizabeth; Yen, Stephen; Urata, Mark M; Hammoudeh, Jeffrey A

    2013-05-01

    Secondary alveolar cleft reconstruction using autologous iliac crest bone graft is currently the standard treatment for alveolar clefts. Although effective, harvesting autologous bone may result in considerable donor-site morbidity, most commonly pain and the potential for long-term sensory disturbances. In an effort to decrease patient morbidity, a novel technique using recombinant human bone morphogenetic protein (rhBMP)-2 encased in a demineralized bone matrix scaffold was developed as an alternative to autografting for secondary alveolar cleft reconstruction. A chart review was conducted for the 55 patients who underwent secondary alveolar cleft reconstruction over a 2-year period with a mean follow-up of 21 months. Of these, 36 patients received rhBMP-2/demineralized bone matrix scaffold (including 10 patients with previously failed repairs using iliac crest bone grafting) and 19 patients underwent iliac crest bone grafting. Postoperatively, bone stock was evaluated using occlusal radiographs rated according to the Bergland and Chelsea scales. Alveolar clefts repaired using rhBMP-2/demineralized bone matrix scaffold were 97.2 percent successful compared with 84.2 percent with iliac crest bone grafting. Radiographically, initial repairs with rhBMP-2/demineralized bone matrix scaffold were superior to iliac crest bone grafting according to both Bergland and Chelsea scales, and significantly more patients in the rhBMP-2/demineralized bone matrix scaffold group had coronal bridging. The postoperative intraoral infection rate following iliac crest bone grafting was significantly greater than for rhBMP-2/demineralized bone matrix scaffold. The cost of rhBMP-2/demineralized bone matrix scaffold products was offset by cost savings associated with a reduction in operative time averaging 102 minutes. rhBMP-2 encased in a demineralized bone matrix scaffold appears to be a viable alternative for secondary alveolar cleft repair. Patients are spared donor-site morbidity and

  11. Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study.

    Science.gov (United States)

    Dunn, Warren R; Spindler, Kurt P; Amendola, Annunziato; Andrish, Jack T; Kaeding, Christopher C; Marx, Robert G; McCarty, Eric C; Parker, Richard D; Harrell, Frank E; An, Angel Q; Wright, Rick W; Brophy, Robert H; Matava, Matthew J; Flanigan, David C; Huston, Laura J; Jones, Morgan H; Wolcott, Michelle L; Vidal, Armando F; Wolf, Brian R

    2010-09-01

    Increased knee pain at the time of anterior cruciate ligament reconstruction may potentially predict more difficult rehabilitation, prolonged recovery, and/or be predictive of increased knee pain at 2 years. A bone bruise and/or other preoperative factors are associated with more knee pain/symptoms at the time of index anterior cruciate ligament reconstruction, and the presence of a bone bruise would be associated with specific demographic and injury-related factors. Cohort study (prevalence); Level of evidence, 2. In 2007, the Multicenter Orthopaedic Outcomes Network (MOON) database began to prospectively collect surgeon-reported magnetic resonance imaging bone bruise status. A multivariable analysis was performed to (1) determine if a bone bruise, among other preoperative factors, is associated with more knee symptoms/pain and (2) examine the association of factors related to bone bruise. To evaluate the association of a bone bruise with knee pain/symptoms, linear multiple regression models were fit using the continuous scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscales and the Short Form 36 (SF-36) bodily pain subscale as dependent variables. To examine the association between a bone bruise and risk factors, a logistic regression model was used, in which the dependent variable was the presence or absence of a bone bruise. Baseline data for 525 patients were used for analysis, and a bone bruise was present in 419 (80%). The cohort comprises 58% male patients, with a median age of 23 years. The median Marx activity level was 13. Factors associated with more pain were higher body mass index (P pain at the time of index anterior cruciate ligament reconstruction. None of the factors included in the SF-36 bodily pain model were found to be significant. After controlling for other baseline factors, the following factors were associated with a bone bruise: younger age (P = .034) and not jumping at the time of injury (P = .006

  12. Chronic low back pain is associated with reduced vertebral bone mineral measures in community-dwelling adults

    Directory of Open Access Journals (Sweden)

    Briggs Andrew M

    2012-03-01

    Full Text Available Abstract Background Chronic low back pain (CLBP experienced in middle-age may have important implications for vertebral bone health, although this issue has not been investigated as a primary aim previously. This study investigated the associations between CLBP and dual energy X-ray absorptiometry (DXA-derived vertebral bone mineral measures acquired from postero-anterior and lateral-projections, among community-dwelling, middle-aged adults. Methods Twenty-nine adults with CLBP (11 male, 18 female and 42 adults with no history of LBP in the preceding year (17 male, 25 female were evaluated. Self-reported demographic and clinical data were collected via questionnaires. Areal bone mineral density (aBMD was measured in the lumbar spine by DXA. Apparent volumetric (ap.v BMD in the lumbar spine was also calculated. Multiple linear regression models were used to examine associations between study group (CLBP and control and vertebral DXA variables by gender, adjusting for height, mass and age. Results There was no difference between groups by gender in anthropometrics or clinical characteristics. In the CLBP group, the mean (SD duration of CLBP was 13.3 (10.4 years in males and 11.6 (9.9 years in females, with Oswestry Disability Index scores of 16.2 (8.7% and 15.4 (9.1%, respectively. Males with CLBP had significantly lower adjusted lateral-projection aBMD and lateral-projection ap.vBMD than controls at L3 with mean differences (standard error of 0.09 (0.04 g/cm2 (p = 0.03 and 0.02 (0.01 g/cm3 (p = 0.04. These multivariate models accounted for 55% and 53% of the variance in lateral-projection L3 aBMD and lateral-projection L3 ap.vBMD. Conclusions CLBP in males is associated with some lumbar vertebral BMD measures, raising important questions about the mechanism and potential clinical impact of this association.

  13. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism.

    Science.gov (United States)

    Ho, Lo-Yi; Wong, Ping-Nam; Sin, Ho-Kwan; Wong, Yuk-Yi; Lo, Kwok-Chi; Chan, Shuk-Fan; Lo, Man-Wai; Lo, Kin-Yee; Mak, Siu-Ka; Wong, Andrew Kui-Man

    2017-01-10

    Hungry bone syndrome (HBS) is an important postoperative complication after parathyroidectomy for severe secondary hyperparathyroidism (SHPT). There is, however, little data in the literature on its detailed clinical course, and the associated risk factors remain controversial. We did a single-center retrospective study on 62 consecutive dialysis patients who underwent total parathyroidectomy for SHPT to examine the risk factors, clinical course and outcome. Data on demographic characteristics, perioperative laboratory parameters including serum calcium, phosphate, alkaline phosphatase (ALP) and parathyroid hormone (PTH), drug treatment for SHPT and operative details of parathyroidectomy were collected. Seventeen (27.4%) patients developed severe postoperative hypocalcemia with HBS. The serum calcium dropped progressively while serum ALP rose after operation until 2 weeks later when serum calcium reached the trough and serum ALP peaked. Serum phosphate also fell but stabilized between 4 and 14 days. The total postoperative calcium and vitamin D supplementation was significantly larger, and hospital stay was significantly longer in the group with HBS as compared with those without HBS. Young age, high body weight, high preoperative ALP level, and low preoperative calcium level independently predicted the development of HBS while preoperative PTH and use of cinacalcet or paricalcitol did not. HBS was common after total parathyroidectomy in patients with SHPT, and it is important to closely monitor the postoperative serum calcium, phosphate and ALP levels in the following 2 weeks, especially for those at risk. The implications of our findings on perioperative management are discussed.

  14. The PRESLO study: evaluation of a global secondary low back pain prevention program for health care personnel in a hospital setting. Multicenter, randomized intervention trial.

    Science.gov (United States)

    Denis, Angélique; Zelmar, Amélie; Le Pogam, Marie-Annick; Chaleat-Valayer, Emmanuelle; Bergeret, Alain; Colin, Cyrille

    2012-11-27

    Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL) personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie), proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues - Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs. This study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group) and those following the global prevention program in addition to their usual treatment (intervention group) are compared in terms of low back pain recurrence and the impairments measured at the beginning and the end of the study

  15. The PRESLO study: evaluation of a global secondary low back pain prevention program for health care personnel in a hospital setting. Multicenter, randomized intervention trial

    Directory of Open Access Journals (Sweden)

    Denis Angélique

    2012-11-01

    Full Text Available Abstract Background Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie, proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues – Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs. Methods/Design This study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group and those following the global prevention program in addition to their usual treatment (intervention group are compared in terms of low back pain recurrence and the

  16. Shoulder pain

    Science.gov (United States)

    ... This condition is called rotator cuff tendinitis or bursitis. Shoulder pain may also be caused by: Arthritis ... shoulder joint Bone spurs in the shoulder area Bursitis , which is inflammation of a fluid-filled sac ( ...

  17. Leg pain

    Science.gov (United States)

    ... to a muscle cramp (also called a charley horse ). Common causes of cramps include: Dehydration or low ... muscle ( strain ) Hairline crack in the bone (stress fracture) Inflamed tendon ( tendinitis ) Shin splints (pain in the ...

  18. Half body irradiation of patients with multiple bone metastases: a phase II trial

    DEFF Research Database (Denmark)

    Berg, Randi S; Yilmaz, Mette K; Høyer, Morten

    2009-01-01

    AIM OF STUDY: The primary aim of this study was to evaluate the effect of half-body irradiation (HBI) on pain and quality of life in cancer patients with multiple bone metastases. The secondary aim was to evaluate side effects of the treatment. PATIENTS AND METHODS: A total of 44 patients receive...... on the patients' global quality of life. CONCLUSION: Single fraction HBI is safe and effective providing long lasting pain reduction in 76% of patients with multiple bone metastases....

  19. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao [Shandong Provincial Hospital Affiliated to Shandong University, Department of Oncology, Jinan, Shandong Province (China); Zhang, Kaixian [Teng Zhou Central People' s Hospital Affiliated to Jining Medical College, Department of Oncology, Tengzhou, Shandong Province (China)

    2015-10-15

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  20. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    International Nuclear Information System (INIS)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao; Zhang, Kaixian

    2015-01-01

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  1. Age does not modify the effects of treatment on pain in patients with low back pain: Secondary analyses of randomized clinical trials

    NARCIS (Netherlands)

    Ferreira, M.L.; Ferreira, P.H.; Henschke, N.; Kamper, S.J.; Koes, B; Hayden, J.A.; Maher, C.G.

    2014-01-01

    Background While many treatment options have been advocated to speed recovery in adults with back pain, it is still unclear whether older patients with back pain respond differently to treatment when compared to younger patients. Aims This study aims to evaluate if age modifies response to treatment

  2. Tolvaptan and Kidney Pain in Patients With Autosomal Dominant Polycystic Kidney Disease : Secondary Analysis From a Randomized Controlled Trial

    NARCIS (Netherlands)

    Casteleijn, Niek F.; Blais, Jaime D.; Chapman, Arlene B.; Czerwiec, Frank S.; Devuyst, Olivier; Higashihara, Eiji; Leliveld, Anna M.; Ouyang, John; Perrone, Ronald D.; Torres, Vicente E.; Gansevoort, Ron T.

    Background: Kidney pain is a common complication in patients with autosomal dominant polycystic kidney disease (ADPKD), and data from the TEMPO 3: 4 trial suggested that tolvaptan, a vasopressin V2 receptor antagonist, may have a positive effect on kidney pain in this patient group. Because pain is

  3. Avascular necrosis of the lunate bone (Kienböck’s disease) secondary to scapholunate ligament tear as a consequence of trauma – a case study

    International Nuclear Information System (INIS)

    Kulhawik, Dorota; Szałaj, Tomasz; Grabowska, Monika

    2014-01-01

    Avascular necrosis of the lunate bone (Kienböck’s disease), is a condition in which lunate bone, loses its blood supply, leading to necrosis of the bone. There is probably no single cause of Kienbock’s disease. Its origin may involve multiple factors, such as the blood supply (arteries), blood drainage (veins), and skeletal variations. Trauma, either isolated or repeated, may possibly be a factor in some cases. This case presented with multifactorial etiology. In the presented case, a patient with negative ulnar variant had injured her right wrist and presented at an orthopedic clinic due to nonspecific pain 6 months later. An arthro-MRI examination revealed necrosis of the lunate bone, scapholunate ligament tear and coexisting TFCC (triangular fibrocartilage complex) tear. Early diagnosis and treatment can prevent progression of necrotic lesions and bone collapse. MRI examination seems to be the key diagnostic method in the early stage of the Kienböck’s disease with negative x-ray and CT images. Arthro-MRI examination also allows us to identify the underlying ligamentous injury. In cases of traumatic etiology, an additional CT test enables stating the final diagnosis

  4. Predicting factors associated with frailty in aged patients with bone-arthrosis pain in the clinic.

    Science.gov (United States)

    Li, Bao-Lin; Li, Wei; Bi, Jia-Qi; Meng, Qing-Gang; Fei, Jian-Feng

    2016-11-01

    To identify frail and pre-frail patients in a group of patients older than 60 years. The phenotype model of Fried's method was used to identify frailty and pre-frailty in total of 78 participants. Cognitive ability and psychosocial function tests were also given to 59 of the 78 patients. Prevalence of frailty and pre-frailty was 14.1% (11/78) and 46.2% (36/78), respectively. Of the 5 phenotype variables, weak grip strength was the most commonly seen variable with 53.8% of all participants and 100% in the frail group. Low energy expenditure, however, was not self-reported by any participant in the current study (0%). Prevalence of frailty in the present study is associated with chronological age. The current study indicates that 4 phenotypic variables (unintentional weight loss, self-reported exhaustion, gait speed and grip strength) contribute to the development to frailty, and that cognitive impairment and psychosocial frailty also predict frailty or pre-frailty in the patients older than 60 years old irrespective of chronic pain or osteoarthritis. The findings of the current study suggest frailty and pre-frailty are common in senior Chinese patients with chronic diseases. Recognition and identification of frailty in a rehabilitation clinic or hospital might help physicians to provide appropriate counseling to patients and families about adverse outcomes of certain treatments such as surgery, and could optimize management of coexisting chronic diseases that might contribute to or be affected by frailty.

  5. Activation of c-jun N-terminal kinase in spinal cord contributes to breast cancer induced bone pain in rats

    Directory of Open Access Journals (Sweden)

    Wang Xiao-Wei

    2012-06-01

    Full Text Available Abstract Background The most frequent pain in patients with metastatic breast and prostate cancer is bone pain, which can be severe and difficult to treat. The mechanisms underlying this pain remain unclear. Here we investigated the role of c-jun N-terminal kinase (JNK pathway in the spinal cord in cancer-induced bone pain (CIBP. Results In this study, we used an established rat CIBP model to investigate the possible role of JNK activation in the spinal cord. After intra-tibial inoculation with Walker 256 rat mammary gland carcinoma cells, the rats displayed mechanical allodynia on day 5, which lasted to day 16. The activation of JNK in neurons and astrocytes in the spinal cord was found on day 12 and day 16 after intra-tibial inoculation with carcinoma cells. A single intrathecal injection with JNK inhibitor SP600125 by lumbar puncture attenuated mechanical allodynia on day 12, and repeated intrathecal injection of SP600126 from day 10 to day 14 had a cumulative analgesic effect on CIBP. Conclusions Taken together, our results demonstrated for the first time that JNK activation in the spinal cord is required in the maintenance of CIBP. Inhibition of the spinal JNK pathway may provide a new therapy for CIBP management.

  6. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

    Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

  7. Giant Cell Tumor with Secondary Aneurysmal Bone Cyst Shows Heterogeneous Metabolic Pattern on18F-FDG PET/CT: A Case Report.

    Science.gov (United States)

    Park, Hee Jeong; Kwon, Seong Young; Cho, Sang-Geon; Kim, Jahae; Song, Ho-Chun; Kim, Sung Sun; Yoon, Yeon Hong; Park, Jin Gyoon

    2016-12-01

    Giant cell tumor (GCT) is a generally benign bone tumor accounting for approximately 5 % of all primary bone neoplasms. Cystic components in GCTs that indicate secondary aneurysmal bone cysts (ABCs) are reported in 14 % of GCTs. Although both of them have been described separately in previous reports that may show considerable fluorodeoxyglucose (FDG) uptake despite their benign nature, the findings of GCT with secondary ABC on 18 F-FDG positron emission tomography/computed tomography (PET/CT) have not been well-known. We report a case of GCT with secondary ABC in a 26-year-old woman. 18 F-FDG PET/CT revealed a heterogeneous hypermetabolic lesion in the left proximal femur with the maximum standardized uptake value of 4.7. The solid components of the tumor showed higher FDG uptake than the cystic components. These observations suggest that the ABC components in GCTs show heterogeneous metabolic patterns on 18 F-FDG PET/CT.

  8. Giant cell tumor with secondary aneurysmal bone cyst shows heterogeneous metabolic pattern on {sup 18}F-FDG PET.CT: A case reort

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hee Jeong; Kwon, Seong Young; Yoon, Yeon Hong [Chonnam National University Hwasun Hospital, Huasun (Korea, Republic of); Cho, Sang Geon; Kim, Jahae; Song, Ho Chun; Kim, Sung Sun; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2016-12-15

    Giant cell tumor (GCT) is a generally benign bone tumor accounting for approximately 5 % of all primary bone neoplasms. Cystic components in GCTs that indicate secondary aneurysmal bone cysts (ABCs) are reported in 14 % of GCTs. Although both of them have been described separately in previous reports that may show considerable fluorodeoxyglucose (FDG) uptake despite their benign nature, the findings of GCT with secondary ABC on 18F-FDG positron emission tomography/computed tomography (PET/CT) have not been well-known. We report a case of GCT with secondary ABC in a 26-year-old woman. 18F-FDG PET/CT revealed a heterogeneous hypermetabolic lesion in the left proximal femur with the maximum standardized uptake value of 4.7. The solid components of the tumor showed higher FDG uptake than the cystic components. These observations suggest that the ABC components in GCTs show heterogeneous metabolic patterns on {sup 18}F-FDG PET/CT.

  9. Lipoxins and aspirin-triggered lipoxin alleviate bone cancer pain in association with suppressing expression of spinal proinflammatory cytokines

    Directory of Open Access Journals (Sweden)

    Hu Shan

    2012-12-01

    Full Text Available Abstract Background The neuroinflammatory responses in the spinal cord following bone cancer development have been shown to play an important role in cancer-induced bone pain (CIBP. Lipoxins (LXs, endogenous lipoxygenase-derived eicosanoids, represent a unique class of lipid mediators that possess a wide spectrum of anti-inflammatory and pro-resolving actions. In this study, we investigated the effects of intrathecal injection with lipoxin and related analogues on CIBP in rats. Methods The CIBP model was induced by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells. Mechanical thresholds were determined by measuring the paw withdrawal threshold to probing with a series of calibrated von Frey filaments. Lipoxins and analogues were administered by intrathecal (i.t. or intravenous (i.v. injection. The protein level of LXA4 receptor (ALX was tested by western blot. The localization of lipoxin receptor in spinal cord was assessed by fluorescent immunohistochemistry. Real-time PCR was carried out for detecting the expression of pro-inflammatory cytokines. Results Our results demonstrated that: 1 i.t. injection with the same dose (0.3 nmol of lipoxin A4 (LXA4, lipoxin B4 (LXB4 or aspirin-triggered-15-epi-lipoxin A4 (ATL could alleviate the mechanical allodynia in CIBP on day 7 after surgery. ATL showed a longer effect than the others and the effect lasted for 6 hours. ATL administered through i.v. injection could also attenuate the allodynia in cancer rats. 2 The results from western blot indicate that there is no difference in the expression of ALX among the naive, sham or cancer groups. 3 Immunohistochemistry showed that the lipoxin receptor (ALX-like immunoreactive substance was distributed in the spinal cord, mainly co-localized with astrocytes, rarely co-localized with neurons, and never co-localized with microglia. 4 Real-time PCR analysis revealed that, compared with vehicle, i.t. injection with ATL could significantly

  10. Bone marrow necrosis secondary to imatinib usage, mimicking spinal metastasis on magnetic resonance imaging and FDG-PET/CT.

    Science.gov (United States)

    Aras, Yavuz; Akcakaya, Mehmet Osman; Unal, Seher N; Bilgic, Bilge; Unal, Omer Faruk

    2012-01-01

    Imatinib mesylate has become the treatment of choice for gastrointestinal stromal tumors (GISTs) and has made a revolutionary impact on survival rates. Bone marrow necrosis is a very rare adverse event in malignant GIST. Bone metastases are also rarely encountered in the setting of this disease. The authors report on a patient with malignant GIST who developed a bone lesion, mimicking spinal metastasis on both MR imaging and FDG-PET/CT. Corpectomy and anterior fusion was performed, but the pathology report was consistent with bone marrow necrosis. Radiological and clinical similarities made the distinction between metastasis and bone marrow necrosis challenging for the treating physicians. Instead of radical surgical excision, more conservative methods such as percutaneous or endoscopic bone biopsies may be more useful for pathological confirmation, even though investigations such as MR imaging and FDG-PET/CT indicate metastatic disease.

  11. Therapeutic Targeting of TRPV1 for the Treatment of Chronic Pain Associated with Prostate Cancer Bone Metastasis

    Science.gov (United States)

    2013-07-30

    exhibited metastastatic tumor growth in hind limb bones showed considerable bone destruction, anthough no fractures were observed. Further, we performed...whole animal perfusion with fixative, and subsequently removed the femur and tibia- fibula for tissue sectioning and H&E, as well as immunostainging...metastastatic tumor growth in hind limb bones showed considerable bone destruction, anthough no fractures were observed. Further, we performed whole

  12. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio; Ballicu, Nicola; Fele, Rosa Maria; Sotgia, Barbara; Melis, Luca [Oncological Hospital ' ' A. Businco' ' , Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Cagliari (Italy); Fancellu, Alessandro [University of Sassari, Department of Clinical and Experimental Medicine, Sassari (Italy)

    2017-04-15

    To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization. Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability. All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4-9) before treatment to 1.6 (range, 0-6), 1 month after treatment, and to 1.4 (range 0-6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months. Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience. (orig.)

  13. Does a modified STarT Back Tool predict outcome with a broader group of musculoskeletal patients than back pain? A secondary analysis of cohort data

    Science.gov (United States)

    Hill, J C; Afolabi, E K; Lewis, M; Roddy, E; van der Windt, D A; Foster, N E

    2016-01-01

    Objectives The STarT Back Tool has good predictive performance for non-specific low back pain in primary care. We therefore aimed to investigate whether a modified STarT Back Tool predicted outcome with a broader group of musculoskeletal patients, and assessed the consequences of using existing risk-group cut-points across different pain regions. Setting Secondary analysis of prospective data from 2 cohorts: (1) outpatient musculoskeletal physiotherapy services (PhysioDirect trial n=1887) and (2) musculoskeletal primary–secondary care interface services (SAMBA study n=1082). Participants Patients with back, neck, upper limb, lower limb or multisite pain with a completed modified STarT Back Tool (baseline) and 6-month physical health outcome (Short Form 36 (SF-36)). Outcomes Area under the receiving operator curve (AUCs) tested discriminative abilities of the tool's baseline score for identifying poor 6-month outcome (SF-36 lower tertile Physical Component Score). Risk-group cut-points were tested using sensitivity and specificity for identifying poor outcome using (1) Youden's J statistic and (2) a clinically determined rule that specificity should not fall below 0.7 (false-positive rate SAMBA, poor 6-month physical health was 18.5% and 28.2%, respectively. Modified STarT Back Tool score AUCs for predicting outcome in back pain were 0.72 and 0.79, neck 0.82 and 0.88, upper limb 0.79 and 0.86, lower limb 0.77 and 0.83, and multisite pain 0.83 and 0.82 in PhysioDirect and SAMBA, respectively. Differences between pain region AUCs were non-significant. Optimal cut-points to discriminate low-risk and medium-risk/high-risk groups depended on pain region and clinical services. Conclusions A modified STarT Back Tool similarly predicts 6-month physical health outcome across 5 musculoskeletal pain regions. However, the use of consistent risk-group cut-points was not possible and resulted in poor sensitivity (too many with long-term disability being missed) or specificity

  14. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39{+-}15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI{sup eventscan)}. Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI{sup eventscand}id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  15. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    International Nuclear Information System (INIS)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo

    2011-01-01

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39±15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI eventscan) . Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI eventscand id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  16. The impact of the opioids fentanyl and morphine on nociception and bone destruction in a murine model of bone cancer pain.

    NARCIS (Netherlands)

    ElMouedden, M.; Meert, T.F.

    2007-01-01

    Chronic pain resulting from metastasis into skeleton of certain neoplastic diseases remains poorly understood and relatively resistant to analgesic treatment. Opioids are the principal axis in drug therapy for this type of pain, especially at the end stage of cancer. Our aim was to examine whether,

  17. Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain.

    Science.gov (United States)

    Steele, James; Fisher, James; Perrin, Craig; Conway, Rebecca; Bruce-Low, Stewart; Smith, Dave

    2018-01-12

    Secondary analysis of data from studies utilising isolated lumbar extension exercise interventions for correlations among changes in isolated lumbar extension strength, pain, and disability. Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention ≥ four weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as "met" or "not met" based on minimal clinically important changes and between groups comparisons conducted. Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r = -0.391 to -0.539, all p Disability Index pooled analysis showed significant weak correlations (r = -0.349 to -0.470, all p disability, isolated lumbar extension strength changes were greater for those "met" compared with those "not met" (p disability. This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability. Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.

  18. Clinical characteristics of patients with suspected cardiac chest pain and angiographically normal coronary arteries in a secondary care hospital.

    Science.gov (United States)

    de Lange, T S; Tijssen, R Y G; Damman, P; van Bergen, P F M M

    2017-06-01

    An important number of patients with suspected cardiac chest pain have non-obstructive coronary artery disease. Our purpose was to describe the clinical characteristics of patients with normal or near-normal coronary arteries in routine cardiological practice in a secondary care hospital. In 2013, consecutive patients referred for invasive coronary angiography with suspected cardiac chest pain were analysed at a single-centre (Westfriesgasthuis, Hoorn, the Netherlands). Coronary arteries were defined as normal or near-normal if they showed no stenosis or only slight wall irregularities on visual assessment. Patients with a final non-cardiac diagnosis for the chest pain were excluded. A total of 558 patients were included. Of these, 151 (27%) showed normal or near-normal coronary arteries on visual assessment. This group of patients were significantly more often female (p normal or near-normal coronary arteries at coronary angiography showed an elevated troponin. In routine cardiological practice, around 1 out of 4 patients with suspected cardiac chest pain undergoing invasive angiography had normal or near-normal coronary arteries. We suggest that premenopausal women with suspected cardiac chest pain could be considered for non-invasive coronary imaging as a first step in clinical practice.

  19. Zoledronic acid improves bone mineral density, reduces bone turnover and improves skeletal architecture over 2 years of treatment in children with secondary osteoporosis

    DEFF Research Database (Denmark)

    Simm, Peter J; Johannesen, Jesper; Briody, Julie

    2011-01-01

    There are limited data on the use of bisphosphonate therapy for secondary osteoporoses in childhood, and no previous reports of the use of zoledronic acid in this group. We report 20 children with a variety of underlying primary diagnoses with associated secondary osteoporosis, who were treated...

  20. Repeated administration of mazindol reduces spontaneous pain-related behaviors without modifying bone density and microarchitecture in a mouse model of complete Freund's adjuvant-induced knee arthritis.

    Science.gov (United States)

    Robledo-González, L E; Martínez-Martínez, A; Vargas-Muñoz, V M; Acosta-González, R I; Plancarte-Sánchez, R; Anaya-Reyes, M; Fernández Del Valle-Laisequilla, C; Reyes-García, J G; Jiménez-Andrade, J M

    2017-01-01

    The role of dopaminergic system in the development of rheumatoid arthritis-related pain, a major symptom in this disease, has not been explored. Therefore, the anti-nociceptive effect of mazindol, a dopamine uptake inhibitor, was evaluated in a model of complete Freund's adjuvant (CFA)-induced arthritis. Furthermore, as studies have shown that the dopaminergic system regulates bone metabolism, the effect of mazindol on bone mass and microarchitecture was determined. Adult ICR male mice received intra-articular injections of either CFA or saline into the right knee joint every week. Spontaneous pain-like behaviors (flinching and guarding) and locomotor activity were assessed at day 26 post-first CFA, following which, a single intraperitoneally (i.p.) administered dose of mazindol was given (1, 3 and 10 mg/kg). Then, the antinociceptive effect of a repeated administration of 3 mg/kg mazindol (daily, i.p.; day 15-day 26) was evaluated. Additionally, at day 26, the participation of D1-like, D2-like or opioid receptors in the antinociceptive effect of mazindol was evaluated. The effect of mazindol on bone density and microarchitecture was evaluated by micro-computed tomography. Acute administration of mazindol decreased the spontaneous pain-like behaviors in a dose-dependent manner without reducing the knee edema. However, mazindol at 10 mg/kg significantly increased the locomotor activity; therefore, 3 mg/kg mazindol was used for further studies. Repeated administration of 3 mg/kg mazindol significantly decreased the pain-like behaviors without modifying locomotor activity. The antinociceptive effect of mazindol was blocked by administration of a D2-like receptor antagonist (haloperidol), but not by administration of D1-like receptor antagonist (SCH 23390) or an opioid receptor antagonist (naloxone). Repeated administration of mazindol did not significantly modify the density and microarchitecture of periarticular bone of the arthritic and nonarthritic knee joints

  1. Hospital visits among women with skeletal-related events secondary to breast cancer and bone metastases: a nationwide population-based cohort study in Denmark

    Directory of Open Access Journals (Sweden)

    Svendsen ML

    2013-03-01

    Full Text Available Marie Louise Svendsen,1 Henrik Gammelager,1 Claus Sværke,1 Mellissa Yong,2 Victoria M Chia,2 Christian F Christiansen,1 Jon P Fryzek1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Center for Observational Research, Amgen, Thousand Oaks, CA, USA Objective: Skeletal-related events (SREs among women with breast cancer may be associated with considerable use of health-care resources. We characterized inpatient and outpatient hospital visits in a national population-based cohort of Danish women with SREs secondary to breast cancer and bone metastases. Methods: We identified first-time breast cancer patients with bone metastases from 2003 through 2009 who had a subsequent SRE (defined as pathologic fracture, spinal cord compression, radiation therapy, or surgery to bone. Hospital visits included the number of inpatient hospitalizations, length of stay, number of hospital outpatient clinic visits, and emergency room visits. The number of hospital visits was assessed for a pre-SRE period (90 days prior to the diagnostic period, a diagnostic period (14 days prior to the SRE, and a post-SRE period (90 days after the SRE. Patients who experienced more than one SRE during the 90-day post-SRE period were defined as having multiple SREs and were followed until 90 days after the last SRE. Results: We identified 569 women with SREs secondary to breast cancer with bone metastases. The majority of women had multiple SREs (73.1%. A total of 20.9% and 33.4% of women with single and multiple SREs died in the post-SRE period, respectively. SREs were associated with a large number of hospital visits in the diagnostic period, irrespective of the number and type of SREs. Women with multiple SREs generally had a higher number of visits compared to those with a single SRE in the post-SRE period, eg, median length of hospitalization was 5 days (interquartile range 0–15 for women with a single SRE and 13 days (interquartile range 4

  2. Unexpected skeletal histology of an ichthyosaur from the Middle Jurassic of Patagonia: implications for evolution of bone microstructure among secondary aquatic tetrapods

    Science.gov (United States)

    Talevi, Marianella; Fernández, Marta S.

    2012-03-01

    During the Mesozoic, one of the most significant evolutionary processes was the secondary adaptation of tetrapods to life in water. Several non-related lineages invaded from the terrestrial realms and from the oceans of the entire world. Among these lineages, ichthyosaurs were particularly successful. Advance parvipelvian ichthyosaurs were the first tetrapods to evolve a fish-shaped body profile. The deep skeletal modifications of their bodies, as well as their biology, depict advance ichthyosaurs as the paradigm of secondary adaptation of reptiles to marine life. Functional inferences point to them as off-shore cruising forms, similar to a living tuna, and some of them were capable of deep diving. Bone histology of some genera such as Temnodontosaurus, Stenopterygius, Ichthyosaurus, and Caypullisaurus, characterized by overall cancellous bone, is consistent with the idea of a fish-shaped ichthyosaurs as fast and far cruisers. Here, we provide histological examination of the ribs of the Middle Jurassic parvipelvian Mollesaurus. Contrasting with the bone histology of other parvipelvian, Mollesaurus ribs are characterized by a compact and thick cortex. Our data indicate that the rib cage was heavy and suggest that not all advanced ichthyosaurs were fast cruisers. The compact and dense ribs in these parvipelvian show that advance ichthyosaurs were ecologically more diverse than previously thought and that the lightening of the skeleton reversed, as also occurred in the evolution of cetacean, at least once along the evolutionary history of ichthyosaurs.

  3. Zoledronic acid improves bone mineral density, reduces bone turnover and improves skeletal architecture over 2 years of treatment in children with secondary osteoporosis

    DEFF Research Database (Denmark)

    Simm, Peter J; Johannesen, Jesper; Briody, Julie

    2011-01-01

    There are limited data on the use of bisphosphonate therapy for secondary osteoporoses in childhood, and no previous reports of the use of zoledronic acid in this group. We report 20 children with a variety of underlying primary diagnoses with associated secondary osteoporosis, who were treated w...... with 3 monthly zoledronic acid for 2 years (annualised dose 0.1mg/kg/year). There was a significant improvement in lumbar spine (by 1.88 SD±1.24 over first 12 months, p......There are limited data on the use of bisphosphonate therapy for secondary osteoporoses in childhood, and no previous reports of the use of zoledronic acid in this group. We report 20 children with a variety of underlying primary diagnoses with associated secondary osteoporosis, who were treated...

  4. Cancer treatment - dealing with pain

    Science.gov (United States)

    Palliative - cancer pain ... The pain from cancer can have a few different causes: The cancer. When a tumor grows it can press ... nerves, bones, organs, or the spinal cord, causing pain. Medical tests. Some medical tests, such as a ...

  5. Bone pain or tenderness

    Science.gov (United States)

    McCormack RG, Lopez CA. Commonly encountered fractures in sports medicine. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

  6. Analogue-digital conversion in order to evaluate long-term changes in uptake of isotopes in bone scintigraphy of secondary hyperparathyroidism

    International Nuclear Information System (INIS)

    Iida, Akihiko

    1994-01-01

    An analogue-digital conversion was developed, thereby allowing the incorporation of whole-body bone scintigrams, obtained by a gamma camera, into digital data via the video camera and then allowing the processing of the incorporated digital data. Using the new method, 18 hemodialysis patients, who were voluntarily selected from those who had undergone bone scintigraphy with 99m Tc-HMDP for secondary hyperparathyroidism, were examined to determine serial changes in tracer uptake. The mean duration of hemodialysis was 6. 3 years (immediately up to 25.2 years). The tracer count ratio of the central part of the skull to the lower part of the sternum correlated most well with C-PTH. The analogue-digital conversion was found to yield a slightly higher value for the above-mentioned ratio than the original data; however, there was a good correlation between the analogue-digital conversion and original data. (N.K.)

  7. Pain and Nociception

    DEFF Research Database (Denmark)

    Falk, Sarah; Dickenson, Anthony H

    2014-01-01

    Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditiona...... spinal cord mechanisms of sensitization, and finally address central processing. Our aim is to provide a mechanistic background for the sensory characteristics of cancer-induced bone pain as a basis for better understanding and treating this condition.......Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditional...... therapies are often only partially effective. Until recently, knowledge of cancer pain mechanisms was poor compared with understanding of neuropathic and inflammatory pain states. We now view cancer-induced bone pain as a complex pain state involving components of both inflammatory and neuropathic pain...

  8. Cancer Pain Physiology

    DEFF Research Database (Denmark)

    Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony

    2014-01-01

    Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells. This ...

  9. Identifying Patients With Chronic Low Back Pain Who Respond Best to Mechanical Diagnosis and Therapy: Secondary Analysis of a Randomized Controlled Trial.

    Science.gov (United States)

    Garcia, Alessandra Narciso; Costa, Luciola da Cunha Menezes; Hancock, Mark; Costa, Leonardo Oliveira Pena

    2016-05-01

    "Mechanical Diagnosis and Therapy" (MDT) (also known as the McKenzie method), like other interventions for low back pain (LBP), has been found to have small effects for people with LBP. It is possible that a group of patients respond best to MDT and have larger effects. Identification of patients who respond best to MDT compared with other interventions would be an important finding. The purpose of the study was to investigate whether baseline characteristics of patients with chronic LBP, already classified as derangement syndrome, can identify those who respond better to MDT compared with Back School. This study was a secondary analysis of data from a previous trial comparing MDT with Back School in 148 patients with chronic LBP. Only patients classified at baseline assessment as being in the directional preference group (n=140) were included. The effect modifiers tested were: clear centralization versus directional preference only, baseline pain location, baseline pain intensity, and age. The primary outcome measures for this study were pain intensity and disability at the end of treatment (1 month). Treatment effect modification was evaluated by assessing the group versus predictor interaction terms from linear regression models. Interactions ≥1.0 for pain and ≥3 for disability were considered clinically important. Being older met our criteria for being a potentially important effect modifier; however, the effect occurred in the opposite direction to our hypothesis. Older people had 1.27 points more benefit in pain reduction from MDT (compared with Back School) than younger participants after 1 month of treatment. The sample (n=140) was powered to detect the main effects of treatment but not to detect the interactions of the potential treatment effect modifiers. The results of the study suggest older age may be an important factor that can be considered as a treatment effect modifier for patients with chronic LBP receiving MDT. As the main trial was not

  10. Barriers to Physical Activity in Low Back Pain Patients following Rehabilitation: A Secondary Analysis of a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Andrea Schaller

    2017-01-01

    Full Text Available Background. Promoting health-enhancing physical activity following rehabilitation is a well-known challenge. This study analysed the barriers to leisure time activity among low back pain patients. Methods. A subset of 192 low back pain patients who participated in a randomized controlled trial promoting physical activity was analysed. Physical activity, barriers, and sociodemographic and indication-related variables were assessed by a questionnaire. Differences in barriers between active and inactive participants were tested by Pearson’s chi squared test. A logistic regression model was fitted to identify influencing factors on physical activity at six months following rehabilitation. Results. Inactive and active participants differed significantly in nine of the 19 barriers assessed. The adjusted regression model showed associations of level of education (OR = 5.366 [1.563; 18.425]; p value = 0.008 and fear of pain (OR = 0.612 [0.421; 0.889]; p value = 0.010 with physical activity. The barriers included in the model failed to show any statistically significant association after adjustment for sociodemographic factors. Conclusions. Low back pain patients especially with a low level of education and fear of pain seem to need tailored support in overcoming barriers to physical activity. This study is registered at German Clinical Trials Register (DRKS00004878.

  11. Lifestyle Advice and Self-Care Integral to Acupuncture Treatment for Patients with Chronic Neck Pain: Secondary Analysis of Outcomes Within a Randomized Controlled Trial.

    Science.gov (United States)

    MacPherson, Hugh; Elliot, Ben; Hopton, Ann; Lansdown, Harriet; Birch, Stephen; Hewitt, Catherine

    2017-03-01

    Lifestyle advice is widely considered as an integral component of acupuncture treatment. However, it is unclear whether lifestyle advice and related self-care are important for sustaining benefit over the longer term. In a novel secondary analysis of trial data, this paper explores the nature and impact of acupuncture-related diagnosis, and associated lifestyle advice and self-care, in patients with chronic neck pain. In a three-arm, randomized, controlled multicenter trial with 12 months of follow-up, a total of 517 patients with chronic neck pain were randomized in equal proportions to acupuncture, Alexander technique, or usual care alone. For each acupuncture patient, practitioners reported treatment components that included an acupuncture-related diagnosis and provision of associated lifestyle advice. Patients reported at baseline, 3, 6, and 12 months on variables related to treatment, which included aspects of self-care, self-efficacy, and lifestyle advice acted upon, as well as pain and disability scores. Congruence between practitioner advice and patient take-up was assessed using chi-squared test. Impact of lifestyle advice and self-efficacy on outcome was evaluated using regression models. Among patients randomized to acupuncture, the most common diagnostic framework involved the Zang-Fu syndromes for 139/160 (87%) patients. Lifestyle advice was provided by practitioners to 134/160 (84%) of patients, most commonly related to exercise, relaxation, diet, rest, and work. Significant congruence with patient take-up was found for diet, rest, and work. Moreover, patients in the acupuncture group improved their ability to use what they had learnt and increased their self-efficacy. In turn, these characteristics were associated with significant reductions in pain and disability scores at 12 months. Acupuncture-related lifestyle advice helped patients improve the way they live and care for themselves and enhanced self-efficacy and ability to use what they had

  12. When physiology becomes pathology: the role of magnetic resonance imaging in evaluating bone marrow oedema in the humerus in elite tennis players with an upper limb pain syndrome.

    Science.gov (United States)

    Hoy, G; Wood, T; Phillips, N; Connell, D; Hughes, D C

    2006-08-01

    Upper limb stresses are well recognised in tennis, and the normal physiological responses of the humerus to externally applied forces are well defined. Changes to both the microscopic and macroscopic bony architecture are often not apparent on plain radiographs in the early stages of a stress reaction. Bone scintigraphy is more sensitive, but not very specific to subtle changes, as is computer aided tomography. Magnetic resonance imaging (MRI) scans are now used to assess many musculoskeletal injuries, and may allow earlier recognition of changes. This study reports on eight high level tennis players (seven professionals, one highly ranked amateur), who all presented during the course of the 2002 Australian Open and its lead up events. All had an upper limb pain syndrome centred around the elbow. Each underwent an MRI scan. A group of asymptomatic players also had scans of the same area to serve as controls. All symptomatic patients had various levels of bone marrow oedema in their distal humerus, some with periosteal reactions, although most without. No scans revealed a cortical breach. The management of these reactions is problematic in players on an international circuit, as review is sporadic and not always coordinated. The timetabling of international tournaments means it is difficult for top players to obtain adequate rest to avoid injury. Awareness of this early overuse reaction needs to be raised to allow preventive and therapeutic options to be considered to reduce the incidence of this humeral stress response producing an upper limb pain syndrome.

  13. Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial.

    Science.gov (United States)

    Neri, Elena; Maestro, Alessandra; Minen, Federico; Montico, Marcella; Ronfani, Luca; Zanon, Davide; Favret, Anna; Messi, Gianni; Barbi, Egidio

    2013-09-01

    To assess the effectiveness of sublingual ketorolac versus sublingual tramadol in reducing the pain associated with fracture or dislocation of extremities in children. A double-blind, randomised, controlled, non-inferiority trial was conducted in the paediatric emergency department of a research institute. One hundred and thirty-one children aged 4-17 years with suspected bone fracture or dislocation were enrolled. Eligible children were randomised to ketorolac (0.5 mg/kg) and placebo, or to tramadol (2 mg/kg) and placebo by sublingual administration, using a double-dummy technique. Pain was assessed by the patients every 20 min, for a maximum period of 2 h, using the McGrath scale for patients up to 6 years of age, and the Visual Analogue Scale for those older than 6 years of age. The mean pain scores fell significantly from eight to four and five in the ketorolac and tramadol groups, respectively, by 100 min (Wilcoxon sign rank test, p<0.001). The mean pain scores for ketorolac were lower than those for tramadol, but these differences were not significant at any time point (Mann-Whitney U Test, p values: 0-20 min: 0.167; 20-40 min: 0.314; 40-60 min: 0.223; 60-80 min: 0.348; 80-100 min: 0.166; 100-120 min: 0.08). The rescue dose of paracetamol-codeine was administered in 2/60 children in the ketorolac group versus 8/65 in the tramadol group (Fisher exact test, p=0.098). There were no statistically significant differences between the two groups in the frequency of adverse effects. Both sublingual ketorolac and tramadol were equally effective for pain management in children with suspected fractures or dislocations.

  14. P2Y12 receptor-mediated activation of spinal microglia and p38MAPK pathway contribute to cancer-induced bone pain

    Directory of Open Access Journals (Sweden)

    Liu MJ

    2017-02-01

    Full Text Available Mingjuan Liu,1 Ming Yao,1,2 Hanqi Wang,1 Longsheng Xu,1 Ying Zheng,1 Bing Huang,1 Huadong Ni,1 Shijie Xu,1 Xuyan Zhou,1 Qingquan Lian2 1Department of Anesthesiology and Pain Medicine, The First Hospital of Jiaxing, The First Affiliated Hospital of Jiaxing University, Jiaxing, 2Department of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China Background: Cancer-induced bone pain (CIBP is one of the most challenging clinical problems due to a lack of understanding the mechanisms. Recent evidence has demonstrated that activation of microglial G-protein-coupled P2Y12 receptor (P2Y12R and proinflammatory cytokine production play an important role in neuropathic pain generation and maintenance. However, whether P2Y12R is involved in CIBP remains unknown.Methods: The purpose of this study was to investigate the role of P2Y12R in CIBP and its molecular mechanisms. Using the bone cancer model inoculated with Walker 256 tumor cells into the left tibia of Sprague Dawley rat, we blocked spinal P2Y12R through intrathecal administration of its selective antagonist MRS2395 (400 pmol/µL, 15 µL.Results: We found that not only the ionized calcium-binding adapter molecule 1 (Iba-1-positive microglia in the ipsilateral spinal cord but also mechanical allodynia was significantly inhibited. Furthermore, it decreased the phosphorylation of p38 mitogen-activated protein kinase (p38 MAPK and the production of proinflammatory cytokines interleukin-1β (IL-1β and interleukin-6 (IL-6, whereas it increased tumor necrosis factor-α (TNF-α.Conclusion: Taken together, our present results suggest that microglial P2Y12R in the spinal cord may contribute to CIBP by the activation of spinal microglia and p38MAPK pathway, thus identifying a potential therapeutic target for the treatment of CIBP. Keywords: P2Y12 receptor, cancer-induced bone pain, p38MAPK pathway, cytokines

  15. Causes of secondary headache (image)

    Science.gov (United States)

    Temporomandibular joint, or TMJ, dysfunction, can be a cause of secondary headache. Secondary headaches result from underlying disorders which produce pain as a symptom. The TMJ may become painful and dysfunctional as a result ...

  16. Disorders of Bone Mineral Density and Secondary Osteoporosis in Pathology of Hepatobiliary System and Gastrointestinal Tract: at the Crossing of Problems

    Directory of Open Access Journals (Sweden)

    I.Yu. Golovach

    2012-08-01

    Full Text Available This review article covers the issues of development of osteoporosis and disorders of bone mineral density in patients with various gastroenterological and hepatobiliary diseases. The article emphasized that the osteoporosis may be associated with many somatic diseases, especially of the digestive tract. Such situation requires participation of therapeutists and gastroenterologists in rehabilitation health care programs. According to the practical guidelines of the World Organization of Gastroenterology (OMGE, 2004 list of chronic diseases of the digestive system triggering the dangerous development of osteoporosis includes short bowel syndrome, postgastrectomy syndrome, inflammatory bowel disease, celiac disease, cholestatic liver disease, as well as glucocorticoid-induced osteoporosis. The etiology and pathogenesis of lower bone mineral density in patients with chronic diseases of the digestive system include, besides population-based risk factors, processes associated with disorders of vitamin D conversion, which leads to reduction of the absorption of calcium, magnesium and phosphorus in the intestine and increase of their excretion by the kidneys. Hypocalcemia results in activation of the parathyroid glands and secondary hyperparathyroidism, and against the background of chronic inflammation increases the activity of cytokines, in particular tumor necrosis factor α and interleukins-1, -6, having bone resorptive action. The main risk factors for osteoporosis for various diseases associated with the peculiarities of the digestive tract’ disease were identified.

  17. The importance of BMI in dosimetry of 153Sm-EDTMP bone pain palliation therapy: A Monte Carlo study

    International Nuclear Information System (INIS)

    Fallahpoor, Maryam; Abbasi, Mehrshad; Asghar Parach, Ali; Kalantari, Faraz

    2017-01-01

    Using digital phantoms as an atlas compared to acquiring CT data for internal radionuclide dosimetry decreases patient overall radiation dose and reduces the required analysis effort and time for organ segmentation. The drawback is that the phantom may not match exactly with the patient. We assessed the effect of varying BMIs on dosimetry results for a bone pain palliation agent, 153 Sm-EDTMP. The simulation was done using the GATE Monte Carlo code. Female XCAT phantoms with the following different BMIs were employed: 18.6, 20.8, 22.1, 26.8, 30.3 and 34.7 kg/m 2 . S-factors (mGy/MBq.s) and SAFs (kg −1 ) were calculated for the dosimetry of the radiation from major source organs including spine, ribs, kidney and bladder into different target organs as well as whole body dosimetry from spine. The differences in dose estimates from different phantoms compared to those from the phantom with BMI of 26.8 kg/m 2 as the reference, were calculated for both gamma and beta radiations. The relative differences (RD) of the S-factors or SAFs from the values of reference phantom were calculated. RDs greater than 10% and 100% were frequent in radiations to organs for photon and beta particles, respectively. The relative differences in whole body SAFs from the reference phantom were 15.4%, 7%, 4.2%, −9.8% and −1.4% for BMIs of 18.6, 20.8, 22.1, 30.3 and 34.7 kg/m 2 , respectively. The differences in whole body S-factors for the phantoms with BMIs of 18.6, 20.8, 22.1, 30.3 and 34.7 kg/m 2 were 39.5%, 19.4%, 8.8%, −7.9% and −4.3%, respectively. The dosimetry of the gamma photons and beta particles changes substantially with the use of phantoms with different BMIs. The change in S-factors is important for dose calculation and can change the prescribed therapeutic dose of 153 Sm-EDTMP. Thus a phantom with BMI better matched to the patient is suggested for therapeutic purposes where dose estimates closer to those in the actual patient are required. - Highlights: • Internal

  18. Early secondary closure of alveolar clefts with mandibular symphyseal bone grafts and beta-tri calcium phosphate (beta-TCP).

    NARCIS (Netherlands)

    Weijs, W.L.J.; Siebers, T.J.H.; Kuijpers-Jagtman, A.M.; Berge, S.J.; Meijer, G.J.; Borstlap, W.A.

    2010-01-01

    Alveolar reconstruction of bony defects in cleft lip and palate patients is a widely accepted treatment regimen for which multiple donor sites can be used. For 25 years, autogeneous bicortical mandibular symphyseal bone grafts have been used at the authors' centre. In cases in which the alveolar

  19. Music in Reducing Anxiety and Pain in Adult Patients Undergoing Bone Marrow Biopsy for Hematologic Cancers or Other Diseases

    Science.gov (United States)

    2017-05-25

    Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Psychosocial Effects of Cancer and Its Treatment

  20. Secondary Patellar Resurfacing as a Rescue Procedure for Persistent Anterior Knee Pain After Primary Total Knee Arthroplasty: Do Our Patients Really Improve?

    Science.gov (United States)

    Toro-Ibarguen, Ainhoa Nekane; Navarro-Arribas, Rafael; Pretell-Mazzini, Juan; Prada-Cañizares, Alfonso Carlos; Jara-Sánchez, Fernando

    2016-07-01

    Secondary patellar resurfacing (SPR) is a procedure that can be used in patients with persistent anterior knee pain (AKP) after a primary total knee arthroplasty. The aim of our study was to analyze the clinical and functional outcomes as well as the complications of this procedure and identify predictive factors for a favorable outcome. Forty-six patients who underwent SPR for persistent AKP after primary total knee arthroplasty were retrospectively studied. The patient's mean age was 68 years (range, 36-86 years). The average follow-up time after SPR was 74 months (range, 24-197 months). Demographic data, Knee Society Score scale, range of motion, pain improvement (Visual Analogue Scale), overall satisfaction, and complications were recorded. The statistical analysis was performed using STATA tm/SE v10. There was an improvement of the Knee Society scale (from 54 ± 11 to 64 ± 16 points; P pain improvement, and 65% of patients were not satisfied. Four patients showed complications, and in 2 cases, reoperation was necessary. We did not find any preoperative predictive factor for a favorable outcome after SPR. Despite improvement of the Knee Society scale, many patients continue with AKP and are dissatisfied with this procedure; therefore, we do not recommend it in this clinical scenario. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Monostotic fibrous dysplasia of a lumbar vertebral body with secondary aneurysmal bone cyst formation: a case report

    NARCIS (Netherlands)

    Snieders, N.M.E.; Kemenade, van F.J.; Royen, van B.J.

    2009-01-01

    We report the case of a 25-year-old Caucasian woman with symptomatic monostotic fibrous dysplasia of the fourth lumbar vertebral body. The patient suffered from a five-week history of progressive low back pain, radiating continuously to the left leg. Her medical history and physical and neurological

  2. External beam radiotherapy for palliation of pain from metastatic carcinoma of the prostate

    International Nuclear Information System (INIS)

    Benson, R.C. Jr.; Hasan, S.M.; Jones, A.G.; Schlise, S.

    1982-01-01

    Radiotherapy often is used for palliation of bone pain from metastatic cancer of the prostate but an objective evaluation of its efficacy in a large series of patients is unavailable. We report the results of external beam irradiation in 62 patients who had bone pain secondary to stage D carcinoma of the prostate. The variables used to judge pain before and after radiotherapy included subjective evaluation of pain, status of activity and quantitation of analgesic use. Complete relief of pain was achieved in 26 patients (42 per cent), partial relief in 22 (35 per cent) and no relief in 14 (23 per cent). On the basis of our experience external beam irradiation is useful palliative therapy for pain from metastatic cancer of the prostate

  3. Effects of low back pain and of stabilization or movement-system-impairment treatments on induced postural responses: A planned secondary analysis of a randomised controlled trial.

    Science.gov (United States)

    Jacobs, Jesse V; Lomond, Karen V; Hitt, Juvena R; DeSarno, Michael J; Bunn, Janice Y; Henry, Sharon M

    2016-02-01

    Motor retraining for non-specific chronic low back pain (LBP) often focuses on voluntary postural tasks. This training, however, may not transfer to other known postural impairments, such as automatic postural responses to external perturbations. To evaluate the extent current treatments of motor retraining ameliorate impaired postural coordination when responding to a perturbation of standing balance. Planned secondary analysis of a prospectively registered (NCT01362049), randomized controlled trial with a blinded assessor. Sixty-eight subjects with chronic, recurrent, non-specific LBP were allocated to perform a postural response task as a secondary assessment one week before and one week after receiving either stabilization or Movement System Impairment (MSI)-directed treatment over 6 weekly 1-h sessions plus home exercises. For assessment, subjects completed the Oswestry disability and numeric pain rating questionnaires and then performed a postural response task of maintaining standing balance in response to 3 trials in each of 4 randomly presented directions of linear surface translations of the platform under the subjects' feet. Integrated amplitudes of surface electromyography (EMG) were recorded bilaterally from the rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles during the postural response task. No significant effects of treatment on EMG responses were evident. Oswestry and numeric pain ratings decreased similarly following both treatments. Stabilization and MSI-directed treatments do not affect trunk EMG responses to perturbations of standing balance in people with LBP, suggesting current methods of motor retraining do not sufficiently transfer to tasks of reactive postural control. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Zoledronic acid treatment for cancerous bone metastases: a phase IV study in Taiwan

    Directory of Open Access Journals (Sweden)

    Po-Hui Chiang

    2013-01-01

    Full Text Available Aim of study: To investigate the features, adverse effects, bone marker changes in patients with breast cancer, prostate cancer, and multiple myeloma with bone metastases under Zometa® therapy. Materials and Methods: This post-marketing study included 414 Taiwanese patients with bone metastases secondary to breast cancer, prostate cancer, or multiple myeloma who received Zometa® for 48 weeks. The patients′ characteristics, medication and adverse events were recorded, meanwhile changes in four serum bone metabolic markers and pain reduction were assessed every three months for one year. Results: A total of 3,711 doses of Zometa® were infused, accounting for 294.5 patient-years. Adverse events occurred in 9.4% of patients, with bone pain, insomnia, constipation, and pyrexia as the most frequently reported. There was no osteonecrosis of the jaw. The incidence of skeletal-related events decreased significantly from 44.9% to 18.8%. Serum NTx, BAP, and TRACP5b steadily decreased to nadir at six months, but serum OPG was persistently elevated until the end of one year. The average decrease in pain score was 14.1, 14.3, and 16.7 for prostate cancer, breast cancer, and multiple myeloma patients, respectively. Conclusion: Zometa® can be safely administered in Taiwanese patients with bone metastases secondary to breast cancer, prostate cancer, and multiple myeloma. There are concomitant decreases in skeletal-related events and bone pain.

  5. [Nutritional or secondary hyperparathyroidism in a German shepherd litter].

    Science.gov (United States)

    Lourens, D C

    1980-06-01

    Nutritional or secondary hyperparathyroidism in a litter of German shepherd dogs is reported. The bitch lost interest in the litter 2 weeks post partum, the owner proceeded to feed the pups on a mainly meat diet (low in calcium) together with whole wheat bread (high in phosphate) until they were presented at Onderstepoort at the age of 6 weeks. Clinically the pups showed poor growth, posterior paresis and pain on palpation of the long bones. Radiological examination revealed decreased bone density and thickness of bone cortices. A diagnosis of nutritional or secondary hyperparathyroidism was made. The diet was corrected and in addition the pups were treated with a balanced supplement of calcium and phosphate with very good clinical response. The pathophysiology of nutritional or secondary hyperparathyroidism as well as ricketts and hypertrophic osteodystrophy as differential diagnoses are discussed.

  6. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D., E-mail: dfilippiadis@yahoo.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Anselmetti, G., E-mail: gc.anselmetti@fastwebnet.it [GVM Care and Research Maria Pia Hospital (Italy); Brountzos, E., E-mail: ebrountz@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Mavrogenis, A., E-mail: afm@otenet.gr; Papagelopoulos, P., E-mail: pjp@hol.gr [University General Hospital “ATTIKON”, A Orthopedic Clinic (Greece); Kelekis, N., E-mail: kelnik@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Martin, J.-B., E-mail: jbmartin@cird.ch [Centre Imaginerie Rive Droite & Gauche (Switzerland)

    2016-01-15

    PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.

  7. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

    International Nuclear Information System (INIS)

    Kelekis, A.; Filippiadis, D.; Anselmetti, G.; Brountzos, E.; Mavrogenis, A.; Papagelopoulos, P.; Kelekis, N.; Martin, J.-B.

    2016-01-01

    PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing

  8. Impact of Out-of-Pocket Expenditure on Physical Therapy Utilization for Nonspecific Low Back Pain: Secondary Analysis of the Medical Expenditure Panel Survey Data.

    Science.gov (United States)

    Dolot, Janet; Viola, Deborah; Shi, Qiuhu; Hyland, Matthew

    2016-02-01

    Physical therapy decreases low back pain, improves function, and may lead to decreased use of medical services. However, factors predicting physical therapy utilization for patients with low back pain are not well understood. The purpose of this study was to identify the impact of out-of-pocket expenditure on physical therapy utilization for US adults with nonspecific low back pain. This study was a secondary analysis of retrospective Medical Expenditure Panel Survey data. The participants were US adults with nonspecific low back pain. The outcome variable was the number of visits per episode of care. The research variable was out-of-pocket expenditure. Covariate variables were Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) component scores. Descriptive statistics and multiple linear regression analyses were performed. Three hundred fourteen adults met the inclusion criteria and submitted SF-12 scores, representing nearly 4 million adults. Out-of-pocket expenditure, physical component score, and the age-insurance category "18-64 years with public coverage only for all of the year or uninsured all of the year" negatively predicted visits per episode of care in the final regression model. Limitations of the study included use of a nonexperimental design, lack of information about symptom severity and content of physical therapy, and SF-12 scores were not taken coincidental with the episode of care. Out-of-pocket expenditure negatively predicts physical therapy utilization. More research is needed to identify all factors influencing physical therapy utilization so that effective health policies may be developed. © 2016 American Physical Therapy Association.

  9. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Meng H

    2015-08-01

    steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no advantage compared to local anesthetic alone. Keywords: chronic low back pain, spinal stenosis, epidural injections, steroids, local anesthetics 

  10. Patient Reported Outcomes After Radiation Therapy for Bone Metastases as a Function of Age: A Secondary Analysis of the NCIC CTG SC-Twenty-Three Randomized Trial.

    Science.gov (United States)

    Chow, Selina; Ding, Keyue; Wan, Bo Angela; Brundage, Michael; Meyer, Ralph M; Nabid, Abdenour; Chabot, Pierre; Coulombe, Genevieve; Ahmed, Shahida; Kuk, Joda; Dar, A Rashid; Mahmud, Aamer; Fairchild, Alysa; Wilson, Carolyn F; Wu, Jackson S Y; Dennis, Kristopher; DeAngelis, Carlo; Wong, Rebecca K S; Zhu, Liting; Chow, Edward

    2018-04-01

    To explore the age difference in response and patient-reported outcomes in patients with cancer having bone metastases undergoing palliative radiotherapy. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life (QOL) Bone Metastases module (QLQ-BM22), EORTC QOL Core-15-Palliative (QLQ-C15-PAL), and Dexamethasone Symptom Questionnaire (DSQ) before a single 8-Gy radiation treatment, on days 10 and 42 after treatment. Patient demographics, performance status, analgesic consumption, BM22, C15, and DSQ were compared with multivariant analysis between patients under 75 years and 75 years and older. Multiple linear regression models were used to assess the differences between age-groups, adjusting for baseline demographics and primary disease sites. There were 298 patients (170 male) with 209 (70%) less than 75 years of age. Most common primary cancer sites include lung, prostate, and breast. At baseline, younger patients had better performance status, consumed more analgesic, and reported worse scores in nausea, insomnia, and functional interference, while older patients more commonly had prostate cancer. There were no significant differences in the incidence of radiation-induced pain flare; response to radiation; changes from baseline for BM22, C15-PAL; and DSQ, nor overall survival at day 42 between the 2 groups. Responders to radiation in the elderly group reported better improvement in physical and emotional domains when compared with nonresponders. In patients with cancer having bone metastases undergoing palliative radiotherapy, there was no significant difference in general with age in response to radiation and patient-reported outcomes. Palliative radiotherapy should be offered to elderly patients when needed.

  11. Increased technetium-99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism: correlation with hyperphosphataemia.

    Science.gov (United States)

    Enevoldsen, Lotte Hahn; Heaf, James; Højgaard, Liselotte; Zerahn, Bo; Hasbak, Philip

    2017-03-01

    In bone scan patients with dialysis-treated chronic kidney disease (CKD) and hyperparathyroidism, soft tissue accumulation of technetium-99 m hydroxy/methylene diphosphonate (Tc-99 m-HDP/MDP) has been reported primarily in case reports and usually explained by hypercalcaemia and/or hyperphosphataemia. As human vascular smooth muscle cells produce hydroxyapatite during cell culture with increased phosphate levels and as Tc-99 m-HDP/MDP primarily binds to hydroxyapatite, we hypothesized that soft tissue accumulation would be found in patients with hyperphosphataemia. We identified 63 CKD patients diagnosed with secondary hyperparathyroidism admitted for Tc-99 m-HDP bone scan. Baseline characteristics and mean concentrations of biochemical markers (including P-calcium and P-phosphate) taken 0-3 months prior to the bone scans were collected. Soft tissue uptake was detected on bone scans in 37 of 63 (59%) patients. Primary locations were in the heart (27/37 = 73%), muscles (12/37 = 32%), lung (9/37 = 24%) and gastrointestinal tract (6/37 = 16%), and 13 of 37 (35%) patients had simultaneous uptake in more than one location. Regarding biochemical markers, patients with soft tissue uptake only differed from patients without in terms of plasma phosphate levels (1·95 ± 0·15 (n = 37) versus 1·27 ± 0·08 (n = 26), P = 0·0012). All patients with myocardial uptake (n = 27) had a coronary arteriography-verified history of coronary artery disease (CAD), whereas CAD was only present in six of the 36 patients without myocardial uptake. In conclusion, dialysis-treated CKD patients with secondary hyperparathyroidism have a high incidence of soft tissue uptake, and this finding is strongly correlated with elevated phosphate, but not calcium values. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  12. Current options for the treatment of Paget’s disease of the bone

    Directory of Open Access Journals (Sweden)

    Daniela Merlotti

    2009-07-01

    Full Text Available Daniela Merlotti, Luigi Gennari, Giuseppe Martini, Ranuccio NutiDepartment of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Siena, ItalyAbstract: Paget’s disease of bone (PDB is a chronic bone remodeling disorder characterized by increased osteoclast-mediated bone resorption, with subsequent compensatory increases in new bone formation, resulting in a disorganized mosaic of woven and lamellar bone at affected skeletal sites. This disease is most often asymptomatic but can be associated with bone pain or deformity, fractures, secondary arthritis, neurological complications, deafness, contributing to substantial morbidity and reduced quality of life. Neoplastic degeneration of pagetic bone is a relatively rare event, occurring with an incidence of less than 1%, but has a grave prognosis. Specific therapy for PDB is aimed at decreasing the abnormal bone turnover and bisphosphonates are currently considered the treatment of choice. These treatments are associated with a reduction in plasma alkaline phosphatase (ALP activity and an improvement in radiological and scintigraphic appearance and with a reduction in bone pain and bone deformity, Recently, the availability of newer, more potent nitrogen-containing bisphosphonates has improved treatment outcomes, allowing a more effective and convenient management of this debilitating disorder.Keywords: Paget’s disease of bone, bisphosphonates, aminobisphosphonates, bone remodeling

  13. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up

    NARCIS (Netherlands)

    de Jong, P. T.; Haverkamp, D.; van der Vis, H. M.; Marti, R. K.

    2006-01-01

    We evaluated the long-term results of 116 total hip replacements with a superolateral shelfplasty in 102 patients with osteoarthritis secondary to developmental dysplasia of the hip. After a mean follow-up of 19.5 years (11.5 to 26.0), 14 acetabular components (12%) had been revised. The cumulative

  14. A Retrospective Analysis of the First 41 mCRPC Patients with Bone Pain Treated with Radium-223 at the National Institute of Oncology in Hungary.

    Science.gov (United States)

    Küronya, Zs; Sinkovics, I; Ágoston, P; Bíró, K; Bodrogi, I; Böde, I; Dank, M; Gyergyay, F; Vajdics, T; Kolonics, Zs; Nagyiványi, K; Rúzsa, Á; Géczi, L

    2017-10-01

    Radium-223 dichloride is an alpha-emitting radiopharmaceutical which significantly prolongs overall survival in patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases. This was a retrospective analysis of the efficacy and safety of Radium-223 in the first 41 patients treated at a single center in Hungary. Radium-223 was given at a dose of 50 kBq/kg intravenously every 4 weeks for up to 6 cycles. Between 23rd July 2014 and 23rd February 2016, 41 patients were treated. Patient demographics, laboratory values, treatment outcomes and adverse events were collected from medical records. The mean age was 72.2 years (SD: 7.1). 24 patients received Radium-223 as first-line treatment (58%), 7 patients as second (17%), 3 as third (7.3%), 6 as (14.6%), and 1 as fifth-line therapy (2.4%). The mean number of cycles administered was 5.5 (SD: 1.1). The most common side effects were anemia (32% grade 1-3), nausea (28%, grade 1), diarrhea (4%, grade 2), thrombocytopenia (4%, grade 3). The mean baseline PSA level was 307.2 ng/ml (SD: 525.7), which increased to a mean value of 728.5 ng/ml (SD: 1277) by the end of treatment. The baseline mean ALP of 521.1 U/L (SD: 728) decreased to 245.1 U/L (SD: 283.5). The majority of patients experienced a decrease (37%) or complete cessation (43%) of bone pain intensity. In our symptomatic prostate cancer patient population, Radium-223 proved to be efficient in terms of pain relief, with moderate side effects. No PSA response was detected, while alkaline phosphatase levels significantly decreased.

  15. The effect of intra-articular injection of autologous bone marrow stem cells on pain and knee function in patients with osteoarthritis.

    Science.gov (United States)

    Garay-Mendoza, Domingo; Villarreal-Martínez, Laura; Garza-Bedolla, Alejandra; Pérez-Garza, Daniela M; Acosta-Olivo, Carlos; Vilchez-Cavazos, Felix; Diaz-Hutchinson, Cesar; Gómez-Almaguer, David; Jaime-Pérez, José C; Mancías-Guerra, Consuelo

    2018-01-01

    Management of osteoarthritis (OA) is basically symptomatic. Recently, stem cells (SC) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra-articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA. This was a prospective, open-label, phase I/II clinical trial to assess the safety and efficacy of a single intra-articular injection of autologous stimulated bone marrow stem cells (BM-SC) in patients with knee OA. Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G-CSF). SC were obtained by BM aspiration and administered in a single intra-articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT01485198. A total of 61 patients were included. Socio-demographic characteristics, OA grades and initial scores were similar in both groups. The BM-SC group showed significant improvement in knee pain and quality of life during the 6-month follow-up. The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  16. Incidence and anatomical variations of accessory navicular bone in patients with foot pain: A retrospective radiographic analysis.

    Science.gov (United States)

    Kalbouneh, Heba; Alajoulin, Omar; Alsalem, Mohammad; Humoud, Noor; Shawaqfeh, Jamil; Alkhoujah, Mohammad; Abu-Hassan, Hana; Mahafza, Waleed; Badran, Darwish

    2017-05-01

    The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patient's symptoms and prevent misinterpreting them as fractures. Foot radiographs from 1,240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender. The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2 A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development. Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. Clin. Anat. 30:436-444, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Changes in electrical pain threshold of fascia and muscle after initial and secondary bouts of elbow flexor eccentric exercise.

    Science.gov (United States)

    Lau, Wing Yin; Blazevich, Anthony J; Newton, Michael J; Wu, Sam Shi Xuan; Nosaka, Kazunori

    2015-05-01

    This study investigated changes in electrical pain threshold (EPT) after repeated eccentric exercise bouts to test the hypothesis that fascia would become more sensitive than muscle when greater delayed onset muscle soreness (DOMS) is induced. Ten young men performed two eccentric exercise bouts (ECC1, ECC2) consisting of ten sets of six maximal isokinetic eccentric contractions of the elbow flexors with the same arm separated by 4 weeks. Maximal voluntary isometric contraction torque, range of motion, muscle soreness assessed by a visual analogue scale (VAS) and pressure pain threshold (PPT) were measured before, immediately after and 1-5 days after exercise. EPT was assessed in the biceps brachii fascia (BBF), biceps brachii muscle, and brachialis fascia (BF) 1 day before, immediately after, and 1, 2 and 4 days after exercise. All measures showed smaller changes (P fascia becomes more sensitive than muscle to electrical stimulation after the initial eccentric exercise, suggesting that damage inflammation to fascia than muscle fibres is more associated with DOMS.

  18. Celecoxib enhances radiation response of secondary bone tumors of a human non-small cell lung cancer via antiangiogenesis in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Klenke, Frank Michael [Bern Univ. (Switzerland). Dept. of Orthopedic Surgery; Abdollahi, Amir [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Radiation Oncology; Tufts Univ. School of Medicine, Boston, MA (United States). Center of Cancer Systems Biology; Bischof, Marc; Huber, Peter E. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Radiation Oncology; Gebhard, Martha-Maria [Heidelberg Univ. (Germany). Dept. of Experimental Surgery; Ewerbeck, Volker [Heidelberg Univ. (Germany). Dept. of Orthopedic Surgery; Sckell, Axel [Charite Univ. Medical Center, Berlin (Germany). Dept. of Orthopedic, Trauma and Reconstructive Surgery

    2011-01-15

    Purpose: Cyclooxygenase-2 (COX-2) inhibitors mediate a systemic antitumor activity via antiangiogenesis and seem to enhance the response of primary tumors to radiation. Radiosensitizing effects of COX-2 inhibition have not been reported for bone metastases. Therefore, the aim of this study was the investigation of the radiosensitizing effects of the selective COX-2 inhibitor celecoxib in secondary bone tumors of a non-small cell lung carcinoma in vivo. Materials and Methods: Human A549 lung carcinomas were implanted into a cranial window preparation in male SCID mice (n = 24). Animals were treated with either celecoxib or radiation (7 Gy single photon dose) alone or a combination of celecoxib and radiation, respectively. Untreated animals served as controls. The impact of radiation and COX-2 inhibition on angiogenesis, microcirculation, and tumor growth was analyzed over 28 days by means of intravital microscopy and histological methods. Results: Monotherapies with radiation as well as celecoxib had significant antitumor effects compared to untreated controls. Both therapies reduced tumor growth and vascularization to a similar extent. The simultaneous administration of celecoxib and radiation further enhanced the antitumor and antiangiogenic effects of single-beam radiation. With the combined treatment approach, tumor vascularization and tumor size were decreased by 57% and 51%, respectively, as compared to monotherapy with radiation. Conclusion: The combined application of radiation therapy and COX-2 inhibition showed synergistic effects concerning the inhibition of tumor growth and tumor angiogenesis. Therefore, the combination of radiation with COX-2 inhibitor therapy represents a promising approach to improve the therapeutic efficacy of radiotherapy of bone metastases. (orig.)

  19. Inhibition of Breast Cancer-lnduced Bone Pain, Metastasis, and Osteolysis in Nude Mice by LOVAZA and DHA Fatty Acids

    Science.gov (United States)

    2012-10-01

    231BO breast cancer cells showed significant reduction of tumor cell invasion by eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Based on... eicosapentaenoic acid (EPA, 20:5 n-3) and docosahexaenoic acid (DHA, 22:6 n-3), protects against inflammation, osteoclastogenesis, bone loss, autoimmune... eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Cells (5 x 104) were plated on 24 well plate Matrigel inserts and allowed to transmigrate for 20

  20. Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

    Directory of Open Access Journals (Sweden)

    Phil Senter

    Full Text Available Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

  1. Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

    Science.gov (United States)

    Senter, Phil; Juengst, Sara L

    2016-01-01

    Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

  2. Human bone marrow-derived and umbilical cord-derived mesenchymal stem cells for alleviating neuropathic pain in a spinal cord injury model.

    Science.gov (United States)

    Yousefifard, Mahmoud; Nasirinezhad, Farinaz; Shardi Manaheji, Homa; Janzadeh, Atousa; Hosseini, Mostafa; Keshavarz, Mansoor

    2016-03-08

    Stem cell therapy can be used for alleviating the neuropathic pain induced by spinal cord injuries (SCIs). However, survival and differentiation of stem cells following their transplantation vary depending on the host and intrinsic factors of the cell. Therefore, the present study aimed to determine the effect of stem cells derived from bone marrow (BM-MSC) and umbilical cord (UC-MSC) on neuropathic pain relief. A compression model was used to induce SCI in a rat model. A week after SCI, about 1 million cells were transplanted into the spinal cord. Behavioral tests, including motor function recovery, mechanical allodynia, cold allodynia, mechanical hyperalgesia, and thermal hyperalgesia, were carried out every week for 8 weeks after SCI induction. A single unit recording and histological evaluation were then performed. We show that BM-MSC and UC-MSC transplantations led to improving functional recovery, allodynia, and hyperalgesia. No difference was seen between the two cell groups regarding motor recovery and alleviating the allodynia and hyperalgesia. These cells survived in the tissue at least 8 weeks and prevented cavity formation due to SCI. However, survival rate of UC-MSC was significantly higher than BM-MSC. Electrophysiological evaluations showed that transplantation of UC-MSC brings about better results than BM-MSCs in wind up of wide dynamic range neurons. The results of the present study show that BM-MSC and UC-MSC transplantations alleviated the symptoms of neuropathic pain and resulted in subsequent motor recovery after SCI. However, survival rate and electrophysiological findings of UC-MSC were significantly better than BM-MSC.

  3. A role for radiotherapy in neuropathic bone pain: preliminary response rates from a prospective trial (Trans-Tasman Radiation Oncology Group, TROG 96.05)

    International Nuclear Information System (INIS)

    Roos, Daniel E.; O'Brien, Peter C.; Smith, Jennifer G.; Spry, Nigel A.; Hoskin, Peter J.; Burmeister, Bryan H.; Turner, Sandra L.; Bernshaw, David M.

    2000-01-01

    Purpose: Radiotherapy (RT) has a proven role in palliation of pain from bone metastases with numerous randomized trials obtaining response rates (RRs) of typically 70-80% regardless of the fractionation employed. However RT for neuropathic bone pain (NBP), i.e., pain with a radiating cutaneous component due to compression/irritation of nerves by tumor has not previously been studied, and its role is thus uncertain. Methods and Materials: In February 1996, the Trans-Tasman Radiation Oncology Group (TROG) initiated a multicenter randomized trial comparing a single 8 Gy fraction with 20 Gy in 5 fractions for NBP with an accrual target of 270. Formal interim analyses were planned at 90 and 180 patients. The 90th patient was accrued in June 1998, and data from the first interim analysis with both arms combined form the basis of this report. Results: Forty-four patients were randomized to a single 8 Gy, 46 to 20 Gy in 5 fractions. The commonest primary sites were prostate (34%), lung (28%) and breast (10%). Median age was 68 years (range 37-89). The index site was spine (86%), rib (13%), base of skull (1%). On an intention-to-treat basis, the overall RR was 53/90 = 59% (95% CI = 48-69%), with 27% achieving a complete response and 32% a partial response. The overall RR for eligible patients was 49/81 = 60% (95% CI = 49-71%) with 27% and 33% achieving complete and partial responses respectively. Estimated median time to treatment failure was 3.2 months (95% CI = 2.1-5.1 months), with estimated median survival of 5.1 months (95% CI = 4.2-7.2 months). To date, six spinal cord/cauda equina compressions and four new or progressive pathological fractures have been detected at the index site after randomization, although one cord compression occurred before radiotherapy was planned to commence. In February 1999, the Independent Data Monitoring Committee strongly recommended continuation of the trial. Conclusion: Although these results are preliminary, it seems clear that there

  4. Comparative Therapeutic Efficacy of 153Sm-EDTMP and 177Lu-EDTMP for Bone Pain Palliation in Patients with Skeletal Metastases: Patients’ Pain Score Analysis and Personalized Dosimetry

    Directory of Open Access Journals (Sweden)

    Baljinder Singh

    2017-05-01

    Full Text Available IntroductionThe aim of the present study was to compare the therapeutic efficacy of 153Sm-EDTMP and 177Lu-EDTMP in pain palliation in cancer patients with skeletal metastases.Materials and methodsThirty patients (25 M:5 F, mean age: 66.0 ± 14.7 years of breast/prostate cancer with documented skeletal metastases were recruited prospectively. Twenty patients were considered randomly for treatment with 153Sm-EDTMP and with 177Lu-EDTMP in 10 patients, respectively. Using fixed dose of 37.0 MBq/kg body weight of each, the mean administered doses of 153Sm-EDTMP and 177Lu-EDTMP were 2,155.2 ± 419.6 MBq (1,347–2,857 and 1,935.1 ± 559.4 MBq (1,073–2,627, respectively. Anterior and posterior whole body images were acquired at different time points following radioactivity administration. The first data set of pre-void images (acquired at 0.5 h representing the total activity of either of 153Sm-EDTMP or 177Lu-EDTMP was considered as reference images. All the serial images were used for patients’ dosimetry analysis by using organ level internal dosimetry assessment algorithm. Reduction in pain scoring was assessed clinically over 8 weeks by using appropriate WHO criteria and correlated with the absorbed dose to the metastatic sites.ResultsA total of 86 metastatic lesions clearly visualized on post-therapy serial images (matching on bone scans were evaluated for absorbed dose calculations. Both 153Sm-EDTMP and 177Lu-EDTMP delivered similar absorbed dose to the metastatic sites, i.e., 6.22 ± 4.21 and 6.92 ± 3.92 mSv/MBq, respectively. The mean absorbed doses to various other organs were found to be comparable and within the safe limits. A complete response (CR for each radionuclide was evaluated as 80.0%. No significant alternation in blood parameters and no untoward reaction were observed. However, a mild to severe toxicity was observed in two patients (1 each with 153Sm-EDTMP and 177Lu-EDTMP. Kaplan

  5. The effect of simple local resection on pain and scoliotic curve in patients with scoliosis secondary to osteoid osteoma and osteoblastoma in the spine.

    Science.gov (United States)

    Balioğlu, Mehmet Bülent; Albayrak, Akif; Atıcı, Yunus; Sökücü, Sami; Tacal, Mehmet Temel; Kaygusuz, Mehmet Akif

    2016-01-01

    The aim of this study was assess the results of local resection without instrumentation in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma. The review of our database revealed 176 cases of osteoid osteomas and 18 of osteoblastomas. Painful scoliosis was seen in 5 out of 6 cases. The lesion was found on the posterior part of the apical vertebra in the concave side of the scoliotic curve. Surgical treatment consisted of simple en bloc excision. Mean period between diagnosis and operation was 2.6 years, mean age at the time of surgery was 12.5 years, and mean preoperative major Cobb angle was 37.2°. Four patients with a mean follow-up of 4.3 years were included in the study. At final follow-up, Cobb angle was 7.6°, and the average percentage of correction was 79.6%. Coronal decompensation was corrected by 87.7%. Pelvic tilt and shoulder imbalance were corrected by 15% and 74.5%, respectively. The preoperative mean Visual Analog Scale score was 9 before the treatment and 0 at the final follow-up. Our results suggested that simple en bloc resection may be a safe and effective treatment option in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma, if patient less than 16 years, with major Cobb angle less than 40°, and duration of complaint less than 22 months.

  6. Indications of 99mTc-MDP scintigraphy bone scan in the evaluation of painful hip arthroplasties

    International Nuclear Information System (INIS)

    Eder, V.; Baulieu, F.; Secchi, V.; Gautier, B.; Pottier, J.M.; Rosset, P.

    2000-01-01

    The purpose of this study was to determine the indication of bone scintigraphy in hip prosthesis complications. Thirty-six patients and 38 hip prosthesis have had a 99 Tc-MDP scintigraphy in our laboratory between 1995 and 1997. It concerns 32 cemented total prosthesis, 3 intermediate prosthesis and 3 non-cemented total prosthesis. For 14 prosthesis, complication (loosening or infection) was confirmed by surgical operation in 12 cases (4 isolated acetabular complications, 2 isolated femoral loosening, 3 global loosening and 3 infections) or by concordant data from different examinations in 2 cases (global loosening) where intervention was unrealizable. About other patients, absence of complication was confirmed by a favourable evolution lasting at least 12 months. A cetabular and femoral complications were detected by scintigraphy respectively with a sensitivity of 100 % and 90 %, a specificity of 85 % and 78 %, a PPV of 75 % and 60 % and NPV of 100 % and 96 %. High negative predictive value allows to eliminate a prosthesis complication in the case of a normal scintigraphy and to override decision when the clinic and the radiography are doubtful. Scintigraphy may recognize other bone fixation abnormalities which may be responsible of clinical symptomatology. (authors)

  7. Enhancing Quality of Life for Breast Cancer Patients with Bone Metastases

    National Research Council Canada - National Science Library

    Arrington, Sarah A; Allen, Matthew J; Damron, Timothy A; Mann, Kenneth A

    2007-01-01

    .... The current standard of care for treating osteolytic bone metastases includes palliating bone pain through radiation therapy and blocking ongoing osteoclastic bone resorption with a bisphosphonate...

  8. Cost-appropriateness of whole body vs limited bone imaging for suspected focal sports injuries

    Energy Technology Data Exchange (ETDEWEB)

    Nagle, C.E.

    1986-07-01

    Bone imaging has been recognized as a useful diagnostic tool in detecting the presence of focal musculoskeletal injury when radiographs are normal. A retrospective review of bone images in a small number of amateur athletes indicates that secondary injuries were commonly detected at sites different from the site of musculoskeletal pain being evaluated for injury. While a larger study will be necessary to confirm the data, this review suggests that it is medically justified and cost-appropriate to perform imaging of the entire skeleton as opposed to imaging limited to the anatomic site of pain and suspected injury.

  9. Painful procedures in children with cancer: comparison of moderate sedation and general anesthesia for lumbar puncture and bone marrow aspiration.

    Science.gov (United States)

    Iannalfi, Alberto; Bernini, Gabriella; Caprilli, Simona; Lippi, Alma; Tucci, Fabio; Messeri, Andrea

    2005-12-01

    The study was conducted to compare moderate sedation (MS) with general anesthesia (GA) in the management of frequently performed lumbar puncture or bone marrow aspiration (BMA) during the treatment of childhood cancer. The MS (14 patients for 30 procedures) was managed by non-anesthesiologists (combined nitrous oxide-midazolam +/- non-pharmacological techniques). The GA was managed by anesthesiologists (17 patients for 30 procedures). A neutral observer recorded side effects, use of sedative antagonists, recovery time, oncologist's evaluation, procedure behaviors check list (PBCL); subjective perceptions during the procedure with a questionnaire administered to children (>6 years) and their parents; drugs costs and professional resources. P-values compliance and cost-effectiveness as it relies on the contribution of non-pharmacological techniques. 2005 Wiley-Liss, Inc.

  10. [Hindfoot pain].

    Science.gov (United States)

    Damiano, Joël; Bouysset, Maurice

    2010-03-20

    The hindfoot is the part of the foot which is proximal to the midtarsal joint. The obvious causes of pain are not considered (post-traumatic etiologies, sprains and fractures but also cutaneous lesions). The main etiologies on the subject are successively exposed by following the localization of the pain. Diffuse pains (ankle arthritis tarsal osteoarthritis, algodystrophy, calcaneo-navicular synostosis but also bone diseases like stress fractures, Paget disease or tumors). Plantar talalgia (Sever's disease, plantar fasciitis and entrapment neuropathies such as (esions of the medial calcaneal nerve, of the first branch of the plantar lateral nerve, medial plantar nerve and lateral plantar nerve). Posterior pains: calcaneal tendinopathy including peritendinitis, tendinosis, retro-calcaneal bursitis and pathology of the postero-lateral talar tuberosity. Medial pains: tendinopathies of the posterior tibial tendon and tendinopathy of the flexor hallucis longus tendon and tarsal tunnel syndrome. Lateral pains: fibularis tendinopathies including split lesions of the fibularis brevis tendon, displacement of the fibularis iongus tendon, sinus tarsi syndrome and finally thickenings of capsules and ligaments and ossifications localized under the tibial malleoli. Anterior pains: antero-inferior tibio-fibular ligament, anterior tibial tendinopathy and anterior impingment syndrome.

  11. [Clinical-demographic factors associated with fear-avoidance in subjects with non-specific chronic low back pain in Primary Care: secondary analysis of intervention study].

    Science.gov (United States)

    Díaz-Cerrillo, Juan Luis; Rondón-Ramos, Antonio; Clavero-Cano, Susana; Pérez-González, Rita; Martinez-Calderon, Javier; Luque-Suarez, Alejandro

    2018-01-30

    To describe some sociodemographics and clinical characteristics of subjects with Non-specific Chronic Low Back Pain (NCLBP) in Primary Care, as well as to investigate their association with Fear-Avoidance (FA). Cross-sectional. Secondary analysis of an intervention study. Basic Health Areas in Costa del Sol Health District (Málaga, Spain). An analysis was performed on 147 subjects with NCLBP from a previous intervention study database in Primary Care Physiotherapy (PCP). Characteristics: age 18-65; understanding of the Spanish language; absence of cognitive disorders, fibromyalgia or dorsolumbar surgery, and to be able to perform physical exercise. The main variable was FA level (FABQ and the FABQ-PA and FABQ-W) sub-scales. Clinical variables included: pain (NRPS-11), disability (RMQ), evolution, previous treatments and diagnostic imaging. The sociodemographic variables included: gender, age, educational level, and employment status. Just over half (51.7%) of the subjects had high FA on the FABQ-PA sub-scale. Sick leave (SL) [β=24.45 (P=.009 * ); β=13.03 (P=.016 * ); β=14.04 (P=.011 * ) for FABQ, FABQ-PA and FABQ-W, respectively]; primary studies level [β=15.09 (P=.01 * ); β=9.73 (P=.01 * ) for FABQ and FABQ-PA], and disability [β=1.45 (P<.001); β=0.61 (P<.001); β=0.68 (P<.001) for FABQ, FABQ-PA and FABQ-W, respectively] were associated with FA when they were modeled by multivariate regression. Some sociodemographic and clinical features of the NCLBP population are presented. Imaging tests (81.63%) and previous passive treatments (55.78%) could reflect problems of adherence to recommendations of CPGs. Sick leave, primary studies level, and disability were associated with FA. The findings should be interpreted in the light of possible limitations. Some suggestions for clinical practice are provided. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. Study for Reliability of Interpretation of the Three Phase Bone Scintigraphy in Patients with Post-traumatic Complex Regional Pain Syndrome

    International Nuclear Information System (INIS)

    Park, Jung Mi; Kim, Seon Jung; Chung, Seung Hyun; Lee, Yong Taek

    2008-01-01

    We performed this study to evaluate reliability on interpretation of three phase bone scintigraphy (TPBS) in patients with post-traumatic complex regional pain syndrome (PT-CRPS). Based on International Association for the Study of Pain guideline in 1994, 34 patients with PT-CRPS were selected for this study. Two nuclear medicine physicians evaluated identical TPBS according to the uptake pattern, extent and intensity of the lesion, and their agreements (kappa values) were analysed. The final diagnosis based on arbitrary criteria of each physician were compared with those obtained by the criteria for PT-CRPS established in this study, which are hyperactivity on all phases (criteria 1), hyperactivity of whole joints on delayed pha