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Sample records for central post-stroke pain

  1. Analgesic effect of transcranial direct current stimulation on central post-stroke pain.

    Science.gov (United States)

    Bae, Sea-Hyun; Kim, Gi-Do; Kim, Kyung-Yoon

    2014-01-01

    Pain that occurs after a stroke lowers the quality of life. Such post-stroke pain is caused in part by the brain lesion itself, called central post-stroke pain. We investigated the analgesic effects of transcranial direct current stimulation (tDCS) in stroke patients through quantitative sensory testing. Fourteen participants with central post-stroke pain (7 female and 7 male subjects) were recruited and were allocated to either tDCS (n = 7) or sham-tDCS (n = 7) group. Their ages ranged from 45 to 55 years. tDCS was administered for 20 min at a 2-mA current intensity, with anodal stimulations were performed at primary motor cortex. The sham-tDCS group was stimulated 30-second current carrying time. Both group interventions were given for 3 days per week, for a period of 3 weeks. Subjective pain was measured using the visual analogue scale (VAS) of 0 to 10. Sensations of cold and warmth, and pain from cold and heat were quantified to examine analgesic effects. The sham-tDCS group showed no statistically significant differences in time. In contrast, tDCS group showed decreased VAS scores and skin temperature (p temperatures for the sense of cold and pain from cold increased (p heat decreased (p stroke patients with central post-stroke pain. PMID:25341455

  2. Population-based study of central post-stroke pain in Rimini district, Italy

    Directory of Open Access Journals (Sweden)

    Raffaeli W

    2013-09-01

    Full Text Available William Raffaeli,1 Cristina E Minella,2 Francesco Magnani,3 Donatella Sarti3 1ISAL Foundation, Institute for Research on Pain, Torre Pedrera, Rimini, Italy 2Pain Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 3Department of Pain Therapy and Palliative Care, Infermi Hospital, Rimini, Italy Abstract: Central post-stroke pain (CPSP is still an underestimated complication of stroke, resulting in impaired quality of life and, in addition to the functional and cognitive consequences of stroke, the presence of CPSP may be associated with mood disorders, such as depression, anxiety, and sleep disturbances. This type of pain may also impair activities of daily living and further worsen quality of life, negatively influencing the rehabilitation process. The prevalence of CSPS in the literature is highly variable (1%–12% according to different studies, and this variability could be influenced by selection criteria and the different ethnic populations being investigated. With this scenario in mind, we performed a population-based study to assess the prevalence of CPSP and its main features in a homogeneous health district (Rimini, Italy, including five hospitals for a total population of 329,970 inhabitants. From 2008 to 2010, we selected 1,494 post-stroke patients and were able to interview 660 patients, 66 (11% of whom reported pain with related tactile and thermal hyperesthesia, accompanied by needle puncture, tingling, swelling, and pressure sensations. Patients reported motor impairment and disability, which influenced their working ability, rehabilitation, and social life. Despite this severe pain state, there was a high percentage of patients who did not receive adequate treatment for pain. Keywords: stroke, central post-stroke pain, disability

  3. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study

    Science.gov (United States)

    2016-01-01

    Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient’s left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20), in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions. PMID:27028404

  4. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study.

    Directory of Open Access Journals (Sweden)

    Grazia Fernanda Spitoni

    Full Text Available Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20, in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

  5. The Effects of Lamotrigine on Pain, Sleep, and Mood in Refractory Form of Central Post-Stroke Pain Syndrome

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    Peyman Petramfar

    2010-12-01

    Full Text Available Background: Central post-stroke pain (CPSP is a distressingpain syndrome, sometimes become refractory to the conventionalpain managements. Anticonvulsants have been used toalleviate different central pains. Lamotrigine is a novel anticonvulsantand its proper dosage and its efficacy have notbeen well studied yet. The aim of this study was to evaluatethe effect of 100 mg lamotrigine on refractory form of CPSP.Methods: The medical files of 17 patients with CPSP who hadnot responded to the other drugs and were treated with lamotriginewere studied. Using Brief Pain Inventory, pain, sleepand mood were assessed before, and after 8 and 24 weeks oftreatment.Results: After 24 weeks, 70.5 % of the patients responded tolamotrigine, and there was an improvement of 2.41 in themean score of average pain (P=0.001.Conclusion: Lamotrigine 100 mg daily was effective in thetreatment of refractory CPSP, and might be prescribed beforeplanning for more aggressive surgical managements.Iran J Med Sci 2010; 35(4: 299-303.

  6. The antalgic effects of non-invasive physical modalities on central post-stroke pain: a systematic review.

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    Chen, Chih-Chung; Chuang, Yu-Fen; Huang, Andrew Chih-Wei; Chen, Chih-Kuang; Chang, Ya-Ju

    2016-04-01

    [Purpose] This study systematically reviewed the antalgic effects of non-invasive physical modalities (NIPMs) on central post-stroke pain (CPSP). [Subjects and Methods] Clinical studies were sought on September 2015 in 10 electronic databases, including Medline and Scopus. The searching strings were "central pain and stroke" and "treatment, and physical or non-pharmacological". The inclusion and exclusion criteria were set for screening the clinical articles by two reviewers. Pain scores on visual analog scale in an article were used as the outcome measure for resulting judgment. The NIPMs intervention summarized from the eligible articles was rated from Levels A to C according to Evidence Classification Scheme for Therapeutic Interventions. [Results] Over 1200 articles were identified in the initial searches and 85 studies were retrieved. Sixteen studies were eligible and judged. Caloric vestibular stimulation (n=3), heterotopic noxious conditioning stimulation (n=1), and transcutaneous electrical stimulation (n=1) were rated below Level C. Transcranial direct current stimulation (TDCS; n=2) and transcranial magnetic stimulation (TMS; n=9) were rated as Level B. [Conclusion] The findings suggest that TMS and TDCS were better than other treatments for CPSP relief but the studies were of insufficient quality. PMID:27190485

  7. The antalgic effects of non-invasive physical modalities on central post-stroke pain: a systematic review

    Science.gov (United States)

    Chen, Chih-Chung; Chuang, Yu-Fen; Huang, Andrew Chih-Wei; Chen, Chih-Kuang; Chang, Ya-Ju

    2016-01-01

    [Purpose] This study systematically reviewed the antalgic effects of non-invasive physical modalities (NIPMs) on central post-stroke pain (CPSP). [Subjects and Methods] Clinical studies were sought on September 2015 in 10 electronic databases, including Medline and Scopus. The searching strings were “central pain and stroke” and “treatment, and physical or non-pharmacological”. The inclusion and exclusion criteria were set for screening the clinical articles by two reviewers. Pain scores on visual analog scale in an article were used as the outcome measure for resulting judgment. The NIPMs intervention summarized from the eligible articles was rated from Levels A to C according to Evidence Classification Scheme for Therapeutic Interventions. [Results] Over 1200 articles were identified in the initial searches and 85 studies were retrieved. Sixteen studies were eligible and judged. Caloric vestibular stimulation (n=3), heterotopic noxious conditioning stimulation (n=1), and transcutaneous electrical stimulation (n=1) were rated below Level C. Transcranial direct current stimulation (TDCS; n=2) and transcranial magnetic stimulation (TMS; n=9) were rated as Level B. [Conclusion] The findings suggest that TMS and TDCS were better than other treatments for CPSP relief but the studies were of insufficient quality.

  8. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China*

    Institute of Scientific and Technical Information of China (English)

    Yi Zhu; Bin Su; Ning Li; Hongzhu Jin

    2013-01-01

    We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospit-als in Nanjing, China between February 2007 and January 2012. Al patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8%of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebel opontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par-ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder tion and complex regional pain syndrome. Multiple linear regression results showed a negative re-lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

  9. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

    OpenAIRE

    Rania E. Mohamed; Mohamed A. Amin; Ashraf A. Aboelsafa

    2014-01-01

    Aim of the work: To describe the structural abnormalities of the painful hemiplegic shoulder (PHS) by ultrasound (U/S) and their relationship with some clinical variables. Materials and methods: Eighty consecutive patients with post-stroke PHS were subjected to both clinical assessment and ultrasonographic examination of both shoulders. Ultrasonographic imaging data were classified into five grades. Results: The biceps tendon sheath effusion (51.25%) and the SA–SD bursitis (43.75%) were...

  10. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

    OpenAIRE

    de Oliveira Rogério Adas; de Andrade Daniel; Machado André Guelman; Teixeira Manoel

    2012-01-01

    Abstract Background Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related ...

  11. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

    Directory of Open Access Journals (Sweden)

    Rania E. Mohamed

    2014-12-01

    Conclusion: Ultrasonography is an essential method in evaluation of post-stroke PHS. However, the U/S grades were not correlated with the stages of motor recovery. Avoiding overuse of the unaffected shoulder will be helpful for prevention of shoulder injuries following hemiplegic stroke.

  12. Post stroke dementia and Post stroke depression

    OpenAIRE

    Trkanjec, Zlatko

    2012-01-01

    Stroke is the rapid loss of brain function due to disturbance in the blood supply to the brain causing predominantly motor and sensory symptoms. However, stroke can cause some other symptoms. Post stroke dementia and depression are probably the most important non-motor consequences of stroke. Post stroke dementia and depression are important and often overlooked symptoms following stroke. Treatment options for Post stroke dementia and depression are still limited, therefore diagnosis of Post ...

  13. COMPARING EFFECT OF SHOULDER CUFF SUPPORT VERSUS SHOULDER STRAPPING IN PREVENTING POST STROKE SHOULDER PAIN

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    Parvinder kaur

    2013-10-01

    Full Text Available Aims and Objectives:The aim of research is to compare the effectiveness of shoulder cuff support versusshoulder strapping.Methodology:A sample of 20 strokesubjects was recruited for the study. The subjectwere randomly dividedin to 2 groups Group A ( shoulder cuff group and Group B (shoulder strapping group.Pre test assessment was done by Visual analogue scale & pain free range of motion to 900degree. A receivedshoulder cuff and group B received shoulder strapping in their rehabilitation protocol. Both groupwere treatedfor 7 days . on seventh day reading were taken for both groups.Results:Development of pain and restrictionof shoulder range is significantly less in group A- shoulder cuff group as compare to group B -shoulder strappinggroup on 7thtreatment day.Discussion:Use of shoulder cuff support with stroke patients particularly in theearly flaccid stage useful in preventing shoulder pain. Support of the flaccid shoulder early in management canreduce the incidence of subluxation.Strapping would not ensure support to the soft tissueall thetime, and itmay encourage some abnormal synergy pattern.Conclusions:Shoulder cuff support significantly decrease theonsetand intensity of pain in affected upper extremity and prevent restriction of range of motion .ascomparedto shoulder strapping.

  14. COMPARING EFFECT OF SHOULDER CUFF SUPPORT VERSUS SHOULDER STRAPPING IN PREVENTING POST STROKE SHOULDER PAIN

    OpenAIRE

    Parvinder kaur; Shiv Kumar Verma; Ravinder Narwal

    2013-01-01

    Aims and Objectives:The aim of research is to compare the effectiveness of shoulder cuff support versusshoulder strapping.Methodology:A sample of 20 strokesubjects was recruited for the study. The subjectwere randomly dividedin to 2 groups Group A ( shoulder cuff group) and Group B (shoulder strapping group).Pre test assessment was done by Visual analogue scale & pain free range of motion to 900degree. A receivedshoulder cuff and group B received shoulder strapping in their rehabilitation pro...

  15. Comparative study of Acupuncture, Bee Venom Acupuncture and Bee Venom Herbal Acupuncture on the treatment of Post-stroke Hemiplegic Shoulder Pain

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    Jae Yong Eom

    2006-02-01

    Full Text Available Objective : This experiment was conducted to evaluate the effectiveness of Acupuncture, Bee Venom Acupuncture (BVA and Bee Venom Herbal Acupuncture (BVHA on post-stroke hemiplegic shoulder pain. Methods : 30 patients were randomly allocated into Acupuncture group, BVA group and BVHA group and was monitored weekly for 4 weeks; initial(T0, 1 week(T1, 2 weeks(T2, 3 weeks(T3 and 4 weeks(T4. Results : Visual analogue scale of shoulder pain showed significant decrease in BVA and BVHA groups compared to the Acupuncture group at T4 evaluation. Painless passive ROM of shoulder external rotation and Fugl-Meyer Motor Assessment of Upper Limb motor function showed significant increase in all groups. Modified Ashworth scale of the spasticity of upper limb showed no differences between the three groups. Conclusion : BVA & BVHA appears to be an effective in treating post-stroke hemiplegic shoulder pain. Further clinical studies must be done to obtain more concrete findings.

  16. Results availability for analgesic device, complex regional pain syndrome, and post-stroke pain trials: comparing the RReADS, RReACT, and RReMiT databases

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    Dufka, Faustine L.; Munch, Troels; Dworkin, Robert H.; Rowbotham, Michael C.

    2015-01-01

    Abstract Evidence-based medicine rests on the assumption that treatment recommendations are robust, free from bias, and include results of all randomized clinical trials. The Repository of Registered Analgesic Clinical Trials search and analysis methodology was applied to create databases of complex regional pain syndrome (CRPS) and central post-stroke pain (CPSP) trials and adapted to create the Repository of Registered Analgesic Device Studies databases for trials of spinal cord stimulation (SCS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). We identified 34 CRPS trials, 18 CPSP trials, 72 trials of SCS, and 92 trials of rTMS/tDCS. Irrespective of time since study completion, 45% of eligible CRPS and CPSP trials and 46% of eligible SCS and rTMS/tDCS trials had available results (peer-reviewed literature, results entered on registry, or gray literature); peer-reviewed publications could be found for 38% and 39%, respectively. Examining almost 1000 trials across a spectrum of painful disorders (fibromyalgia, diabetic painful neuropathy, post-herpetic neuralgia, migraine, CRPS, CPSP) and types of treatment, no single study characteristic consistently predicts unavailability of results. Results availability is higher 12 months after study completion but remains below 60% for peer-reviewed publications. Recommendations to increase results availability include supporting organizations advocating for transparency, enforcing existing results reporting regulations, enabling all primary registries to post results, stating trial registration numbers in all publication abstracts, and reducing barriers to publishing “negative” trials. For all diseases and treatment modalities, evidence-based medicine must rigorously adjust for the sheer magnitude of missing results in formulating treatment recommendations. PMID:25599303

  17. Central Pain Syndrome

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    ... Enhancing Diversity Find People About NINDS NINDS Central Pain Syndrome Information Page Table of Contents (click to ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

  18. Central Neuropathic Pain Syndromes.

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    Watson, James C; Sandroni, Paola

    2016-03-01

    Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury. This review focuses on unique clinical features that help distinguish central neuropathic pain. The most common clinical central pain syndromes-central poststroke pain, multiple sclerosis-related pain, and spinal cord injury-related pain-are reviewed in detail. Recent progress in understanding of the pathogenesis of central neuropathic pain is reviewed, and pharmacological, surgical, and neuromodulatory treatments of this notoriously difficult to treat pain syndrome are discussed. PMID:26944242

  19. [Post Stroke Dementia].

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    Ihara, Masafumi

    2016-07-01

    Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke. Current evidence suggests that 25-30% of ischemic stroke survivors develop immediate or delayed vascular cognitive impairment or vascular dementia. The type of stroke can be either ischemic, hemorrhagic or hypoperfusive. There are multiple risk factors for PSD including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischemic attack or recurrent stroke and depressive illness. Pre-stroke dementia refers to the occurrence of cognitive impairment before the index stroke, which may be caused by a vascular burden as well as insidious neurodegenerative changes. Neuroimaging determinants of dementia after stroke include silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Published clinical trials have not been promising and there is little information on whether PSD can be prevented using pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are key to reducing the burden of cognitive decline and post-stroke dementia. Modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment. PMID:27395459

  20. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

    Directory of Open Access Journals (Sweden)

    de Oliveira Rogério Adas

    2012-09-01

    Full Text Available Abstract Background Central post-stroke pain (CPSP is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS, painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients. Methods CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS, McGill Pain Questionnaire (MPQ, and Beck Depression Scale (BDS were filled out by all participants. Results Forty CPSP patients were included. Thirty-six (90.0% had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10. There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0% patients and intermittent in the remainder. Burning was the most common descriptor (70%. Main aggravating factors were contact to cold (62.5%. Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5% patients and was more common in the supratentorial extra-thalamic group (P Conclusions The presence of MPS is not an exception after stroke and may present in association with CPSP

  1. Hypernatremia secondary to post-stroke hypodipsia: just add water!

    OpenAIRE

    Ramthun, Maikel; Mocelin, Altair Jacob; Alvares Delfino, Vinicius Daher

    2011-01-01

    Disorders in water metabolism may occur in stroke patients. When hypernatremia arises in this setting, it is usually secondary to the development of central diabetes insipidus or it is the result of neurologic lesions that prevent patients from having free access to water. Much rarer are the cases of post-stroke hypernatremia caused by hypodipsia secondary to lesions of the thirst center. We report the case of a patient with severe hypernatremia, probably secondary to post-hemorrhagic stroke ...

  2. Effectiveness of strength training in post stroke

    International Nuclear Information System (INIS)

    The study was done to evaluate the effectiveness of strength training in post stroke. This was an experimental randomized study, conducted at various Physical Therapy OPD setting areas. Sample n = 30; 3 females and 12 males as experimental group and 3 females and 12 males as control group were selected through probability sampling. Mean age of 57 with middle recovery stage of post stroke were included. Different selected strength training exercises were applied on experimental group to assess spasticity, cadence and manual muscle testing. Result was taken by using Mann - Whiteny U test for outcome measures as in cadence, spasticity and manual muscle testing. The result of two outcome measure shows significant result which means the strength training is more effective than the conventional treatment for post stroke of middle recovery stage. (author)

  3. Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management

    OpenAIRE

    Siniscalchi, Antonio; Gallelli, Luca; Labate, Angelo; Malferrari, Giovanni; Palleria, Caterina; De Sarro, Giovambattista

    2012-01-01

    Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders ...

  4. Early Detection of Post-Stroke Depression

    OpenAIRE

    de Man - van Ginkel, J.M.

    2012-01-01

    In the first two years after stroke approximately one-third of the patients suffer from depression, also referred to as post-stroke depression (PSD). Patients with PSD suffer from symptoms, such as a diminished interest or pleasure (anhedonia), depressed mood, sleep disturbances, loss of energy, changes in appetite, feelings of inappropriate guilt, concentration difficulties, psychomotor retardation or agitation, and suicidal thoughts. PSD aggravates the burden of physical, psychological and ...

  5. Oral care post stroke: a scoping review.

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    Kwok, C; McIntyre, A; Janzen, S; Mays, R; Teasell, R

    2015-01-01

    Health concerns post stroke may be the result of, or exacerbated by, neglected oral health care (OHC). However, OHC may be challenging post stroke due to hemiparesis, hemiplegia, a lack of coordination, and/or cognitive deficits. The objective of this study was to conduct a scoping review and summarise the current state of knowledge pertaining to OHC post stroke. A literature search was conducted using the multiple databases (MEDLINE, CINAHL, EMBASE, etc.). Combinations of multiple keywords were searched: oral, dental, health, care, hygiene, teeth, dentures, tooth brushing, stroke, cardiovascular health and cardiovascular disease. A grey literature search was also conducted. Articles included were those published in English between 1970 and July 2013, which focused on at least one aspect of OHC among a stroke population. For clinical trials, ≥50% of the sample must have sustained a stroke. In total, 60 articles met inclusion and focused on three primary area: (i) OHC Importance/Stroke Implications; (ii) Current Research; and (iii) Current Practice. It was found that OHC concerns are mainly related to mastication, dysphagia/nutrition, hygiene, prostheses and quality of life. Research indicates that there is limited specialised and individual care provided, and there are few assessment tools, guidelines and established protocols for oral health that are specific to the stroke population. Further, dental professionals' and nurses' knowledge of OHC is generally inadequate; hence, proper education for health professionals in acute and rehabilitation settings, patients, and caregivers has been discussed. PMID:25244419

  6. Post-stroke depression therapy: where are we now?

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    Nabavi, Seyed Fazel; Turner, Alyna; Dean, Olivia; Sureda, Antoni; Mohammad, Seyed

    2014-01-01

    Post-stroke depression is an important psychological consequence of ischemic stroke, and affects around one third of stroke patients at any time post-stroke. It has a negative impact on patient morbidity and mortality, and as such development of effective post-stroke recognition and treatment strategies are very important. There are several therapeutic strategies for post-stroke depression, including both pharmacological and non-pharmacological approaches. In this review, we present evidence regarding the underlying biology of post-stroke depression, commonalities between post-stroke depression and Major Depressive Disorder and explore several treatment approaches, including antidepressant therapy, psychotherapy, surgical therapy, electroconvulsive therapy, acupuncture, music therapy and natural products. Further experimental and clinical studies are required, particularly in emerging fields such as the role of nutraceuticals in the treatment of stroke. PMID:24852795

  7. Pain Mechanisms and Centralized Pain in Temporomandibular Disorders.

    Science.gov (United States)

    Harper, D E; Schrepf, A; Clauw, D J

    2016-09-01

    Until recently, most clinicians and scientists believed that the experience of pain is perceptually proportional to the amount of incoming peripheral nociceptive drive due to injury or inflammation in the area perceived to be painful. However, many cases of chronic pain have defied this logic, leaving clinicians perplexed as to how patients are experiencing pain with no obvious signs of injury in the periphery. Conversely, there are patients who have a peripheral injury and/or inflammation but little or no pain. What makes some individuals experience intense pain with minimal peripheral nociceptive stimulation and others experience minimal pain with serious injury? It is increasingly well accepted in the scientific community that pain can be generated and maintained or, through other mechanisms, suppressed by changes in the central nervous system, creating a complete mismatch between peripheral nociceptive drive and perceived pain. In fact, there is no known chronic pain condition where the observed extent of peripheral damage reproducibly engenders the same level of pain across individuals. Temporomandibular disorders (TMDs) are no exception. This review focuses on the idea that TMD patients range on a continuum-from those whose pain is generated peripherally to those whose pain is centralized (i.e., generated, exacerbated, and/or maintained by central nervous system mechanisms). This article uses other centralized chronic pain conditions as a guide, and it suggests that the mechanistic variability in TMD pain etiology has prevented us from adequately treating many individuals who are diagnosed with the condition. As the field moves forward, it will be imperative to understand each person's pain from its own mechanistic standpoint, which will enable clinicians to deliver personalized medicine to TMD patients and eventually provide relief in even the most recalcitrant cases. PMID:27422858

  8. Central hypersensitivity in chronic musculoskeletal pain

    DEFF Research Database (Denmark)

    Curatolo, Michele; Arendt-Nielsen, Lars

    2015-01-01

    Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold...... standards. Reference values in the pain-free population have been generated, but need replication. Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central...... level and some non-pharmacological approaches, including psychological interventions, are likely to attenuate central hypersensitivity....

  9. Cinesioterapia previne ombro doloroso em pacientes hemiplégicos/paréticos na fase sub-aguda do acidente vascular encefálico Kinesiotherapy prevents shoulder pain in hemiplegic/paretic patients on sub-acute stage post-stroke

    Directory of Open Access Journals (Sweden)

    Agnes Irna Horn

    2003-09-01

    Full Text Available CONTEXTO: Ombro doloroso é freqüente em pacientes com hemiplegia/hemiparesia (H/P por acidente vascular encefálico (AVE, dificultando a recuperação neuromotora gerando incapacidade funcional. OBJETIVO: Estudar tratamento fisioterapêutico para a prevenção da dor no ombro com H/P em pacientes com AVE na fase sub-aguda, e analisar desfechos secundários (força muscular do ombro acometido e movimentos funcionais ativos básicos. MÉTODO: Estudaram-se 21 pacientes (12 homens, 9 mulheres; idades 26 a 87 anos com H/P. O tratamento fisioterapêutico consistiu de 30 minutos diários de cinesioterapia, desde as 48 horas após o AVE até a alta hospitalar. Os pacientes foram avaliados antes e após o tratamento em relação à presença ou ausência de dor no ombro H/P, à força dos diversos grupos musculares do ombro e quanto aos movimentos funcionais de transferência e manutenção postural básica. RESULTADOS: Nenhum paciente apresentava dor no ombro H/P na alta (pBACKGROUND: Painful shoulder is considered the most common complication of hemiplegic/parethic (H/P stroke patients. It is a negative factor for neuromotor recovery. PURPOSE: To study the effects of kinesiotherapy treatment on shoulder pain prevention, and as a secondary endpoints, to analyze muscle strength of H/P shoulder looking at basic functional active mobility. METHOD: Twenty one inpatients (12 men, 9 women aged 26 to 87 years, with post-stroke H/P were submitted to thirty minutes daily program kinesiotherapy, started at 48 hours post-stroke up to their hospital discharge. Patients were evaluated pre and post treatment according to the presence or absence of shoulder pain, movements and shoulder strength, and for presence or absence of basic functional movements. RESULTS: No patient complaining of shoulder pain at the hospital discharge (p<0.001. The muscle strength improved signifcantly for elevation, protusion, abduction and flexion of the shoulder (p<0.001. There was

  10. Soleus H-reflex excitability during pedaling post-stroke

    DEFF Research Database (Denmark)

    Schindler-Ivens, Sheila; Brown, David A.; Lewis, Gwyn N.; Nielsen, Jens Bo; Ondishko, Kathy L.; Wieser, Jon

    2008-01-01

    A major contributor to impaired locomotion post-stroke is abnormal phasing of paretic muscle activity, but the mechanisms remain unclear. Previous studies have shown that, in the paretic limb of people post-stroke, Group Ia reflexes are abnormally elevated and fail to decrease in amplitude during...

  11. Treatment of Post-Stroke Ankylosis by Warm-Needling

    Institute of Scientific and Technical Information of China (English)

    刘傲霜

    2004-01-01

    @@ Ankylosis is one of the post-stroke sequelae that hampers seriously the daily activities of the patients.Since 1996, the author has adopted warm needling for treatment of post-stroke ankylosis and obtained excellent therapeutic results. The statistical findings have shown that this therapeutic method can exert an important action in improving the joint spasm for patients with post-stroke sequelae. Especially, a better effect can be expected when it is used at the points of yin channels. A report follows.

  12. Post stroke rehabilitation based on SMART goals: a case study

    OpenAIRE

    Amir-ur Rehman; Jocelyn Berry; Siddiqui, Muhammad A.

    2014-01-01

    Post stroke rehabilitation has been consistently reported in physiotherapy as being difficult to manage and limiting to rehabilitation outcome. It is reported that the first few months post stroke are crucial for rehabilitation to reach a maximum potential. However, after this period further recovery is unlikely. Specific, measurable, achievable, realistic, and time-framed (SMART) goals are used for goal setting for rehabilitation. They can provide coordination between a multidisciplinary tea...

  13. Impaired Hyperemic Response to Exercise Post Stroke.

    Directory of Open Access Journals (Sweden)

    Matthew J Durand

    Full Text Available Individuals with chronic stroke have reduced perfusion of the paretic lower limb at rest; however, the hyperemic response to graded muscle contractions in this patient population has not been examined. This study quantified blood flow to the paretic and non-paretic lower limbs of subjects with chronic stroke after submaximal contractions of the knee extensor muscles and correlated those measures with limb function and activity. Ten subjects with chronic stroke and ten controls had blood flow through the superficial femoral artery quantified with ultrasonography before and immediately after 10 second contractions of the knee extensor muscles at 20, 40, 60, and 80% of the maximal voluntary contraction (MVC of the test limb. Blood flow to the paretic and non-paretic limb of stroke subjects was significantly reduced at all load levels compared to control subjects even after normalization to lean muscle mass. Of variables measured, increased blood flow after an 80% MVC was the single best predictor of paretic limb strength, the symmetry of strength between the paretic and non-paretic limbs, coordination of the paretic limb, and physical activity. The impaired hemodynamic response to high intensity contractions was a better predictor of lower limb function than resting perfusion measures. Stroke-dependent weakness and atrophy of the paretic limb do not explain the reduced hyperemic response to muscle contraction alone as the response is similarly reduced in the non-paretic limb when compared to controls. These data may suggest a role for perfusion therapies to optimize rehabilitation post stroke.

  14. Clinical analysis and treatment of central pain due to headinjury

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    @@Central pain is induced by the involvement of the abnormal pain pathway due to diseases of the central nervous system. Central pain after brain trauma is common clinically, but it is often misdiagnosed and neglected because of lack of objective disturbances. We treated 20 cases of central pain after head injury by invigorating blood circulation and satisfactory result was obtained.

  15. Impact and risk factors of post-stroke bone fracture.

    Science.gov (United States)

    Huo, Kang; Hashim, Syed I; Yong, Kimberley L Y; Su, Hua; Qu, Qiu-Min

    2016-02-20

    Bone fracture occurs in stroke patients at different times during the recovery phase, prolonging recovery time and increasing medical costs. In this review, we discuss the potential risk factors for post-stroke bone fracture and preventive methods. Most post-stroke bone fractures occur in the lower extremities, indicating fragile bones are a risk factor. Motor changes, including posture, mobility, and balance post-stroke contribute to bone loss and thus increase risk of bone fracture. Bone mineral density is a useful indicator for bone resorption, useful to identify patients at risk of post-stroke bone fracture. Calcium supplementation was previously regarded as a useful treatment during physical rehabilitation. However, recent data suggests calcium supplementation has a negative impact on atherosclerotic conditions. Vitamin D intake may prevent osteoporosis and fractures in patients with stroke. Although drugs such as teriparatide show some benefits in preventing osteoporosis, additional clinical trials are needed to determine the most effective conditions for post-stroke applications. PMID:26929915

  16. Facilities of Early Rehabilitation post Stroke in Poland 2010

    DEFF Research Database (Denmark)

    Opara, Jozef; Langhorne, Peter; Larsen, Torben

    2012-01-01

    Rationale -The aim of this work was to survey the contemporary facilities for early poststroke rehabilitation in Poland. The main research questions were: what is the availability of inpatient rehabilitation for post-stroke patients in neurological departments and in rehabilitation departments...... and its continuation after discharge from stroke unit. Participants - Two questionnaires evaluating neurorehabilitation of people who underwent stroke was designed and distributed: first to 221 neurological wards and second to 154 rehabilitation departments in Poland. Design - We asked about delay...... post-stroke, i.e. within 3 months of stroke. Comment - Taking into account that about half of stroke survivors will need rehabilitation (30 days after stroke onset), the current facilities of early post-stroke rehabilitation in Poland cannot meet this need. We should do our best to introduce...

  17. Determining Optimal Post-Stroke Exercise (DOSE)

    Science.gov (United States)

    2015-07-23

    Cerebrovascular Accident; Stroke; Cerebral Infarction; Brain Infarction; Brain Ischemia; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases

  18. Understanding gait control in post-stroke: implications for management.

    Science.gov (United States)

    Verma, Rajesh; Arya, Kamal Narayan; Sharma, Pawan; Garg, R K

    2012-01-01

    The role of the brain in post-stroke gait is not understood properly, although the ability to walk becomes impaired in more than 80% of post-stroke patients. Most, however, regain some ability to walk with either limited mobility or inefficient, asymmetrical or unsafe gait. Conventional intervention focuses on support of weak muscles or body part by use of foot orthosis and walking aids. This review provides an overview of available evidence of neuro-kinesiology & neurophysiology of normal and post-stroke gait. The role of the spinal cord has been explored, more in animals than humans. Mammalian locomotion is based on a rhythmic, "pacemaker" activity of the spinal stepping generators. Bipedal human locomotion is different from quadripedal animal locomotion. However, knowledge derived from the spinal cord investigation of animals, is being applied for management of human gait dysfunction. The potential role of the brain is now recognized in the independent activation of muscles during walking. The brain modifies the gait pattern during the complex demands of daily activities. Though the exact role of the motor cortex in control of gait is unclear, available evidence may be applied to gait rehabilitation of post-stroke patients. PMID:22196422

  19. Chromium supplementation improved post-stroke brain infarction and hyperglycemia.

    Science.gov (United States)

    Chen, Wen-Ying; Mao, Frank Chiahung; Liu, Chia-Hsin; Kuan, Yu-Hsiang; Lai, Nai-Wei; Wu, Chih-Cheng; Chen, Chun-Jung

    2016-04-01

    Hyperglycemia is common after acute stroke and is associated with a worse outcome of stroke. Thus, a better understanding of stress hyperglycemia is helpful to the prevention and therapeutic treatment of stroke. Chromium is an essential nutrient required for optimal insulin activity and normal carbohydrate and lipid metabolism. Beyond its nutritional effects, dietary supplement of chromium causes beneficial outcomes against several diseases, in particular diabetes-associated complications. In this study, we investigated whether post-stroke hyperglycemia involved chromium dynamic mobilization in a rat model of permanent focal cerebral ischemia and whether dietary supplement of chromium improved post-stroke injury and alterations. Stroke rats developed brain infarction, hyperglycemia, hyperinsulinemia, glucose intolerance, and insulin resistance. Post-stroke hyperglycemia was accompanied by elevated secretion of counter-regulatory hormones including glucagon, corticosterone, and norepinephrine, decreased insulin signaling in skeletal muscles, and increased hepatic gluconeogenesis. Correlation studies revealed that counter-regulatory hormone secretion showed a positive correlation with chromium loss and blood glucose increased together with chromium loss. Daily chromium supplementation increased tissue chromium levels, attenuated brain infarction, improved hyperglycemia, and decreased plasma levels of glucagon and corticosterone in stroke rats. Our findings suggest that stroke rats show disturbance of tissue chromium homeostasis with a net loss through urinary excretion and chromium mobilization and loss might be an alternative mechanism responsible for post-stroke hyperglycemia. PMID:26477944

  20. Patients' Experiences of Disruptions Associated with Post-Stroke Dysarthria

    Science.gov (United States)

    Dickson, Sylvia; Barbour, Rosaline S.; Brady, Marian; Clark, Alexander M.; Paton, Gillian

    2008-01-01

    Background: Post-stroke dysarthria rehabilitation should consider social participation for people with dysarthria, but before this approach can be adopted, an understanding of the psychosocial impact of dysarthria is required. Despite the prevalence of dysarthria as a result of stroke, there is a paucity of research into this communication…

  1. Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain:a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Sung Min Lim; Sook-Hyun Lee

    2015-01-01

    BACKGROUND:Shoulder pain is a common complication of stroke. Bee venom acupuncture (BVA) is increasingly used in the treatment of post-stroke shoulder pain. OBJECTIVE: To summarize and evaluate evidence on the effectiveness of BVA in relieving shoulder pain after stroke. SEARCH STRATEGY: Nine databases, namely MEDLINE, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Japan Science and Technology Information Aggregator, Electronic (J-STAGE), and four Korean medical databases, namely, the National Assembly Library, the Research Information Service System, the National Discovery for Science Leaders, and OASIS, were searched from their inception through August 2014 without language restrictions. INCLUSION CRITERIA: Randomized controled trials (RCTs) were included if BVA was used at acupoints as the sole treatment, or as an adjunct to other treatments, for shoulder pain after stroke. DATA EXTRACTION AND ANALYSIS:Two review authors independently selected trials for inclusion, assessed methodological quality and extracted data. RESULTS: A total of 138 potentialy relevant articles were identiifed, 4 of which were RCTs that met our inclusion criteria. The quality of studies included was generaly low, and a preponderance of positive results was demonstrated. Al four trials reported favorable effects of BVA on shoulder pain after stroke. Two RCTs assessing the effects of BVA on post-stroke shoulder pain, as opposed to saline injections, were included in the meta-analysis. Pain was signiifcantly lower for BVA than for saline injections (standardized mean difference on 10-cm visual analog scale: 1.46 cm, 95% CI = 0.30–2.62,P = 0.02, n = 86) CONCLUSION: This review provided evidence suggesting that BVA is effective in relieving shoulder pain after stroke. However, further studies are needed to conifrm the role of BVA in aleviating post-stroke shoulder pain. Future studies should be conducted with large samples and rigorous study designs.

  2. Difficulties in post-stroke gait improvement caused by post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Stanislaw Kijowski

    2014-01-01

    Background Depression is a common problem impeding post-stroke rehabilitation.Up to 70% of patients show depression symptoms during the first twelve months after stroke onset.However,the depression and its effect on functional recovery can be difficult to diagnose.The purpose of this study was to use gait analysis as a tool to compare the recovery after stroke in patients with and without depression and to assess the impact of the initiation time of rehabilitation after stroke onset.Methods One hundred and forty five consecutive patients after first ever stroke admitted for designed rehabilitation program within 2 to 31 months after stroke onset participated.All patients received 4 weeks treatment program included comprehensive rehabilitation consisted of multipurpose activities 5 days a week.These included individual and group exercises,physiotherapy,occupational therapy and gait training.Gait analysis with Kistler force plates was employed to assess gait pattern symmetry before and after the treatment.Gait symmetry was evaluated based on seven gait parameters.Regaining of gait pattern symmetry was assumed as a measure of rehabilitation outcome.Results After rehabilitation program gait symmetry w()ined in patients without depression.Gait asymmetry remained unchanged in patients diagnosed with depression.No major differences in outcome from rehabilitation were noted in regards to the initiation time of rehabilitation after the stroke onset.Conclusions Depression limits gait recovery after stroke.The time of initiation of rehabilitation after stroke onset does not limit the motor recovery after rehabilitation program.

  3. Central adaptation of pain perception in response to rehabilitation of musculoskeletal pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Christoffer H; Sundstrup, Emil;

    2012-01-01

    Understanding the mechanisms of long-standing musculoskeletal pain and adaptations in response to physical rehabilitation is important for developing optimal treatment strategies. The influence of central adaptations of pain perception in response to rehabilitation of musculoskeletal pain remains...

  4. Post stroke rehabilitation based on SMART goals: a case study

    Directory of Open Access Journals (Sweden)

    Amir-ur Rehman

    2014-02-01

    Full Text Available Post stroke rehabilitation has been consistently reported in physiotherapy as being difficult to manage and limiting to rehabilitation outcome. It is reported that the first few months post stroke are crucial for rehabilitation to reach a maximum potential. However, after this period further recovery is unlikely. Specific, measurable, achievable, realistic, and time-framed (SMART goals are used for goal setting for rehabilitation. They can provide coordination between a multidisciplinary team to develop a plan for the individual needs of patients. This case study explored the use of SMART goals, which are often not used in a rehabilitation setting due to being time-consuming and difficult to create. This case report provides the first evidence that SMART goals may serve as a powerful tool for rehabilitation following stroke. The case study illustrates the clinical role of physiotherapists in the management of a patient with stroke. [J Exp Integr Med 2014; 4(1.000: 71-73

  5. Gait post-stroke: Pathophysiology and rehabilitation strategies.

    Science.gov (United States)

    Beyaert, C; Vasa, R; Frykberg, G E

    2015-11-01

    We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait. PMID:26547547

  6. The mirror neuron system in post-stroke rehabilitation

    OpenAIRE

    Carvalho, Diana; Teixeira, Silmar; Lucas, Marina; Yuan, Ti-Fei; Chaves, Fernanda; Peressutti, Caroline; Machado, Sergio; Bittencourt, Juliana; Menéndez-González, Manuel; Nardi, Antonio Egidio; Velasques, Bruna; Cagy, Mauricio; Piedade, Roberto; Ribeiro, Pedro; Arias-Carrión, Oscar

    2013-01-01

    Different treatments for stroke patients have been proposed; among them the mirror therapy and motion imagery lead to functional recovery by providing a cortical reorganization. Up today the basic concepts of the current literature on mirror neurons and the major findings regarding the use of mirror therapy and motor imagery as potential tools to promote reorganization and functional recovery in post-stroke patients. Bibliographic research was conducted based on publications over the past thi...

  7. Clinical Observation on Electroacupuncture for Post-stroke Flaccid Paralysis

    Institute of Scientific and Technical Information of China (English)

    Zhu Xian-min; Hou Jing-yue

    2013-01-01

    Objective:To observe the clinical efficacy of electroacupuncture (EA) in treating post-stroke flaccid paralysis.Methods:Forty patients with post-stroke flaccid paralysis were randomized by the random number table into a treatment group and a control group,20 cases in each.The treatment group was intervened by acupuncture at Jiquan (HT 1),Tianquan (PC 2),Ququan (LR 8),Yinlingquan (SP 9),and Yongquan (KI 1),and the control group was treated by acupuncture with conventional acupoint selection.Barthel index (BI) was adopted for evaluating the activities of daily living (ADL),and therapeutic efficacy was analyzed.Results:The two groups both had marked increases of BI score after treatment.Compared to the control group after 1 treatment course and 2treatment courses respectively,the treatment group had significant differences in BI score (P<0.01).The total effective rate was 100.0% in the treatment group versus 90.0% in the control group,and the difference was statistically significant (P<0.01).Conclusion:EA at Jiquan (HT 1),Tianquan (PC 2),Ququan (LR 8),Yinlingquan (SP 9),Yongquan (KI 1) is an effective approach in treating post-stroke flaccid paralysis.

  8. Delayed-Onset Post-Stroke Delusional Disorder: A Case Report

    OpenAIRE

    Raíssa B. Barboza; Gabriel R. de Freitas; Fernanda Tovar-Moll; Fontenelle, Leonardo F.

    2013-01-01

    Although the prevalence of neuropsychiatric disorders among patients with cerebrovascular illness is relatively high, there are only few case reports describing post-stroke psychotic symptoms. In general, post-stroke psychoses have been reported to emerge few days after the vascular event and to vanish soon afterwards. In this report, we describe delayed-onset post-stroke delusional disorder, persecutory type. A middle-aged female patient developed a persistent delusional disorder with homici...

  9. Post-stroke infection: A systematic review and meta-analysis

    OpenAIRE

    Dijkgraaf Marcel G; Vermeij Jan-Dirk; Nederkoorn Paul J; Westendorp Willeke F; van de Beek Diederik

    2011-01-01

    Abstract Background stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome. Methods MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical tri...

  10. COMBINED EFFECTS OF FAST TREADMILL WALKING AND FUNCTIONAL ELECTRICAL STIMULATION ON POST-STROKE GAIT

    OpenAIRE

    Kesar, Trisha M.; Reisman, Darcy S.; Perumal, Ramu; Jancosko, Angela M.; Higginson, Jill S.; Rudolph, Katherine S.; Binder-Macleod, Stuart A

    2010-01-01

    Gait dysfunctions are highly prevalent in individuals post-stroke and affect multiple lower extremity joints. Recent evidence suggests that treadmill walking at faster than self-selected speeds can help improve post-stroke gait impairments. Also, the combination of functional electrical stimulation (FES) and treadmill training has emerged as a promising post-stroke gait rehabilitation intervention. However, the differential effects of combining FES with treadmill walking at the fast versus a ...

  11. Post-stroke cognitive impairments: diagnosis and therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Natalia Vyacheslavovna Pizova

    2013-11-01

    Full Text Available Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI. Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients.

  12. Factors affecting return to driving post-stroke.

    LENUS (Irish Health Repository)

    Tan, K M

    2012-02-01

    BACKGROUND: Stroke can affect a person\\'s ability to drive, an important means of transportation in the developed world. AIMS: To determine percentage of patients and factors associated with return to driving post-stroke in a service with emphasis on driver assessment. METHODS: Retrospective study of patients discharged from the Stroke Service of our 470-bed teaching hospital from 1998 to 2002. RESULTS: Of 72 drivers pre-stroke, 54% recalled a driving assessment and 68% returned to driving. Younger patients (58.6 +\\/- 12.0 vs. 66.5 +\\/- 10.5, p = 0.008) with lower Modified Rankin Score (median 1 vs. 2, p = 0.0001) and normal cognition (55 vs. 43%, p = 0.45) were more likely to resume driving. More patients who were assessed returned to driving than those who were not (74 vs. 61%, p = 0.31). CONCLUSIONS: A relatively high level of return to driving can be achieved post-stroke with a pro-active approach to driver assessment and rehabilitation. A structured assessment and referral programme should be offered where appropriate.

  13. Radiological Projection for Diagnosis of Shoulder Subluxation in Patients with Post-Stroke Hemiplegia

    International Nuclear Information System (INIS)

    The purpose of this study was to find out useful radiological projection of shoulder subluxation in patients with post-stroke hemiplegia. A total of 33 patients with post-stroke hemiplegia were included(20 men and 13 women, mean age 62.3 years) and having the subluxed shoulder over one finger breath. The shoulder subluxation was determined as the ratio of the radiographic vertical and horizontal distance. The vertical distance was determined by measuring the distance between the most inferolateral point of the acromion and the central point of the humeral head. The horizontal distance was determined by measuring the distance between the central point of the glenoid fossa and the central point of the humeral head. To measure of the shoulder subluxation, the shoulder AP, axial and transthoracic lateral projections were taken on both affected and unaffected shoulders. We analyzed the difference of subluxation distance by t-test. When patients was in sitting position, the average time of being shoulder subluxation was 123 second. There was significant difference between supine(49.90±13.6 mm) and sitting position(60.72±16.3 mm) in the vertical distance of shoulder anterior-posterior projection. Also, there was significant difference on transthoracic lateral projections, Affected 35.92±6.2 mm, Unaffected 28.76±5.4 mm. But in case of shoulder axial projection(supine position), there was no significant difference (Unaffected and affected was 23.01±9.0 mm, 22.45±8.2 mm each). Radiological projection of shoulder subluxation has diagnostic value when it goes after check out the process of subluxation through finger breadth test. For this, patients must be in sitting and shoulder neutral position about 2 minutes. In addition, Shoulder anterior-posterior and transthoracic projection were significant to diagnose subluxation. But in axial projection, there wasn't meaningful differences.

  14. The impact of patient's weight on post-stroke rehabilitation.

    Science.gov (United States)

    Kalichman, Leonid; Alperovitch-Najenson, Deborah; Treger, Iuly

    2016-08-01

    Purpose To evaluate the influence of patient's weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission - FIM at discharge) were evaluated. The Kruskal-Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho = -0.20, p = 0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients' BMI. Implications for Rehabilitation In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients. PMID:27248186

  15. Central adaptation of pain perception in response to rehabilitation of musculoskeletal pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Christoffer H; Sundstrup, Emil;

    2012-01-01

    BACKGROUND: Understanding the mechanisms of long-standing musculoskeletal pain and adaptations in response to physical rehabilitation is important for developing optimal treatment strategies. The influence of central adaptations of pain perception in response to rehabilitation of musculoskeletal...... 2 min group, respectively, and 29 (1 to 58) kPa and 36 (7 to 64) kPa in the 12 min group. LIMITATIONS: Blinding of participants is not possible in behavioural interventions. CONCLUSION: Central adaptations of pain perception occur in response to rehabilitation of musculoskeletal pain. Thus, treating...... pain in one region of the body reduces sensitivity to pressure in other regions of the body. Clinicians and researchers may use this knowledge to better understand adaptations of pain perception in patients with musculoskeletal pain....

  16. Central Pain Following Cord Severance for Cephalosomatic Anastomosis.

    Science.gov (United States)

    Canavero, Sergio; Bonicalzi, Vincenzo

    2016-04-01

    One of the key obstacles to a successful head transplant is the possible onset of central pain, a chronic pain condition that would impair the quality of life of the transplantee. In this review, we provide the reader with a knowledge of this neglected aspect of the head transplant initiative and outline the management should this eventuality occur. PMID:26880305

  17. miR-137, a new target for post-stroke depression?

    Institute of Scientific and Technical Information of China (English)

    Lixia Zhao; Huazi Li; Ruiyou Guo; Teng Ma; Rongyao Hou; Xiaowei Ma; Yifeng Du

    2013-01-01

    Expression of miR-137 is downregulated in brain tissue from patients with depression and suicidal behavior, and is also downregulated in peripheral blood from stroke patients. However, it is not yet known if miR-137 acts as a bridge between stroke and depression. To test this, we used middle cerebral artery occlusion and chronic mild stress to establish a post-stroke depression model in rats. Compared with controls, we found significantly lower miR-137 levels in the brain and peripheral blood from post-stroke depression rats. Injection of a miR-137 antagonist into the brain ventricles upregulated miR-137 levels, and improved behavioral changes in post-stroke depression rats. Lu-ciferase assays showed miR-137 bound to the 3′UTR of Grin2A, regulating Grin2A expression in a neuronal cel line. Grin2A gene overexpression in the brain of post-stroke depression rats, noticea-bly suppressed the inhibitory effect of miR-137 on post-stroke depression. Overal , our results show that miR-137 suppresses Grin2A protein expression through binding to Grin2A mRNA, thereby ex-erting an inhibitory effect on post-stroke depression. Our results offer a new therapeutic direction for post-stroke depression.

  18. [Analgesic effects of cannabinoids on central pain syndrome].

    Science.gov (United States)

    Igon'kina, S I; Churiukanov, M V; Churiukanov, V V; Kukushkin, M L

    2011-01-01

    It was shown that cannabinoids anandamide, HU210 and WIN 55,212-2 inhibit both spontaneous episodes of pain and mechanical allodynia in rats with central pain syndrome caused by disturbance of inhibitory processes in the dorsal horns of lumbar spinal cord. The analgesic effect is most pronounced in the intrathecal route of administration. The intensity of analgesic actions of cannabinoids on the central pain syndrome in rats, depending on the drug is as follows: HU210 > WIN 55,212-2 > anandamide. PMID:22359935

  19. Spinal cord stimulation therapy for localized central pain

    International Nuclear Information System (INIS)

    We studied the pathophysiology of localized central pain and the surgical result of spinal cord stimulation. There were 10 cases; 7 males and 3 females from 24 to 77 years old. Pain was caused by peripheral nerve injury in one case, spinal cord injury in two cases and cerebrovascular disease (CVD) (thalamic pain) in 7 cases. All cases were treated by epidural spinal cord stimulation and followed from 0.8 to 8.8 years. Sufficient pain relief was achieved in one case of peripheral nerve and spinal cord injury and in 4 cases of CVD. Moderate pain control was achieved in 2 cases of CVD. In one each case of spinal cord injury and of CVD, pain control was ineffective. In cases with thalamic pain, we studied the correlation between the surgical result of spinal cord stimulation and the clinical features, MRI, fluoro-deoxyglucose (FDG)-positron emission tomography (PET), and somatosensory evoked potentials (SEP) findings before operation. MRI revealed a small to moderate sized lesion on the thalamus or putamen in each case. PET also showed decreased accumulation of FDG on the affected thalamus. In all cases without one fair responder to spinal cord stimulation, we could recognize definite SEP originating in the sensory cortex ipsilateral side to the CVD lesion during contralateral median or posterior tibial nerve stimulation. In the good responders, we could recognize SEP originating in the sensory cortex of the lesion side with less delayed latency or decreased amplitude than in the moderate responders. In this group, test stimulation with low voltage on the spinal cord evoked a sensory effect (paresthesia) over the painful part of the body. Spinal cord stimulation proved to be an effective treatment for localized central pain. In cases with localized central pain after CVD, we could expect to ameliorate the intractable pain in those cases in which SEP or spinal cord test stimulation revealed that the thalamo-cortical system was preserved. (author)

  20. Post-stroke seizures in consecutive elderly stroke patients

    Institute of Scientific and Technical Information of China (English)

    Yue Chen; Lufang Chen; Yiqing Tao; Maomao Han; Chunlan Cui; Shichao Liu

    2011-01-01

    This prospective study sought to investigate the clinical, radiological and electroencephalographic (EEG) characteristics of seizures in elderly stroke patients, and their outcomes. Over a 2-year study period, 158 consecutive eldedy patients with stroke were examined and followed up. Of these patients, 32 (20%) developed seizures, primarily related to stroke, within a follow up period between 5 months and 2 years. Of these 32 cases, 20 experienced infarctions, and 12 experienced hemorrhages. Involvement of cortical regions was detected in most of the patients exhibiting seizures. In these patients, 44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography (CT) images. Twenty-five patients (78%)developed early seizures (within 2 weeks after stroke), and half exhibited immediate post-stroke seizures. None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy, while 57% of late onset seizures (four cases) developed epilepsy. No specific EEG patterns were apparent in those who later developed epilepsy. Overall, early onset seizures after stroke were found to be relatively common, and did not affect outcome. Late onset seizures were less common, but were associated with chronic epilepsy.

  1. The sensory side of post-stroke motor rehabilitation.

    Science.gov (United States)

    Bolognini, Nadia; Russo, Cristina; Edwards, Dylan J

    2016-04-11

    Contemporary strategies to promote motor recovery following stroke focus on repetitive voluntary movements. Although successful movement relies on efficient sensorimotor integration, functional outcomes often bias motor therapy toward motor-related impairments such as weakness, spasticity and synergies; sensory therapy and reintegration is implied, but seldom targeted. However, the planning and execution of voluntary movement requires that the brain extracts sensory information regarding body position and predicts future positions, by integrating a variety of sensory inputs with ongoing and planned motor activity. Neurological patients who have lost one or more of their senses may show profoundly affected motor functions, even if muscle strength remains unaffected. Following stroke, motor recovery can be dictated by the degree of sensory disruption. Consequently, a thorough account of sensory function might be both prognostic and prescriptive in neurorehabilitation. This review outlines the key sensory components of human voluntary movement, describes how sensory disruption can influence prognosis and expected outcomes in stroke patients, reports on current sensory-based approaches in post-stroke motor rehabilitation, and makes recommendations for optimizing rehabilitation programs based on sensory stimulation. PMID:27080070

  2. Post-stroke epilepsy in Burkina Faso (West Africa).

    Science.gov (United States)

    Napon, Christian; Dabilgou, Anselme; Kyelem, Julie; Kaboré, Jean

    2016-09-15

    Post-stroke epilepsy (PSE) is defined as "recurrent seizures following stroke with confirmed diagnosis of epilepsy". Our objective was to describe the epidemiological, clinical and therapeutic PSE aspects at the Yalgado Ouedraogo Teaching Hospital, the main reference centre for neurological conditions in Burkina Faso. We conducted a retrospective study from January 2006 to December 2014. The data on thirty-two (32) cases of PSE was collected from a total of 1616 patients hospitalized for stroke, representing a rate of 1.98%. The patients' ages ranged from 25 to 77years old with a mean age of 58±10.39. There were 21 men and 11 women, with a gender ratio of 1.9. The time of occurrence of PSE ranged between 10 and 3600days (10years). The brain CT scan helped distinguish the different subtypes of stroke. Sixty-four percent (64%) of the cases experienced ischemic stroke and 36% of the cases cerebral hemorrhage. With regard to medical treatment, 23 patients received monotherapy, and 4 patients dual therapy. Exactly 96.87% of seizures were stabilized during the hospitalization period. PSE is a symptomatic type of epilepsy occurring during stroke sequelae. It is important not to lose sight of this before the occurrence of any focal or generalized seizure after a stroke. PMID:27538600

  3. Literature and art therapy in post-stroke psychological disorders.

    Science.gov (United States)

    Eum, Yeongcheol; Yim, Jongeun

    2015-01-01

    Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process. PMID:25744067

  4. Motor cortex stimulation therapy for post-stroke weakness

    International Nuclear Information System (INIS)

    Motor cortex stimulation (MCS) delivered concurrently with rehabilitation therapy may enhance motor recovery following stroke. We investigated the effects of MCS on the recovery from upper extremity paresis in patients with chronic stroke. In 12 patients who had moderate arm and finger paresis at more than 4 months after stroke, an electrode was placed through a small craniotomy on the epidural space of the motor cortex that was identified using functional MRI. MCS during occupational therapy for one hour was performed 3 times a day for at least 4 weeks. The mean scores for Fugl-Meyer assessments of the arm improved, from 37 preoperatively to 46 postoperatively. The mean grip strength improved from 3.25 to 9.0 kg. All patients appeared satisfactory in their results because they recognized an improvement of arm function. Although the mechanism of the beneficial effects of MCS on recovery after stroke has not been well known, the neuroplasticity might play a important role. In a few cases of the present series, it was observed that the hand motor cortex area detected on functional MRI had been enlarged after MCS therapy. MCS could become a novel neurosurgical treatment modality for the chronic post-stroke weakness. (author)

  5. Habituation to pain: further support for a central component.

    Science.gov (United States)

    Rennefeld, C; Wiech, K; Schoell, E D; Lorenz, J; Bingel, U

    2010-03-01

    Habituation to repetitive painful stimulation may represent an important protection mechanism against the development of chronic pain states. However, the exact neurobiological mechanisms of this phenomenon remain unclear. In this study we (i) explore the somatotopic specificity of pain attenuation over time and (ii) investigate the role of the endogenous opioid system in its development. We investigated 24 healthy volunteers with a paradigm of daily painful stimulation of the left volar forearm for 1 week. Habituation was assessed by comparing pain-related responses (ratings and thresholds) between days 1 and 8. To test whether a repetition-dependent attenuation of pain is restricted to the site of stimulus application or induces additional systemic effects indicative of a central mechanism, we also measured pain-related responses at the contralateral arm and the left leg. To assess the role of the endogenous opioid system in this mechanism, we used the opioid-receptor antagonist naloxone in a double-blind design. Repetitive painful stimulation over several days resulted in a significant habituation to pain at the site of daily stimulation. In addition, we also observed significant pain attenuation at the non-stimulated limbs. This effect was less pronounced at the untreated arm compared to the treated arm and even weaker in the leg, displaying a significant Stimulation-Site x Time interaction. The development of pain habituation was unaffected by the opioid antagonist naloxone. Taken together, these results strongly support the role of central components in the mechanism of pain habituation that do not directly involve the endogenous opioid system. PMID:20097005

  6. Pain and efficacy of local anesthetics for central venous access

    Directory of Open Access Journals (Sweden)

    William C Culp Jr

    2008-11-01

    Full Text Available William C Culp Jr1, Mohammed Yousaf2, Benjamin Lowry1, Timothy C McCowan3, William C Culp21Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; 2Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USAPurpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L, buffered 1% lidocaine (LB, or 2% chloroprocaine (CP injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine

  7. Post-Stroke Caregiving at Home Tops $11,000 a Year

    Science.gov (United States)

    ... nih.gov/medlineplus/news/fullstory_157341.html Post-Stroke Caregiving at Home Tops $11,000 a Year: ... News) -- The time spent caring for an older stroke survivor in the home totals about 22 hours ...

  8. The pain of RSI. The central issue.

    Science.gov (United States)

    Quintner, J L

    1989-12-01

    In this paper RSI (repetition strain injury) is used to refer to those diffuse neck and arm pain syndromes that appear to be directly related to occupational factors; for example, occupational overuse syndrome (OOS) and occupational cervicobrachial disorder (OCD). The author examines the clinical evidence that suggests the involvement of neural tissues in the pathogenesis of these conditions. He also speculates on the possible underlying pathophysiological mechanisms that may explain their development and persistence. PMID:2696462

  9. Problems with balance and binocular visual dysfunction are associated with post-stroke fatigue

    DEFF Research Database (Denmark)

    Schow, Trine; Teasdale, Thomas William; Jensen Quas, Kirsten;

    2016-01-01

    Trine Schow, Thomas William Teasdale, Kirsten Jensen Quas& Morten Arendt Rasmussen (2016): Problems with balance and binocular visual dysfunction are associated with post-stroke fatigue, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2016.1188475......Trine Schow, Thomas William Teasdale, Kirsten Jensen Quas& Morten Arendt Rasmussen (2016): Problems with balance and binocular visual dysfunction are associated with post-stroke fatigue, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2016.1188475...

  10. 4-CLASS MOTOR IMAGERY CLASSIFICATION FOR POST STROKE REHABILITATION USING BRAIN-COMPUTER INTERFACE

    OpenAIRE

    Aarathi Kumar*, Nisha. P. V

    2016-01-01

    Brain-Computer Interface (BCI) is a mechanism that helps in the control/communication of one’s environment through the brain signals obtained directly from the brain via an EEG signal acquisition unit. A BCI incorporating Motor Imagery for post-stroke rehabilitation of upper limbs and knee in fully disabled patients is designed. It helps in restoring some of the activities of the daily living. It aids post-stroke sufferers to carry out functionalities like movement of right an...

  11. Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review.

    Science.gov (United States)

    Louie, Dennis R; Eng, Janice J

    2016-01-01

    Powered robotic exoskeletons are a potential intervention for gait rehabilitation in stroke to enable repetitive walking practice to maximize neural recovery. As this is a relatively new technology for stroke, a scoping review can help guide current research and propose recommendations for advancing the research development. The aim of this scoping review was to map the current literature surrounding the use of robotic exoskeletons for gait rehabilitation in adults post-stroke. Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of Clinical Trials) were searched for articles from inception to October 2015. Reference lists of included articles were reviewed to identify additional studies. Articles were included if they utilized a robotic exoskeleton as a gait training intervention for adult stroke survivors and reported walking outcome measures. Of 441 records identified, 11 studies, all published within the last five years, involving 216 participants met the inclusion criteria. The study designs ranged from pre-post clinical studies (n = 7) to controlled trials (n = 4); five of the studies utilized a robotic exoskeleton device unilaterally, while six used a bilateral design. Participants ranged from sub-acute (6 months) stroke. Training periods ranged from single-session to 8-week interventions. Main walking outcome measures were gait speed, Timed Up and Go, 6-min Walk Test, and the Functional Ambulation Category. Meaningful improvement with exoskeleton-based gait training was more apparent in sub-acute stroke compared to chronic stroke. Two of the four controlled trials showed no greater improvement in any walking outcomes compared to a control group in chronic stroke. In conclusion, clinical trials demonstrate that powered robotic exoskeletons can be used safely as a gait training intervention for stroke. Preliminary findings suggest that exoskeletal gait training is equivalent to traditional therapy for chronic stroke

  12. Acetaminophen prevents hyperalgesia in central pain cascade

    OpenAIRE

    Crawley, Brianna; Saito, Osamu; Malkmus, Shelle; Fitzsimmons, Bethany; Hua, Xiao-Ying; Yaksh, Tony L.

    2008-01-01

    Acetaminophen is an analgesic and antipyretic drug believed to exert its effect through interruption of nociceptive processing. In order to determine whether this effect is due to peripheral or central activity, we studied the efficacy of systemic (oral) and intrathecal (IT) application of acetaminophen in preventing the development of hyperalgesia induced through the direct activation of pro-algogenic spinal receptors. Spinal administration of substance P (SP, 30 nmol, IT) in rats produced a...

  13. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System.

    Science.gov (United States)

    Linnman, Clas; Borsook, David

    2013-01-01

    This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain pathway, from injury site to behavioral consequence, in a quantitative manner. Such a development could lead to diagnostics determining the source of pain (peripheral or central), objective monitoring of treatment progression, and, hopefully, objective biomarkers of pain. PMID:24228169

  14. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System

    Directory of Open Access Journals (Sweden)

    Clas Linnman

    2013-10-01

    Full Text Available This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain pathway, from injury site to behavioral consequence, in a quantitative manner. Such a development could lead to diagnostics determining the source of pain (peripheral or central, objective monitoring of treatment progression, and, hopefully, objective biomarkers of pain.

  15. Motor cortex electric stimulation for the treatment of neuropathic pain

    Directory of Open Access Journals (Sweden)

    Walter J. Fagundes-Pereyra

    2010-12-01

    Full Text Available OBJECTIVE: Motor cortex stimulation (MCS is considered to be an effective treatment for chronic neuropathic pain. The aim of the present study was to assess the efficacy of MCS for treating neuropathic pain. METHOD: 27 patients with chronic neuropathic pain were operated. Electrodes were implanted with the use of an stereotactic frame. Electrophysiological evaluations (motor stimulation and somatosensory evoked potentials were performed, with guidance by means of three-dimensional reconstruction of magnetic resonance images of the brain. 10 patients (37% presented central neuropathic pain (post-stroke pain and 17 others (63% presented peripheral neuropathic pain (brachial plexus avulsion, phantom limb pain or trigeminal pain. RESULTS: In 15 patients (57.7% the pain relief was 50% or more; while in ten patients (38.5%, more than 60% of the original pain was relieved. No differences were found in relation to central and peripheral neuropathic pain (p=0.90, pain location (p=0.81, presence of motor deficit (p=0.28 and pain duration (p=0.72. No major complications were observed. CONCLUSION: MCS was efficient for treating patients presenting chronic central or peripheral neuropathic pain.

  16. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

    Science.gov (United States)

    Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen

    2015-01-01

    Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…

  17. Overexpression of brain-derived neurotrophic factor in the hippocampus protects against post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Hao-hao Chen; Ning Zhang; Wei-yun Li; Ma-rong Fang; Hui Zhang; Yuan-shu Fang; Ming-xing Ding; Xiao-yan Fu

    2015-01-01

    Post-stroke depression is associated with reduced expression of brain-derived neurotrophic factor (BDNF). In this study, we evaluated whether BDNF overexpression affects depression-like behavior in a rat model of post-stroke depression. The middle cerebral artery was occluded to produce a model of focal cerebral ischemia. These rats were then subjected to isolation-housing combined with chronic unpredictable mild stress to generate a model of post-stroke depression. ABDNF gene lentiviral vector was injected into the hippocampus. At 7 days after injection, western blot assay and real-time quantitative PCR revealed that BDNF expression in the hippo-campus was increased in depressive rats injected with BDNF lentivirus compared with depressive rats injected with control vector. Furthermore, sucrose solution consumption was higher, and horizontal and vertical movement scores were increased in the open ifeld test in these rats as well. These ifndings suggest that BDNF overexpression in the hippocampus of post-stroke depressive rats alleviates depression-like behaviors.

  18. Post-stroke depression treated with acupuncture and moxibustion: an evaluation of therapeutic effect and safety

    Institute of Scientific and Technical Information of China (English)

    聂容荣

    2013-01-01

    Objective To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of post-stroke depression (PSD) by regulating the liver and strengthening the root prescription.Methods In light of the random controlled trial principle,123 cases were

  19. Effects of Physical Exercise on Working Memory and Prefrontal Cortex Function in Post-Stroke Patients.

    Science.gov (United States)

    Moriya, M; Aoki, C; Sakatani, K

    2016-01-01

    Physical exercise enhances prefrontal cortex activity and improves working memory performance in healthy older adults, but it is not clear whether this remains the case in post-stroke patients. Therefore, the aim of this study was to examine the acute effect of physical exercise on prefrontal cortex activity in post-stroke patients using near-infrared spectroscopy (NIRS). We studied 11 post-stroke patients. The patients performed Sternberg-type working memory tasks before and after moderate intensity aerobic exercise (40 % of maximal oxygen uptake) with a cycling ergometer for 15 min. We measured the NIRS response at the prefrontal cortex during the working memory task. We evaluated behavioral performance (response time and accuracy) of the working memory task. It was found that physical exercise improved behavioral performance of the working memory task compared with the control condition (p physical exercise enhanced prefrontal cortex activation, particularly in the right prefrontal cortex (p exercise enhances prefrontal cortex activity and improves working memory performance in post-stroke patients. PMID:27526144

  20. The "Living with Dysarthria" Group for Post-Stroke Dysarthria: The Participant Voice

    Science.gov (United States)

    Mackenzie, C.; Kelly, S.; Paton, G.; Brady, M.; Muir, M.

    2013-01-01

    Background:The "Living with Dysarthria" group programme, devised for people with post-stroke dysarthia and family members, was piloted twice. Feedback from those who experience an intervention contributes to the evaluation of speech and language therapy programmes, giving the participant view of the intervention's value and guiding…

  1. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia

    Science.gov (United States)

    Chen, Aiqing; Akinyemi, Rufus O.; Hase, Yoshiki; Firbank, Michael J.; Ndung’u, Michael N.; Foster, Vincent; Craggs, Lucy J. L.; Washida, Kazuo; Okamoto, Yoko; Thomas, Alan J.; Polvikoski, Tuomo M.; Allan, Louise M.; Oakley, Arthur E.; O’Brien, John T.; Horsburgh, Karen; Ihara, Masafumi

    2016-01-01

    White matter hyperintensities as seen on brain T2-weighted magnetic resonance imaging are associated with varying degrees of cognitive dysfunction in stroke, cerebral small vessel disease and dementia. The pathophysiological mechanisms within the white matter accounting for cognitive dysfunction remain unclear. With the hypothesis that gliovascular interactions are impaired in subjects with high burdens of white matter hyperintensities, we performed clinicopathological studies in post-stroke survivors, who had exhibited greater frontal white matter hyperintensities volumes that predicted shorter time to dementia onset. Histopathological methods were used to identify substrates in the white matter that would distinguish post-stroke demented from post-stroke non-demented subjects. We focused on the reactive cell marker glial fibrillary acidic protein (GFAP) to study the incidence and location of clasmatodendrosis, a morphological attribute of irreversibly injured astrocytes. In contrast to normal appearing GFAP+ astrocytes, clasmatodendrocytes were swollen and had vacuolated cell bodies. Other markers such as aldehyde dehydrogenase 1 family, member L1 (ALDH1L1) showed cytoplasmic disintegration of the astrocytes. Total GFAP+ cells in both the frontal and temporal white matter were not greater in post-stroke demented versus post-stroke non-demented subjects. However, the percentage of clasmatodendrocytes was increased by >2-fold in subjects with post-stroke demented compared to post-stroke non-demented subjects (P = 0.026) and by 11-fold in older controls versus young controls (P < 0.023) in the frontal white matter. High ratios of clasmotodendrocytes to total astrocytes in the frontal white matter were consistent with lower Mini-Mental State Examination and the revised Cambridge Cognition Examination scores in post-stroke demented subjects. Double immunofluorescent staining showed aberrant co-localization of aquaporin 4 (AQP4) in retracted GFAP+ astrocytes with

  2. Clinical use of pregabalin in the management of central neuropathic pain

    Directory of Open Access Journals (Sweden)

    Nanna B Finnerup

    2007-01-01

    Full Text Available Nanna B Finnerup, Troels S JensenDanish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, DenmarkAbstract: Central neuropathic pain (central pain is treated with antidepressants, various anticonvulsants, opioids, and cannabinoids, but in many cases treatment is insufficient and associated with a range of side-effects. This review addresses a new treatment for neuropathic pain, the anticonvulsant pregabalin. We review the pharmacology, mode of action, pharmacokinetics, and safety of pregabalin as well as two randomized efficacy studies in central pain and a brief overview of efficacy in peripheral neuropathic pain. Pregabalin appears to have efficacy in treating central pain comparable to that in peripheral neuropathic pain as well as efficacy of other recommended drugs for central pain. Pregabalin also improves disturbed sleep and anxiety. Pregabalin is well tolerated; the most common side-effects are somnolence, dizziness, ataxia, and weight gain. Pregabalin is suitable for patients on multiple drugs although there may be additive CNS-related side-effects. Thus, pregabalin has a primary role in central pain patients.Keywords: central pain, neuropathic pain, pregabalin, pharmacology

  3. Virtual reality environments for post-stroke arm rehabilitation

    Directory of Open Access Journals (Sweden)

    Beaudoin Christian

    2007-06-01

    Full Text Available Abstract Introduction Optimal practice and feedback elements are essential requirements for maximal motor recovery in patients with motor deficits due to central nervous system lesions. Methods A virtual environment (VE was created that incorporates practice and feedback elements necessary for maximal motor recovery. It permits varied and challenging practice in a motivating environment that provides salient feedback. Results The VE gives the user knowledge of results feedback about motor behavior and knowledge of performance feedback about the quality of pointing movements made in a virtual elevator. Movement distances are related to length of body segments. Conclusion We describe an immersive and interactive experimental protocol developed in a virtual reality environment using the CAREN system. The VE can be used as a training environment for the upper limb in patients with motor impairments.

  4. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  5. The influence of demographic, environmental and physical factors on functional independence post stroke

    OpenAIRE

    M.V. Mamabolo; W. Mudzi; A.S. Stewart; N. P. Mbambo; S. Olorunju

    2008-01-01

    Purpose: The magnitude of disability observed in strokesurvivors is believed to be dependent in part, on the severity of neurological deficits incurred. A s important but less well understood, is thecontribution of demographic, physical and environmental factors. The objective of this study was to establish what demographic, environmentaland physical factors influence functional independence post stroke. Method: Convenience sampling was used in the selection of subjects from four stroke outpa...

  6. Quality-of-life of Chinese older adults with post-stroke dysphagia

    OpenAIRE

    Tsai, Chun-fung, Kelvin; 蔡振鋒

    2013-01-01

    Background: One of the common complications of stroke is dysphagia. Dysphagia can be a disabling problem with negative psycho-social consequences. The effect of dysphagia on quality-of-life is not well understood among the stroke survivors. The Chinese version of Swallow Quality-of-Life Questionnaire can be a reliable instrument to provide a multidimensional evaluation on the impact of post-stroke dysphagia in the population of Hong Kong Chinese older adults. Objective: To investigate fa...

  7. Effect of Auditory Constraints on Motor Learning Depends on Stage of Recovery Post Stroke

    Directory of Open Access Journals (Sweden)

    Viswanath eAluru

    2014-06-01

    Full Text Available In order to develop evidence-based rehabilitation protocols post stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in twenty subjects with chronic hemiparesis, and used a bimanual wrist extension task using a custom-made wrist trainer to facilitate learning of wrist extension in the paretic hand under four auditory conditions: 1 without auditory cueing; 2 to non-musical happy sounds; 3 to self-selected music; and 4 to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post stroke.

  8. Concurrent deficits of soleus and gastrocnemius muscle fascicles and Achilles tendon post stroke

    OpenAIRE

    Zhao, Heng; Ren, Yupeng; Roth, Elliot J.; Harvey, Richard L.; Zhang, Li-Qun

    2015-01-01

    Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomec...

  9. Effect of auditory constraints on motor performance depends on stage of recovery post-stroke.

    Science.gov (United States)

    Aluru, Viswanath; Lu, Ying; Leung, Alan; Verghese, Joe; Raghavan, Preeti

    2014-01-01

    In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke. PMID

  10. Post-stroke infection: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Dijkgraaf Marcel G

    2011-09-01

    Full Text Available Abstract Background stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome. Methods MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome. Results 87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU. There was significant heterogeneity between studies (P 2 = 97%. The overall pooled infection rate was 30% (24-36%; rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10% and 10% (95%CI 9-12%. For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%, 28% (95%CI 18-38% and 20% (95%CI 0-40%. Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68. Conclusions Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.

  11. Professional Competences of Music Therapists Working in Post-stroke Rehabilitation

    OpenAIRE

    Esa Ala-Ruona; Anita Forsblom

    2012-01-01

    The aim of this qualitative study is to gain more insight into the skills and knowledge that music therapists feel they need in order to work successfully with people who have had an acute stroke. For this purpose, 6 music therapists were interviewed about their own particular specialist education. Another interview topic for them was to recount their subjective experiences of post-stroke rehabilitation work in hospitals and health care units, during the course of two projects: the Music List...

  12. Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients

    OpenAIRE

    Yang, Jin Kyu; Ahn, Na El; Kim, Dae Hyun; Kim, Deog Young

    2014-01-01

    Objective To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients. Methods Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted wal...

  13. Post-stroke epilepsy in young adults: a long-term follow-up study

    OpenAIRE

    Arntz, R.M.; Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Dijk, E.J. van; de Leeuw, F E

    2013-01-01

    BACKGROUND: Little is known about the incidence and risk of seizures after stroke in young adults. Especially in the young seizures might dramatically influence prognosis and quality of life. We therefore investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH). METHODS AND FINDINGS: We performed a prospective cohort study among 697 consecutive patients with a first-ever...

  14. Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy.

    Directory of Open Access Journals (Sweden)

    Keith R Lohse

    Full Text Available BACKGROUND: The objective of this analysis was to systematically review the evidence for virtual reality (VR therapy in an adult post-stroke population in both custom built virtual environments (VE and commercially available gaming systems (CG. METHODS: MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18 post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro. RESULTS: Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38. For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66. For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. DISCUSSION: VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. TRIAL REGISTRATION: Prospero CRD42013004338.

  15. Clinical Observation on Acupuncture Treatment for Post-stroke Spastic Hemiplegia

    Institute of Scientific and Technical Information of China (English)

    Zhang Yan; Liu Guo-cheng; Wang Jin-yu; Sun Yun-guang; Yang Liu-jiang

    2013-01-01

    Objective:To observe the clinical effect of contralateral needling plus rehabilitation for post-stroke spastic hemiplegia.Methods:Thirty-six patients with post-stroke spastic hemiplegia were randomly divided into a treatment group and a control group,18 cases in each group.The two groups were all given rehabilitation training.The contralateral needling was adopted in the treatment group on the acupoints group of brain-refreshing and orifice-opening needling method.The routine acupuncture was applied in the control group on the same acupoints.Respectively before and after the treatment,the modified Ashworth scale (MAS) and clinical spasticity index (CSI) were used to assess the therapeutic effects.Results:The total effective rate was 94.4% in the treatment group and 67.7% in the control group,with a statistical difference in comparison of the two groups (P<0.05).In comparison of MAS and CSl scores after the treatment between the treatment group and control group,the differences were statistically significant (P<0.05).Conclusion:The contralateral needling plus rehabilitation training is an effective method for the treatment of post-stroke spastic hemiplegia.

  16. Association Between Serum Levels of Vitamin D and the Risk of Post-Stroke Anxiety

    Science.gov (United States)

    Wu, Chaowen; Ren, Wenwei; Cheng, Jianhua; Zhu, Beilei; Jin, Qianqian; Wang, Liping; Chen, Cao; Zhu, Lin; Chang, Yaling; Gu, Yingying; Zhao, Jiyun; Lv, Dezhao; Shao, Bei; Zhang, Shunkai; He, Jincai

    2016-01-01

    Abstract Low levels of serum vitamin D are common in patients with mood disorders and stroke. It has been shown that low levels of serum vitamin D indicate a risk of depression in post-stroke subjects. Our aim was to determine the relationship between vitamin D and post-stroke anxiety (PSA). A consecutive series of 226 first acute ischemic stroke patients were recruited and followed up for 1 month. Serum levels of vitamin D were measured within 24 hours of admission. Patients with significant clinical symptoms of anxiety and a Hamilton anxiety scale score >7 were diagnosed as having PSA. In addition, 100 healthy subjects were recruited as controls and underwent measurements of serum vitamin D. A total of 60 patients (26.55%) showed anxiety at 1 month. Both PSA patients and non-PSA patients had lower serum levels of vitamin D than healthy subjects. A significant relationship was found between PSA and serum levels of vitamin D. Low serum levels of vitamin D (≤38.48 nmol/L) were independently associated with the development of PSA (OR: 2.49, 95% CI: 1.21–5.13, P = 0.01). Serum vitamin D status is related to the occurrence of anxiety in post-stroke patients and may be an independent risk factor of PSA after 1 month. PMID:27149477

  17. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study.

    Science.gov (United States)

    Park, Jin-Woo; Kim, Youngsun; Oh, Jong-Chi; Lee, Ho-Jun

    2012-12-01

    We tested the effect of effortful swallow combined with surface electrical stimulation used as a form of resistance training in post-stroke patients with dysphagia. Twenty post-stroke dysphagic patients were randomly divided into two groups: those who underwent effortful swallow with infrahyoid motor electrical stimulation (experimental group, n = 10) and effortful swallow with infrahyoid sensory electrical stimulation (control group, n = 10). In the experimental group, electrical stimulation was applied to the skin above the infrahyoid muscle with the current was adjusted until muscle contraction occurred and the hyoid bone was depressed. In the control group, the stimulation intensity was applied just above the sensory threshold. The patients in both groups were then asked to swallow effortfully in order to elevate their hyolaryngeal complex when the stimulation began. A total of 12 sessions of 20 min of training for 4 weeks were performed. Blinded biomechanical measurements of the extent of hyolaryngeal excursion, the maximal width of the upper esophageal sphincter (UES) opening, and the penetration-aspiration scale before and after training were performed. In the experimental group, the maximal vertical displacement of the larynx was increased significantly after the intervention (p method in post-stroke patients with dysphagia. PMID:22447240

  18. Factors associated with post-stroke depression and fatigue: lesion location and coping styles.

    Science.gov (United States)

    Wei, Changjuan; Zhang, Fang; Chen, Li; Ma, Xiaofeng; Zhang, Nan; Hao, Junwei

    2016-02-01

    Post-stroke depression (PSD) and post-stroke fatigue (PSF) are frequent and persistent problems among stroke survivors. Therefore, awareness of signs and symptoms of PSD and PSF is important for their treatment and recovery from stroke. Additionally, since sudden serious illness can result in disequilibrium, early institution of a coping process is essential to restoring stability. The brain damage of stroke leaves patients with unique physical and mental dysfunctions for which coping maybe a key resource while rebuilding lives. We evaluated 368 consecutive patients with acute ischemic stroke for post-stroke emotional disorders at admission and 3 months later. PSD was evaluated by using the Beck Depression Inventory, and PSF was scored with the Fatigue Severity Scale. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Locations of lesions were based on MRI. Those scans revealed infarcts located in the basal ganglia, corona radiate and internal capsule and constituted the independent factors associated with PSF 3 months after stroke occurrence. Conversely, PSD was not related to lesion location. Acceptance-resignation related to PSD and PSF both at admission and 3 months after stroke. Avoidance was the independent factor most closely related to PSD, whereas confrontation was the independent factor best related to PSF at 3 months after stroke onset. PMID:26568559

  19. Regulatory T Cells in Post-stroke Immune Homeostasis.

    Science.gov (United States)

    Liesz, Arthur; Kleinschnitz, Christoph

    2016-08-01

    The secondary neuroinflammatory response has come into focus of experimental stroke research. Immunological mechanisms after acute stroke are being investigated in the hope to identify novel and druggable pathways that contribute to secondary infarct growth after stroke. Among a variety of neuroimmunological events after acute brain ischemia, including microglial activation, brain leukocyte invasion, and secretion of pro-inflammatory factors, lymphocytes have been identified as the key leukocyte subpopulation driving the neuroinflammatory response and contributing to stroke outcome. Several studies have shown that pro-inflammatory lymphocyte subpopulations worsen stroke outcome and that inhibiting their invasion to the injured brain is neuroprotective. In contrast to the effector functions of pro-inflammatory lymphocytes, regulatory T cells (Treg) are critically involved in maintaining immune homeostasis and have been characterized as disease-limiting protective cells in several inflammatory conditions, particularly in primary inflammatory diseases of the central nervous system (CNS). However, due to the complex function of regulatory cells in immune homeostasis and disease, divergent findings have been described for the role of Treg in stroke models. Emerging evidence suggests that this discrepancy arises from potentially differing functions of Treg depending on the predominant site of action within the neurovascular unit and the surrounding inflammatory milieu. This article will provide a comprehensive review of current findings on Treg in brain ischemia models and discuss potential reasons for the observed discrepancies. PMID:27030356

  20. Supraspinal stimulation for treatment of refractory pain.

    Science.gov (United States)

    Parmar, V K; Gee, L; Smith, H; Pilitsis, J G

    2014-08-01

    Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. Consideration for neuromodulatory treatment begins with rigorous patient selection based on exhaustive conservative management, elimination of secondary gains, and a proper psychology evaluation. Trial stimulation prior to DBS is nearly always performed while trial stimulation prior to MCS surgery is symptom dependent. Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail. PMID:24956545

  1. Design and Development of a Low Cost Platform to Facilitate Post-Stroke Rehabilitation of the Elbow/Shoulder Region

    OpenAIRE

    Curran, Stephen

    2013-01-01

    For post-stroke rehabilitation of the upper limbs, increased amounts of therapy are directly related to improved rehabilitation outcomes. As such, a low cost therapy platform is proposed suitable for facilitating active therapy and administering activeassist therapy to the shoulder/elbow region of the upper limbs of individuals post-stroke in a local clinic or domestic setting. Enabling a person to undergo intensive rehabilitation therapy outside of a rehabilitation hospital setting permits t...

  2. Central modulators of human pain: Effects of oxytocin, exam stress, breathing exercises and transcranial magnetic stimulation

    OpenAIRE

    Zunhammer, Matthias

    2014-01-01

    The available means to control human pain are insufficient, novel mechanisms of pain modulation must be explored and understood. This cumulative dissertation comprises four studies, which explored potential means to modulate pain in the central nervous system. An overview on the current understanding of pain, its basic mechanisms, and its known modulators is provided. Study 1 tested if a high intranasal dose of the neuro-hypophyseal hormone oxytocin affected perception and processing of therm...

  3. Altered central sensitization and pain modulation in the CNS in chronic joint pain

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Skou, Søren Thorgaard; Nielsen, Thomas Arendt;

    2015-01-01

    Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral and ...... mechanisms, available tools are important for patent profiling and providing the basic knowledge for development of new drugs and for developing pain management regimes....

  4. Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke

    Directory of Open Access Journals (Sweden)

    Patten Carolynn

    2009-06-01

    Full Text Available Abstract Background While manually-assisted body-weight supported treadmill training (BWSTT has revealed improved locomotor function in persons with post-stroke hemiparesis, outcomes are inconsistent and it is very labor intensive. Thus an alternate treatment approach is desirable. Objectives of this pilot study were to: 1 compare the efficacy of body-weight supported treadmill training (BWSTT combined with the Lokomat robotic gait orthosis versus manually-assisted BWSTT for locomotor training post-stroke, and 2 assess effects of fast versus slow treadmill training speed. Methods Sixteen volunteers with chronic hemiparetic gait (0.62 ± 0.30 m/s post-stroke were randomly allocated to Lokomat (n = 8 or manual-BWSTT (n = 8 3×/wk for 4 weeks. Groups were also stratified by fast (mean 0.92 ± 0.15 m/s or slow (0.58 ± 0.12 m/s training speeds. The primary outcomes were self-selected overground walking speed and paretic step length ratio. Secondary outcomes included: fast overground walking speed, 6-minute walk test, and a battery of clinical measures. Results No significant differences in primary outcomes were revealed between Lokomat and manual groups as a result of training. However, within the Lokomat group, self-selected walk speed, paretic step length ratio, and four of the six secondary measures improved (p = 0.04–0.05, effect sizes = 0.19–0.60. Within the manual group, only balance scores improved (p = 0.02, effect size = 0.57. Group differences between fast and slow training groups were not revealed (p ≥ 0.28. Conclusion Results suggest that Lokomat training may have advantages over manual-BWSTT following a modest intervention dose in chronic hemiparetic persons and further, that our training speeds produce similar gait improvements. Suggestions for a larger randomized controlled trial with optimal study parameters are provided.

  5. Post-stroke depression: Prevalence and relationship with disability in chronic stroke survivors

    Directory of Open Access Journals (Sweden)

    Srivastava Abhishek

    2010-01-01

    Full Text Available Objectives: To evaluate (1 the prevalence of operationally defined depressive disorder (ICD-10 in chronic stroke subjects and (2 the relationship of post-stroke depression (PSD with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration, cognition (mini mental state examination, depressive ideation (Hamilton Depression Rating Scale - HRDS, impairment (Scandinavian Stroke Scale, balance (Berg Balance Scale, ambulatory status (Functional Ambulation Category, walking ability (speed, and independence in activities of daily living (Barthel Index. Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10 of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days were included in the study. Eighteen of the 51 participants (35.29% met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05. Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05 and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.

  6. Persistent post-stroke depression in mice following unilateral medial prefrontal cortical stroke.

    Science.gov (United States)

    Vahid-Ansari, F; Lagace, D C; Albert, P R

    2016-01-01

    Post-stroke depression (PSD) is a common outcome following stroke that is associated with poor recovery. To develop a preclinical model of PSD, we targeted a key node of the depression-anxiety circuitry by inducing a unilateral ischemic lesion to the medial prefrontal cortex (mPFC) stroke. Microinjection of male C57/BL6 mice with endothelin-1 (ET-1, 1600 pmol) induced a small (1 mm(3)) stroke consistently localized within the left mPFC. Compared with sham control mice, the stroke mice displayed a robust behavioral phenotype in four validated tests of anxiety including the elevated plus maze, light-dark, open-field and novelty-suppressed feeding tests. In addition, the stroke mice displayed depression-like behaviors in both the forced swim and tail suspension test. In contrast, there was no effect on locomotor activity or sensorimotor function in the horizontal ladder, or cylinder and home cage activity tests, indicating a silent stroke due to the absence of motor abnormalities. When re-tested at 6 weeks post stroke, the stroke mice retained both anxiety and depression phenotypes. Surprisingly, at 6 weeks post stroke the lesion site was infiltrated by neurons, suggesting that the ET-1-induced neuronal loss in the mPFC was reversible over time, but was insufficient to promote behavioral recovery. In summary, unilateral ischemic lesion of the mPFC results in a pronounced and persistent anxiety and depression phenotype with no evident sensorimotor deficits. This precise lesion of the depression circuitry provides a reproducible model to study adaptive cellular changes and preclinical efficacy of novel interventions to alleviate PSD symptoms. PMID:27483381

  7. A Comparative Study Between Modified Starch and Xanthan Gum Thickeners in Post-Stroke Oropharyngeal Dysphagia.

    Science.gov (United States)

    Vilardell, N; Rofes, L; Arreola, V; Speyer, R; Clavé, P

    2016-04-01

    Thickeners are used in post-stroke oropharyngeal dysphagia (OD) as a compensatory therapeutic strategy against aspirations. To compare the therapeutic effects of modified starch (MS) and xanthan gum (XG) thickeners on swallow safety and efficacy in chronic post-stroke OD patients using clinical and videofluoroscopic (VFS) assessment. Patients were studied by clinical assessment (volume-viscosity swallow test, V-VST) and VFS using 3 volumes (5, 10, 20 mL) and 3 viscosities (liquid, nectar and spoon thick), comparing MS and XG. We studied 122 patients (46MS, 76XG). (A) V-VST showed that both thickeners similarly improved safety of swallow. Prevalence of safe swallowing significantly increased with enhanced viscosity (P < 0.001 vs liquid), MS: 47.83 % at liquid, 84.93 % at nectar and 92.96 % at spoon thick; XG: 55.31 % at liquid, 77.78 % at nectar and 97.84 % at spoon thick. Patients on MS reported higher prevalence of pharyngeal residue at spoon-thick viscosities. (B) VFS: increasing bolus viscosity with either thickener increased prevalence of safe swallows (P < 0.001 vs liquid), MS: 30.25 % liquid, 61.07 % nectar and 92.64 % spoon thick; XG: 29.12 % liquid, 71.30 % nectar and 89.91 % spoon thick. Penetration-aspiration scale score was significantly reduced with increased viscosity with both thickeners. MS increased oral and pharyngeal residues at nectar and spoon-thick viscosities but XG did not. Timing of airway protection mechanisms and bolus velocity were not affected by either thickener. Increasing bolus viscosity with MS and XG thickeners strongly and similarly improved safety of swallow in chronic post-stroke OD by a compensatory mechanism; in contrast only MS thickeners increased oropharyngeal residue. PMID:26607158

  8. The effect of optokinetic and galvanic vestibular stimulations in reducing post-stroke postural asymmetry

    OpenAIRE

    Bonan, I. V.; Leblong, E.; Leplaideur, S.; Laviolle, B; Tasseel Tonche, Sophie; Yelnik, A. P.

    2015-01-01

    Objective: To investigate the postural effect of 2 types of sensory stimulation in patients with a left hemispheric lesion (LHL) or right hemispheric lesion (RHL) compared with controls. Methods: 35 patients (18 LHL, 17 RHL) and 27 controls (Mean age 54.1 years), with a mean delay post-stroke of 3.0 months were enrolled. Subjects stood on a force platform and were stimulated on the left and right side by optokinetic (Okn) and galvanic vestibular (Gv) stimulation. Lateral displacement followin...

  9. Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2014-02-01

    Full Text Available A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6, after stroke functional status (mRankin≥3, poor pre-stroke functional level (mRankin≥3 and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled

  10. Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Prior, Anders; Laursen, Thomas Munk; Larsen, Karen Kjær; Johnsen, Søren Paaske; Christensen, Jakob; Andersen, Grethe; Vestergaard, Mogens

    2014-01-01

    Background and Purpose: It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use. Methods: We conducted a nationwide, popula...... mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.......Background and Purpose: It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use. Methods: We conducted a nationwide......, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke...

  11. Quantitative videofluoroscopic analysis of penetration-aspiration in post-stroke patients

    Directory of Open Access Journals (Sweden)

    Bingjie Li

    2010-01-01

    Full Text Available Background : Dysphagia is a common complication of stroke and is a potential cause for aspiration and malnutrition and is also associated with poor outcome. Videofluoroscopic Swallowing Study (VFSS is the most objective method for evaluation of swallowing disorders. Aim : To investigate the incidence and characteristics of penetration-aspiration in post-stroke patients, and to study the relationship between penetration-aspiration and kinematic parameters of swallow. Materials and Methods : We prospectively studied swallowing function in 105 consecutive post-stroke patients and 100 normal adults by videofluoroscopic swallowing studies. The severity of airway invasion, penetration-aspiration, was studied quantitatively and kinematic parameters of swallow i.e. oral transit time, pharyngeal transit time (PTT, pharyngeal delay timem (PDT, maximal extent of vertical and anterior movement of larynx and hyoid bone for four kinds of boluses were also studied. Logistic regression was used to analyze the association between aspiration and kinematic parameters of swallow. Results : Stroke patients scored significantly higher scores on penetration-aspiration scale than the normal subjects (P < 0.001 during four bolus swallows. Logistic regression analysis showed that PTT, PDT, maximal extent of vertical laryngeal and hyoid movement were statistically associated with the prevalence of aspiration (P < 0.05. Conclusion : Penetration-aspiration is common in stroke patients. Several kinematic parameters of swallow are associated with the presence of aspiration on fluoroscopy. These data demonstrate that VFSS may be helpful for objective identification of dysphagia in stroke patients.

  12. 卒中后尿失禁%Post-stroke urinary incontinence

    Institute of Scientific and Technical Information of China (English)

    李彦丽; 武如冰

    2014-01-01

    Urinary incontinence is a common complication of stroke,40% to 60% of inpatients with stroke have urinary incontinence.Post-stroke urinary incontinence is a strong predictor of death,functional disability,and admission of rehabilitation institutions.Recovery of urinary incontinence is associated with a better stroke outcome.This article reviews the epidemiology,causes and classification,effects on stroke outcome,and treatment strategies of post-stroke urinary incontinence.%尿失禁是卒中的一种常见并发症,40%~60%的卒中住院患者存在尿失禁.卒中后尿失禁是患者死亡、功能残疾和入住康复机构的强烈预测因素.尿失禁的恢复与卒中转归更好相关.文章对卒中后尿失禁的流行病学、原因和分类、对卒中转归的影响以及治疗策略进行了综述.

  13. Moving Forward by Stimulating the Brain: Transcranial Direct Current Stimulation in Post-Stroke Hemiparesis

    Science.gov (United States)

    Peters, Heather T.; Edwards, Dylan J.; Wortman-Jutt, Susan; Page, Stephen J.

    2016-01-01

    Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015), while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity. PMID:27555811

  14. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation

    Directory of Open Access Journals (Sweden)

    Priyanka Shah

    2013-12-01

    Full Text Available Stroke victims tend to prioritize speaking, writing and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, noninvasive brain stimulation (NBS is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS and transcranial direct current stimulation (tDCS as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.

  15. Factors associated with post-stroke depression and emotional incontinence: lesion location and coping styles.

    Science.gov (United States)

    Wei, Changjuan; Gao, Juan; Chen, Li; Zhang, Fang; Ma, Xiaofeng; Zhang, Nan; Zhang, Wei; Xue, Rong; Luo, Lanlan; Hao, Junwei

    2016-07-01

    Post-stroke depression (PSD) and post-stroke emotional incontinence (PSEI) have attracted worldwide interest in recent years. These emotional disturbances have a negative impact on the rehabilitation process and the associated worse outcome. Consequently, defining the risk factors for development of PSD and PSEI is important. In this study, we evaluated 368 consecutive patients with acute ischemic stroke at admission and at three months later. PSD was evaluated by using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Multivariate analyses showed that anterior cortex infarction was associated with PSEI three months after stroke occurrence. The appearance of PSD was not related to lesion location. Both motor and sensory dysfunctions was independently associated with PSD at admission, whereas low degree of social utilization was the independent factor associated with PSD 3 months after stroke. Acceptance-resignation is related to PSD and PSEI both at admission and 3 months after stroke. Avoidance was the independent factor related to PSD at 3 months after stroke onset. PMID:26005045

  16. Moving Forward by Stimulating the Brain: Transcranial Direct Current Stimulation in Post-Stroke Hemiparesis.

    Science.gov (United States)

    Peters, Heather T; Edwards, Dylan J; Wortman-Jutt, Susan; Page, Stephen J

    2016-01-01

    Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015), while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity. PMID:27555811

  17. Validating ArmAssist Assessment as outcome measure in upper-limb post-stroke telerehabilitation.

    Science.gov (United States)

    Rodriguez-de-Pablo, Cristina; Balasubramanian, Sivakumar; Savic, Andrej; Tomic, Tijana D; Konstantinovic, Ljubica; Keller, Thierry

    2015-08-01

    The ArmAssist is a low-cost robotic system for post-stroke upper-limb telerehabilitation based on serious games. The system incorporates a set of games for the assessment of arm function, the ArmAssist Assessment (AAA), which allows a remote monitoring of the progress of the patient and an automatic adaptation of the therapy. In this study, different components of the AAA are compared against three widely-used clinical tests, the Fugl-Meyer Assessment (FMA) [1], the Action Research Arm Test (ARAT) [2] and the Wolf Motor Function Test (WMFT) [3] in order to select the most clinically meaningful ones for the final score provided to patients and therapist, and evaluate their capability to predict or even improve some aspects of these standard scales. All four tests were performed in 38 separate sessions in 19 post-stroke individuals in their sub-acute phase, as part of a broader study. Statistically significant correlation could be shown with the three clinical tests. These preliminary results are promising for the validation of AAA as a fast, automatic and clinically meaningful tool for remote progress assessment and therapy adaptation; however, more data and further analysis is needed to confirm this. PMID:26737324

  18. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome

    OpenAIRE

    Eric Moulton; Mélika Amor-Sahli; Vincent Perlbarg; Christine Pires; Sophie Crozier; Damien Galanaud; Romain Valabregue; Marion Yger; Flore Baronnet-Chauvet; Yves Samson; Didier Dormont; Charlotte Rosso

    2015-01-01

    International audience Fractional anisotropy (FA) is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after throm-bolysis with diffusion tensor imaging (DTI) at 24 hours post-stroke. Twenty-eight thrombo-lyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean...

  19. Meta-Analysis of Placebo Responses in Central Neuropathic Pain: Impact of Subject, Study, and Pain Characteristics

    DEFF Research Database (Denmark)

    Cragg, Jacquelyn J; Warner, Freda M; Finnerup, Nanna Brix; Jensen, Mark P; Mercier, Catherine; Richards, J Scott; Wrigley, Paul; Soler, Dolors; Kramer, John Lk

    2016-01-01

    interventions for central neuropathic pain. Study design, subject characteristics, and pain ratings for the placebo group were extracted from each trial. Pooling of results and identification of moderating factors were carried out using random effects meta-analysis and meta-regression techniques. A total of 39......The placebo response is a complex construct related to psychobiological effects, as well as natural history and regression to the mean. Moreover, patient and study design characteristics have also been proposed as significantly affecting placebo responses. The aim of the current investigation was...... to identify factors that contribute to variable placebo responses in clinical trials involving individuals with central neuropathic pain. To this end, we performed a systematic review and meta-analysis of placebo-controlled trials examining pharmacological and non-invasive brain stimulation...

  20. Reaction to topical capsaicin in spinal cord injury patients with and without central pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Pedersen, Louise H.; Terkelsen, Astrid J.;

    2007-01-01

    above the level of a spinal cord injury which already is hyperexcitable, would cause enhanced responses in patients with central pain at the level of injury compared to patients without neuropathic pain and healthy controls. Touch, punctuate stimuli, cold stimuli and topical capsaicin was applied above...

  1. Musculoskeletal pain among postmenopausal women in Nigeria: Association with overall and central obesity

    Directory of Open Access Journals (Sweden)

    Omoyemi O. Ogwumike, PhD

    2016-06-01

    Conclusion: Lower extremity and back pain symptoms were the most prevalent. For overall and central obesity directly associated with MSP, WHtR seemed the best obesity screening tool for MSP in postmenopausal women.

  2. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System

    OpenAIRE

    Clas Linnman; David Borsook

    2013-01-01

    This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain p...

  3. Central pain processing in chronic tension-type headache

    DEFF Research Database (Denmark)

    Lindelof, Kim; Ellrich, Jens; Jensen, Rigmor;

    2009-01-01

    OBJECTIVE: Chronic tension-type headache (CTTH) affects 3% of the population. Directly and indirectly it causes high costs and considerable loss of quality of life. The mechanisms of this disorder are poorly understood and the treatment possibilities are therefore limited. The blink reflex (BR) r...... combined homotopic and heterotopic effect of the conditioning pain onto the blink reflex could account for this finding.......) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck...... muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We...

  4. Can pelvic floor muscle training improve quality of life in men with mild to moderate post-stroke and lower urinary tract symptoms?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Dehlendorff, Christian;

    2016-01-01

    BACKGROUND: Lower urinary tract symptoms (LUTS) have a significant impact on quality of life (QoL) in post-stroke patients. AIM: To evaluate the effect of pelvic floor muscle training (PFMT) on QoL parameters in men with post-stroke LUTS. DESIGN: Randomised, controlled and single-blinded trial...

  5. Virtual Reality for Sensorimotor Rehabilitation Post-Stroke: The Promise and Current State of the Field.

    Science.gov (United States)

    Fluet, Gerard G; Deutsch, Judith E

    2013-03-01

    Developments over the past 2 years in virtual reality (VR) augmented sensorimotor rehabilitation of upper limb use and gait post-stroke were reviewed. Studies were included if they evaluated comparative efficacy between VR and standard of care, and or differences in VR delivery methods; and were CEBM (center for evidence based medicine) level 2 or higher. Eight upper limb and two gait studies were included and described using the following categories hardware (input and output), software (virtual task and feedback and presentation) intervention (progression and dose), and outcomes. Trends in the field were commented on, gaps in knowledge identified, and areas of future research and translation of VR to practice were suggested. PMID:24579058

  6. Assessment of pressure-pain thresholds and central sensitization of pain in lateral epicondylalgia

    DEFF Research Database (Denmark)

    Jespersen, Anders; Amris, Kirstine; Graven-Nielsen, Thomas;

    2013-01-01

    OBJECTIVE.: To assess pain sensitivity and spreading hyperalgesia in lateral epicondylalgia (LE). SUBJECTS.: Twenty-two women with LE, and 38 controls were included. OUTCOME MEASURES.: Computerized cuff pressure algometry was used for assessment of pressure-pain threshold and tolerance. The stimu...

  7. The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine*

    Institute of Scientific and Technical Information of China (English)

    Yongmei Yan; Wentao Fan; Li Liu; Ru Yang; Wenjia Yang

    2013-01-01

    The Xingnao Jieyu capsule has been shown to effectively relieve neurologic impairments and lessen depression. It remains poorly understood whether this capsule can be used to treat post-stroke depression. Thus, in the present study, we established a rat model of post-stroke de-pression using left middle cerebral artery occlusions in combination of chronic unpredictable stress and solitary housing during development. Experimental rats received intragastric perfusion with 0.82, 0.41, and 0.20 g/kg Xingnao Jieyu capsules separately dissolved in 2 mL distil ed water. Fluoxetine served as a positive control. The treatment was conducted over 28 days. Sugar water consumption test, open-field test, real-time fluorescent quantitative PCR and immunohistochemical staining re-sults demonstrated that intragastric perfusion with various doses of Xingnao Jieyu capsules in-creased sugar water consumption, voluntary behaviors and synaptotagmin mRNA and protein ex-pression in rats with post-stroke depression. These therapeutic effects were similar to those of fluoxetine. These results indicate that Xingnao Jieyu capsules upregulate synaptotagmin expres-sion in hippocampi of rats with post-stroke depression, and exert antidepressant effects.

  8. Non-Speech Oro-Motor Exercises in Post-Stroke Dysarthria Intervention: A Randomized Feasibility Trial

    Science.gov (United States)

    Mackenzie, C.; Muir, M.; Allen, C.; Jensen, A.

    2014-01-01

    Background: There has been little robust evaluation of the outcome of speech and language therapy (SLT) intervention for post-stroke dysarthria. Non-speech oro-motor exercises (NSOMExs) are a common component of dysarthria intervention. A feasibility study was designed and executed, with participants randomized into two groups, in one of which…

  9. Surgical treatment for central pain after stroke based on the neural mechanism

    International Nuclear Information System (INIS)

    Previous neurophysiological and neuroimaging studies have suggested that functional changes might occur in the sensory thalamus, associated with reorganization of the thalamocortical system, in cases with central pain after stroke (thalamic pain). It might cause the misconduction of the sensory signal or a hyperactive response to peripheral natural stimulation on the thalamus, resulting in it playing an important roles in the genesis of central pain. Hyperactivity in the cerebral cortex adjacent to the central sulcus on the side ipsilateral to a cerebrovascular disease (CVD) lesion also might relate to central pain. We performed various kinds of surgical treatments in 29 cases with central pain after stroke based on the neural mechanism deserbed above. Epidural spinal cord stimulation was effective in 4 out of 7 cases with localized pain on the distal part of the leg and arm. We achieved pain control in these cases showing definite somatosensory evoked potential (SEP) originating in the sensory cortex before surgery. Stereotactic (Vim-Vcpc) thalamotomy with the aid of depth microrecording was effective in 4 out of 7 cases with diffuse pain. In good responders, we could find responses to natural peripheral stimulation and seldom encountered irregular burst discharges in the sensory thalamus during the operation. Preoperative positron emission tomography (PET) studies also revealed an increase of regional cerebral blood flow (rCBF) in the sensory cortex ipsilateral to the thalamic CVD lesion during contralateral thumb brushing. Gamma knife treatment was effective in 5 out of 7 cases after stereotactic thalamotomy. It became stable in 3 out of these 5 cases. Each case was treated with a maximum dose of 120-150 Gy using a 4 mm collimator. Precentral electrical cortical stimulation was performed in 8 cases. Sufficient pain relief was achieved in 3 out of 6 cases in which we could implant an importable pulse generator (IPG). In one of these cases, we found definite

  10. Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization

    OpenAIRE

    Costantini, Raffaele; Affaitati, Giannapia; Massimini, Francesca; Tana, Claudio; Innocenti, Paolo; Giamberardino, Maria Adele

    2016-01-01

    Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1wee...

  11. Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review

    Directory of Open Access Journals (Sweden)

    Monica Lavoie

    2015-04-01

    Procedures and analyses: The PRISMA statement(1 for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions was used as a guideline to conduct the present review. A systematic search of publications on PubMed and PsycInfo was conducted. Experimental studies designed to assess the effectiveness of an intervention delivered by a technology, namely computer, smart tablet or teletreatment, to specifically improve anomia in post-stroke participants were selected, without limitations as to the dates of publication. The main outcomes studied were improvement in naming skills and generalization to untreated items and daily communication. The Downs and Black checklist for randomised and non-randomised studies of health care interventions(2 was used by two reviewers (ML and JM to conduct the methodological quality assessment. Results: A total of 20 studies were included in this review. Up to now, computer is by far the most popular technology, whereas only a few studies aimed at exploring the effectiveness of smart tablet or teletreatment. In some studies, technology was used as a therapy tool in a clinical setting, in the presence of the clinician, while in others, therapy with technology was self-administered at home, without the clinician. All studies confirmed the effectiveness of therapy provided by technology to improve naming of trained items. However, generalization to untrained items is unclear and assessment of generalization to daily communication is scarce. Conclusions: The results of this systematic review confirm that technology is a promising avenue in the management of post-stroke anomia. Self-administered therapies are particularly interesting since they allow increasing significantly the intensity and frequency of therapeutic activities, a factor that has been explicitly recognized as a positive determinant of the efficacy of language treatment(3. In future studies, ecological tasks aiming to evaluate therapy

  12. Transcranial magnetic resonance imaging-guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain

    OpenAIRE

    Jeanmonod, D.; Werner, B.; Morel, A.; Michels, L; Zadicario, E; Schiff, G.; Martin, E.

    2012-01-01

    Object Recent technological developments open the field of therapeutic application of focused ultrasound to the brain through the intact cranium. The goal of this study was to apply the new transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) technology to perform noninvasive central lateral thalamotomies (CLTs) as a treatment for chronic neuropathic pain. Methods In 12 patients suffering from chronic therapy-resistant neuropathic pain, tcMRgFUS CLT was propos...

  13. Two years post-stroke: the effects of dissatisfaction with services and quality of information on patients’ quality of life in Luxembourg

    OpenAIRE

    Baumann, Michèle; Chau, Nearkasen

    2013-01-01

    Stroke is the second cause of death and helps from socio-medical services and information are crucial for promoting post-stroke patient’s quality of life. We analysed the impact of dissatisfaction with these services and information on post-stroke patient’s quality of life taking into account socioeconomic factors and functional impairments, which remains little documented. Methods: All 2-year post-stroke patients admitted to all hospitals in Luxembourg were identified using the only care-exp...

  14. Innate Immunity and Inflammation Post-Stroke: An α7-Nicotinic Agonist Perspective

    Directory of Open Access Journals (Sweden)

    Silke Neumann

    2015-12-01

    Full Text Available Stroke is one of the leading causes of death and long-term disability, with limited treatment options available. Inflammation contributes to damage tissue in the central nervous system across a broad range of neuropathologies, including Alzheimer’s disease, pain, Schizophrenia, and stroke. While the immune system plays an important role in contributing to brain damage produced by ischemia, the damaged brain, in turn, can exert a powerful immune-suppressive effect that promotes infections and threatens the survival of stroke patients. Recently the cholinergic anti-inflammatory pathway, in particular its modulation using α7-nicotinic acetylcholine receptor (α7-nAChR ligands, has shown potential as a strategy to dampen the inflammatory response and facilitate functional recovery in stroke patients. Here we discuss the current literature on stroke-induced inflammation and the effects of α7-nAChR modulators on innate immune cells.

  15. Prediction of responders for outcome measures of Locomotor Experience Applied Post Stroke trial

    Directory of Open Access Journals (Sweden)

    Bruce H. K. Dobkin, MD

    2014-03-01

    Full Text Available The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking and 0.8 m/s (community walking. Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.

  16. Professional Competences of Music Therapists Working in Post-stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Esa Ala-Ruona

    2012-11-01

    Full Text Available The aim of this qualitative study is to gain more insight into the skills and knowledge that music therapists feel they need in order to work successfully with people who have had an acute stroke. For this purpose, 6 music therapists were interviewed about their own particular specialist education. Another interview topic for them was to recount their subjective experiences of post-stroke rehabilitation work in hospitals and health care units, during the course of two projects: the Music Listening Project (=MUKU, which specifically used music listening during acute stroke rehabilitation; and the Active Music Therapy Project (=MT-STROKE, which used more active music therapy techniques. The interviews pointed to three key categories regarding the factors that are seen to affect clinical thinking: the first hinges on knowledge concerning the neurological basis of strokes; the second on patient interaction itself; and the third on the physiological and emotional aspects of music therapy. The results provide a better understanding of the tacit knowledge possessed by music therapists who work within Stroke Rehabilitation.

  17. A literature review on the efficacy and safety of botulinum toxin: An injection in post-stroke spasticity

    Directory of Open Access Journals (Sweden)

    Majid Ghasemi

    2013-01-01

    Full Text Available Background: A variety of techniques for the management of spasticity have been suggested, including positioning, cryotherapy, splinting and casting, biofeedback, electrical stimulation, and medical management by pharmacological agents, Botulinum toxin A (BTA is now the pharmacological treatment of choice in focal spasticity. BTA by blocking acetylcholine release at neuromuscular junctions accounts for its therapeutic action to relieve spasticity. Methods: A computerized search of Pub Med was carried out to find the latest result about efficacy of BTA in management of post stroke spasticity. Result: Among 84 articles were found, frothy of them included in this review and divided to lower and upper extremity. Conclusions: BTA is a treatment choice in reducing tone and managing post stroke spasticity .

  18. Changes in patterns of EMG activity in post-stroke subjects following robot-assisted hand rehabilitation.

    OpenAIRE

    Salman, Berna

    2009-01-01

    A feasibility study of robot-assisted hand rehabilitation post-stroke was conducted to investigate changes in activation patterns of forearm and hand muscles. Four stroke survivors received robot-assisted hand rehabilitation twice a week for two months. Eight healthy age-matched control subjects performed the same exercises as stroke subjects in a single training session. The pattern of activation of forearm and hand muscles was analyzed by performing Principal Component Analysis on the root-...

  19. Impact of trichostatin A and sodium valproate treatment on post-stroke neurogenesis and behavioral outcomes in immature mice

    OpenAIRE

    Kadam, Shilpa D.; Charles Rohde; Smith, Dani R.; Anne Marie Comi

    2013-01-01

    Stroke in the neonatal brain frequently results in neurologic impairments including cognitive disability. We investigated the effect of long-term sodium valproate (valproate) and trichostatin A (TSA) treatment upon post-stroke neurogenesis in the dentate gyrus (DG) of stroke-injured immature mice. Decreased or abnormal integration of newborn DG neurons into hippocampal circuits can result in impaired visual-spatial function, abnormal modulation of mood-related behaviors, and the development o...

  20. Functional connectivity in post-stroke aphasia: innovative tools at the service of evidence-based practice

    Directory of Open Access Journals (Sweden)

    Edith Durand

    2014-05-01

    This study presents an innovative approach to clinical management in post-stroke aphasia. Specifically, the evidence shows that specific anomia therapy for verbs normalizes DMN integration, thus reflecting the large scope impact of speech therapy. Also, the correlation between DMN integration values and reactivity to SFA/V shows that DMN status before therapy can be predictive of response to specific therapy. Altogether, these results show that functional integration measures of the DMN can highlight prognosis and therapy efficiency in aphasia rehabilitation.

  1. Evidence for a central mode of action for etoricoxib (COX-2 inhibitor) in patients with painful knee osteoarthritis.

    Science.gov (United States)

    Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær

    2016-08-01

    The COX-2 inhibitor etoricoxib modulates the peripheral and central nociceptive mechanisms in animals. This interaction has not been studied in patients with pain. This randomized, double-blind, placebo-controlled, 2-way crossover, 4-week treatment study investigated the pain mechanisms modulated by etoricoxib in patients with painful knee osteoarthritis. Patients were randomized to group A (60 mg/d etoricoxib followed by placebo) or B (placebo followed by 60 mg/d etoricoxib). The quantitative, mechanistic pain biomarkers were pressure pain thresholds, temporal summation (TS), and conditioning pain modulation. Clinical readouts were Brief Pain Inventory, WOMAC, painDETECT questionnaire (PD-Q), and time and pain intensity during walking and stair climbing. Etoricoxib as compared with placebo significantly modulated the pressure pain thresholds (P = 0.012, localized sensitization) at the knee and leg (control site) (P = 0.025, spreading sensitization) and TS assessed from the knee (P = 0.038) and leg (P = 0.045). Conditioning pain modulation was not modulated. The Brief Pain Inventory (pain scores), PD-Q, WOMAC, and walking and stair climbing tests were all significantly improved by etoricoxib. Based on a minimum of 30% or 50% pain alleviation (day 0-day 28), responders and nonresponders were defined. The nonresponders showed a significant association between increased facilitation of TS and increased pain alleviation. None of the other parameters predicted the degree of pain alleviation. Generally, a responder to etoricoxib has the most facilitated TS. In conclusion, etoricoxib (1) modulated central pain modulatory mechanisms and (2) improved pain and function in painful osteoarthritis. Stronger facilitation of TS may indicate a better response to etoricoxib, supporting the central mode-of-action of the drug. PMID:27007068

  2. The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery

    Science.gov (United States)

    Park, Jihong; Lee, Gangpyo; Lee, Shi-Uk

    2016-01-01

    Objective To assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke. Methods Forty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into 'good status' and 'poor status' according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis. Results The z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS. Conclusion Impairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome. PMID:27152270

  3. Association of post stroke depression with social factors, insomnia, and neurological status in Chinese elderly population.

    Science.gov (United States)

    Wang, Lingru; Tao, Yong; Chen, Yang; Wang, Hua; Zhou, Huadong; Fu, Xiaoyan

    2016-08-01

    The purpose of this study was to investigate the association of post stroke depression (PSD) with social factors, insomnia, and neurological status among elderly Chinese patients with ischemic stroke. Six hundred and eight patients over 60 years of age, who had suffered from a first episode of ischemic stroke within 7 days, were enrolled into the study. They were divided into PSD and non-PSD groups according to the Self-rating Depression Scale (SDS) scores. The association of PSD with social factors, insomnia, and neurological status was analyzed using multivariable logistic regression analysis. Compared with the patients who did not develop PSD, those with PSD reported adverse life events more frequently, and more subjects with PSD lived alone, had left carotid artery infarction and cortical infarction (P < 0.05), history of insomnia, and high National Institute of Health Stroke Scale (NIHSS) scores and low Barthel Index (BI) scores (P < 0.01). The multivariable logistic regression analysis showed that the occurrence of PSD was associated with a history of insomnia (HR = 1.59, 95 % CI 1.12-2.36, P < 0.01), NIHSS scores (HR = 2.45, 95 % CI 1.42-3.91, P < 0.01) and BI scores (HR = 2.56, 95 % CI 1.39-4.25, P < 0.01). Insomnia and the degree of neurological deficit were associated with PSD in an elderly population of Chinese people. PMID:27120072

  4. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    Directory of Open Access Journals (Sweden)

    Bouwense SA

    2015-07-01

    -generating study provides the first evidence that pain relief with pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation. No such effects were observed in patients experiencing pain relief with the placebo treatment. The mechanisms underlying analgesic response to placebo vs drug treatments are different and, together with their interactions, deserve further study.Keywords: chronic pancreatitis, pregabalin, placebo, chronic pain treatment, quantitative sensory testing, central sensitization

  5. Evidence for a central mode of action for etoricoxib (COX-2 Inhibitor) in patients with painful knee osteoarthritis

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær

    2016-01-01

    The COX-2 inhibitor etoricoxib modulates the peripheral and central nociceptive mechanisms in animals. This interaction has not been studied in pain patients. This randomized, double-blind, placebo-controlled, 2-way crossover, 4-week treatment study investigated the pain mechanisms modulated by...... etoricoxib in patients with painful knee osteoarthritis.Patients were randomized to group A) (60 mg/day etoricoxib followed by placebo), or B) (placebo followed by 60 mg/day etoricoxib). The quantitative, mechanistic pain biomarkers were pressure pain thresholds (PPTs), temporal summation (TS), and...... conditioning pain modulation (CPM). Clinical readouts were Brief Pain Inventory (BPI), WOMAC, PainDetect Questionnaire (PDQ), time and pain intensity during walking and stair climbing.Etoricoxib as compared with placebo significantly modulated the PPTs (P=0.012, localized sensitization) at the knee and leg...

  6. Evidence-based pharmacological management of chronic neuropathic pain

    Directory of Open Access Journals (Sweden)

    Zarrin Ansari

    2013-06-01

    Full Text Available Neuropathic pain (NP is a chronic, debilitating symptomatology of lesions/injuries of the central and peripheral nervous system. As per pooled estimates, the prevalence is 7-8% in the general population; however, the prevalence varies with different neuropathic conditions. The aetiology can range from peripheral neuropathic conditions viz. peripheral diabetic neuropathic pain (PDNP, post-herpetic neuralgia (PHN, trigeminal neuralgia, HIV- associated polyneuropathy, cervical radiculopathy to central neuropathic conditions, viz. central post-stroke pain, spinal cord injury and the neuropathic pain associated with multiple sclerosis. Apart from the symptomatic perception of pain, neuropathic pain affects the cognitive and emotional aspects of the affected individual. The pain, being debilitating and resistant to over-the-counter analgesics, diminishes the quality of life, disrupts sleep and leads to psychiatric complications such as comorbid anxiety and depression. The management is palliative and involves drugs, psychological intervention, stimulations and nerve-blocking techniques. This review concentrates on the pharmacological therapeutic options available and focuses on the selection of the agent/s in accordance with the evidence. The first-line treatment includes the tricyclic antidepressants ([TCAs]; amitriptyline, nortriptyline, selective serotonin norepinephrine inhibitors ([SNRIs]; duloxetine, venlafaxine, calcium channel alpha 2 - delta ligands (pregabalin, gabapentin, carbamazepine and oxcarbazepine. Lidocaine plasters are first-line options for specific focal conditions such as post-herpetic neuralgia. The second-line therapy includes the opioid analgesics and tramadol. The choice of drug selection should complement the patient’s age, type of neuropathic condition, tolerability to an agent, comorbid condition and cost-effectiveness. Management must be individualized with a realistic and composite goal of making the pain tolerable and

  7. Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke

    Directory of Open Access Journals (Sweden)

    Patten Carolynn

    2013-01-01

    Full Text Available Abstract Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP and HYBRID (combined FTP and power training in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome, upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049, regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03. Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID following HYBRID vs. FTP (p = .03. MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05. Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p p

  8. Bihemispheric Motor Cortex Transcranial Direct Current Stimulation Improves Force Steadiness in Post-Stroke Hemiparetic Patients: A Randomized Crossover Controlled Trial.

    Science.gov (United States)

    Montenegro, Rafael A; Midgley, Adrian; Massaferri, Renato; Bernardes, Wendell; Okano, Alexandre H; Farinatti, Paulo

    2016-01-01

    Post-stroke patients usually exhibit reduced peak muscular torque (PT) and/or force steadiness during submaximal exercise. Brain stimulation techniques have been proposed to improve neural plasticity and help to restore motor performance in post-stroke patients. The present study compared the effects of bihemispheric motor cortex transcranial direct current stimulation (tDCS) on PT and force steadiness during maximal and submaximal resistance exercise performed by post-stroke patients vs. healthy controls. A double-blind randomized crossover controlled trial (identification number: TCTR20151112001; URL: http://www.clinicaltrials.in.th/) was conducted involving nine healthy and 10 post-stroke hemiparetic individuals who received either tDCS (2 mA) or sham stimulus upon the motor cortex for 20 min. PT and force steadiness (reflected by the coefficient of variation (CV) of muscular torque) were assessed during unilateral knee extension and flexion at maximal and submaximal workloads (1 set of 3 repetitions at 100% PT and 2 sets of 10 repetitions at 50% PT, respectively). No significant change in PT was observed in post-stroke and healthy subjects. Force steadiness during knee extension (~25-35%, P < 0.001) and flexion (~22-33%, P < 0.001) improved after tDCS compared to the sham condition in post-stroke patients, but improved only during knee extension (~13-27%, P < 0.001) in healthy controls. These results suggest that tDCS may improve force steadiness, but not PT in post-stroke hemiparetic patients, which might be relevant in the context of motor rehabilitation programs. PMID:27601988

  9. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS-II Study

    Directory of Open Access Journals (Sweden)

    Klemens Fheodoroff

    2015-04-01

    Full Text Available In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A treatment in 456 adults with post-stroke upper limb spasticity (ULS. Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001, contractures (soft tissue shortening [STS] (p = 0.006 and spasticity (p = 0.02 than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001, contracture (p < 0.0001, spasticity (p < 0.001 and shorter time since stroke (p = 0.001. Patients setting goals for pain were older (p = 0.01 with more contractures (p = 0.008. The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year vs. longer-term (>1 year post-stroke (80.0% vs. 79.2% or presence or absence of severe contractures (76.7% vs. 80.6%, although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

  10. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome

    Science.gov (United States)

    Moulton, Eric; Amor-Sahli, Mélika; Perlbarg, Vincent; Pires, Christine; Crozier, Sophie; Galanaud, Damien; Valabregue, Romain; Yger, Marion; Baronnet-Chauvet, Flore; Samson, Yves; Dormont, Didier; Rosso, Charlotte

    2015-01-01

    Fractional anisotropy (FA) is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after thrombolysis with diffusion tensor imaging (DTI) at 24 hours post-stroke. Twenty-eight thrombolyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean (MD), axial (AD), and radial (RD) diffusivities values were calculated in different Regions-of-Interest (ROIs): (1) the white matter underlying the precentral gyrus (M1), (2) the corona radiata (CoRad), (3) the posterior limb of the internal capsule (PLIC) and (4) the cerebral peduncles (CP). NIHSS scores were acquired at admission, day 1, and day 7; modified Rankin Scores (mRS) at 3 months. Significant decreases were found in FA, MD, and AD of the ipsilesional CoRad and M1. MD and AD were also significantly lower in the PLIC. The ratio of ipsi and contralesional AD of the CoRad (CoRad-rAD) was the strongest diffusion parameter correlated with motor NIHSS scores on day 7 and with the mRS at 3 months. A Receiver-Operator Curve analysis yielded a model for the CoRad-rAD to predict good outcome based on upper limb NIHSS motor scores and mRS with high specificity and sensitivity. FA values were not correlated with clinical outcome. In conclusion, axial diffusivity of the CoRad from clinical DTI at 24 hours post-stroke is the most appropriate diffusion metric for quantifying stroke damage to predict outcome, suggesting the importance of early axonal damage. PMID:26562509

  11. Studying post-stroke functional impairment after treatment with neural progenitor cells – an analysis of behavioral tests

    Directory of Open Access Journals (Sweden)

    Thorsten R. Doeppner

    2014-10-01

    Full Text Available Systemic transplantation of neural progenitor cells (NPCs in rodents reduces functional impairment after cerebral ischemia. In light of upcoming stroke trials regarding safety and feasibility of NPC transplantation, experimental studies have to successfully analyze the extent of NPC-induced neurorestoration on the functional level. However, appropriate behavioral tests for analysis of post-stroke motor coordination deficits and cognitive impairment after NPC grafting are not fully established. We therefore exposed male C57BL6 mice to either 45 min (mild or 90 min (severe of cerebral ischemia, using the thread occlusion model followed by intravenous injection of PBS or NPCs 6 h post-stroke with an observation period of three months. Post-stroke motor coordination was assessed by means of the rota rod, tight rope, corner turn, inclined plane, grip strength, foot fault, adhesive removal, pole test and balance beam test, whereas cognitive impairment was analyzed using the water maze, the open field and the passive avoidance test. Significant motor coordination differences after both mild and severe cerebral ischemia in favor of NPC-treated mice were observed for each motor coordination test except for the inclined plane and the grip strength test, which only showed significant differences after severe cerebral ischemia. Cognitive impairment after mild cerebral ischemia was successfully assessed using the water maze test, the open field and the passive avoidance test. On the contrary, the water maze test was not suitable in the severe cerebral ischemia paradigm, as it too much depends on motor coordination capabilities of test mice. In terms of both reliability and cost-effectiveness considerations, we thus recommend the corner turn, foot fault, balance beam, and open field test, which do not depend on durations of cerebral ischemia.

  12. Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study

    Directory of Open Access Journals (Sweden)

    van Lummel Rob C

    2011-05-01

    Full Text Available Abstract Background Multiple aspects of gait are typically impaired post-stroke. Asymmetric gait is common as a consequence of unilateral brain lesions. The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear. The objective of this exploratory study is to quantify the effects of hemiparesis on two putatively independent aspects of the bilateral coordination of gait to gain insight into mechanisms and their relationship and to assess their potential as clinical markers. Methods Twelve ambulatory stroke patients and age-matched healthy adults wore a tri-axial piezo-resistive accelerometer and walked back and forth along a straight path in a hall at a comfortable walking speed during 2 minutes. Gait speed, gait asymmetry (GA, and aspects of the bilateral coordination of gait (BCG were determined. Bilateral coordination measures included the left-right stepping phase for each stride φi, consistency in the phase generation φ_CV, accuracy in the phase generation φ_ABS, and Phase Coordination Index (PCI, a combination of accuracy and consistency of the phase generation. Results Group differences (p Conclusions In ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired. Although these features are not related to each other in healthy controls, they are strongly related in stroke patients, which is a novel finding. A measurement approach based on body-fixed sensors apparently may provide sensitive markers that can be used for clinical assessment and for enhancing rehabilitation targeting in post-stroke patients.

  13. Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening.

    Science.gov (United States)

    Swartz, Richard H; Bayley, Mark; Lanctôt, Krista L; Murray, Brian J; Cayley, Megan L; Lien, Karen; Sicard, Michelle N; Thorpe, Kevin E; Dowlatshahi, Dar; Mandzia, Jennifer L; Casaubon, Leanne K; Saposnik, Gustavo; Perez, Yael; Sahlas, Demetrios J; Herrmann, Nathan

    2016-07-01

    Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment ("DOC"). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA. PMID:27073189

  14. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome.

    Directory of Open Access Journals (Sweden)

    Eric Moulton

    Full Text Available Fractional anisotropy (FA is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after thrombolysis with diffusion tensor imaging (DTI at 24 hours post-stroke. Twenty-eight thrombolyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean (MD, axial (AD, and radial (RD diffusivities values were calculated in different Regions-of-Interest (ROIs: (1 the white matter underlying the precentral gyrus (M1, (2 the corona radiata (CoRad, (3 the posterior limb of the internal capsule (PLIC and (4 the cerebral peduncles (CP. NIHSS scores were acquired at admission, day 1, and day 7; modified Rankin Scores (mRS at 3 months. Significant decreases were found in FA, MD, and AD of the ipsilesional CoRad and M1. MD and AD were also significantly lower in the PLIC. The ratio of ipsi and contralesional AD of the CoRad (CoRad-rAD was the strongest diffusion parameter correlated with motor NIHSS scores on day 7 and with the mRS at 3 months. A Receiver-Operator Curve analysis yielded a model for the CoRad-rAD to predict good outcome based on upper limb NIHSS motor scores and mRS with high specificity and sensitivity. FA values were not correlated with clinical outcome. In conclusion, axial diffusivity of the CoRad from clinical DTI at 24 hours post-stroke is the most appropriate diffusion metric for quantifying stroke damage to predict outcome, suggesting the importance of early axonal damage.

  15. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome.

    Science.gov (United States)

    Moulton, Eric; Amor-Sahli, Mélika; Perlbarg, Vincent; Pires, Christine; Crozier, Sophie; Galanaud, Damien; Valabregue, Romain; Yger, Marion; Baronnet-Chauvet, Flore; Samson, Yves; Dormont, Didier; Rosso, Charlotte

    2015-01-01

    Fractional anisotropy (FA) is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after thrombolysis with diffusion tensor imaging (DTI) at 24 hours post-stroke. Twenty-eight thrombolyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean (MD), axial (AD), and radial (RD) diffusivities values were calculated in different Regions-of-Interest (ROIs): (1) the white matter underlying the precentral gyrus (M1), (2) the corona radiata (CoRad), (3) the posterior limb of the internal capsule (PLIC) and (4) the cerebral peduncles (CP). NIHSS scores were acquired at admission, day 1, and day 7; modified Rankin Scores (mRS) at 3 months. Significant decreases were found in FA, MD, and AD of the ipsilesional CoRad and M1. MD and AD were also significantly lower in the PLIC. The ratio of ipsi and contralesional AD of the CoRad (CoRad-rAD) was the strongest diffusion parameter correlated with motor NIHSS scores on day 7 and with the mRS at 3 months. A Receiver-Operator Curve analysis yielded a model for the CoRad-rAD to predict good outcome based on upper limb NIHSS motor scores and mRS with high specificity and sensitivity. FA values were not correlated with clinical outcome. In conclusion, axial diffusivity of the CoRad from clinical DTI at 24 hours post-stroke is the most appropriate diffusion metric for quantifying stroke damage to predict outcome, suggesting the importance of early axonal damage. PMID:26562509

  16. Post-Stroke Infections Exacerbate Ischemic Brain Injury in Middle-Aged Rats: Immunomodulation and Neuroprotection by Progesterone

    OpenAIRE

    Yousuf, Seema; Atif, Fahim; Sayeed, Iqbal; Wang, Jun; Stein, Donald G.

    2012-01-01

    We investigated the effect of delayed, prolonged systemic inflammation on stroke outcomes and progesterone (P4) neuroprotection in middle-aged rats. After transient middle cerebral artery occlusion/reperfusion (MCAO) surgery, rats received P4 (8 or 16 mg/kg) or vehicle injections at 2h, 6h and every 24h until day 7 post-occlusion. At 24h post-injury systemic inflammation was induced by giving 3 doses of lipopolysaccharide (LPS; 50 mg/kg, at 4h intervals) to model post-stroke infections. We me...

  17. The Cortical Signature of Central Poststroke Pain: Gray Matter Decreases in Somatosensory, Insular, and Prefrontal Cortices.

    Science.gov (United States)

    Krause, T; Asseyer, S; Taskin, B; Flöel, A; Witte, A V; Mueller, K; Fiebach, J B; Villringer, K; Villringer, A; Jungehulsing, G J

    2016-01-01

    It has been proposed that cortical structural plasticity plays a crucial role in the emergence and maintenance of chronic pain. Various distinct pain syndromes have accordingly been linked to specific patterns of decreases in regional gray matter volume (GMV). However, it is not known whether central poststroke pain (CPSP) is also associated with cortical structural plasticity. To determine this, we employed T1-weighted magnetic resonance imaging at 3 T and voxel-based morphometry in 45 patients suffering from chronic subcortical sensory stroke with (n = 23) and without CPSP (n = 22), and healthy matched controls (n = 31). CPSP patients showed decreases in GMV in comparison to healthy controls, involving secondary somatosensory cortex (S2), anterior as well as posterior insular cortex, ventrolateral prefrontal and orbitofrontal cortex, temporal cortex, and nucleus accumbens. Comparing CPSP patients to nonpain patients revealed a similar but more restricted pattern of atrophy comprising S2, ventrolateral prefrontal and temporal cortex. Additionally, GMV in the ventromedial prefrontal cortex negatively correlated to pain intensity ratings. This shows for the first time that CPSP is accompanied by a unique pattern of widespread structural plasticity, which involves the sensory-discriminative areas of insular/somatosensory cortex, but also expands into prefrontal cortex and ventral striatum, where emotional aspects of pain are processed. PMID:25129889

  18. Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain.

    Science.gov (United States)

    Jiang, Ying; Oathes, Desmond; Hush, Julia; Darnall, Beth; Charvat, Mylea; Mackey, Sean; Etkin, Amit

    2016-09-01

    Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive-emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress. PMID:27168362

  19. Gabapentin reverses central pain sensitization following a collagenase-induced intrathalamic hemorrhage in rats

    Directory of Open Access Journals (Sweden)

    Castel A

    2013-12-01

    Full Text Available Aude Castel, Pascal VachonFaculty of Veterinary Medicine, Department of Veterinary Biomedicine, University of Montreal, Saint-Hyacinthe, QC, CanadaPurpose: The treatment of central neuropathic pain remains amongst the biggest challenges for pain specialists. The main objective of this study was to assess gabapentin (GBP, amitriptyline (AMI, and carbamazepine (CARBA for the treatment of a rodent central neuropathic pain model.Methods: Male Sprague Dawley rats were trained on the rotarod, Hargreaves, Von Frey and acetone behavioral tests, and baseline values were obtained prior to surgery. A stereotaxic injection of either a collagenase solution or saline was made in the right ventral posterolateral thalamic nucleus. The rats were tested on days 2, 4, 8, and 11 postsurgery. They were retested at regular intervals from day 15 to day 25 postsurgery, after oral administration of either the vehicle (n=7 and n=8 rats with intracerebral injections of collagenase and saline, respectively or the different drugs (GBP [60 mg/kg], AMI [10 mg/kg], CARBA [100 mg/kg]; n=8 rats/drug.Results: A significant decrease in the mechanical thresholds and no change in heat threshold were observed in both hind limbs in the collagenase group, as we had previously shown elsewhere. Reversal of the mechanical hypersensitivity was achieved only with GBP (P<0.05. AMI and CARBA, at the dosages used, failed to show any effect on mechanical thresholds. Transient cold allodynia was observed in some collagenase-injected rats but failed to be statistically significant.Conclusion: Intrathalamic hemorrhaging in the ventrolateral thalamic nucleus induced a bilateral mechanical allodynia, which was reversed by GBP but not AMI or CARBA.Keywords: central pain, thalamus, amitriptyline, carbamazepine

  20. MRI findings in the painful hemiplegic shoulder

    International Nuclear Information System (INIS)

    Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

  1. MRI findings in the painful hemiplegic shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Tavora, D.G.F., E-mail: danielgurgel@sarah.b [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Gama, R.L.; Bomfim, R.C. [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Nakayama, M. [Department of Radiology, Federal University of Grande Dourados, Dourados (Brazil); Silva, C.E.P. [Department of Statistics, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil)

    2010-10-15

    Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

  2. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'central sensitisation pain\\' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of CSP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of three symptoms and one sign predictive of CSP, including: \\'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple\\/non-specific aggravating\\/easing factors\\

  3. Influence of Xingnao Jieyu capsule on hippocampal and frontal lobe neuronal growth in a rat model of post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Wentao Fan; Qian Wang; Yongmei Yan

    2012-01-01

    The present study established a rat model of post-stroke depression using incomplete ischemia induced by unilateral carotid artery ligation in combination with solitary raising and subcutaneous injection of a small dose of reserpine. After intragastric perfusion with 45 mg/100 g, 15 mg/100 g, and 7.5 mg/100 g of Xingnao Jieyu for 7, 14 and 21 days, neuronal morphology in the frontal lobe and hippocampus was improved, depression state and voluntary behaviors were also effectively improved in rats with post-stroke depression. Moreover, the effects of Xingnao Jieyu at a dose of 45 and 15 mg/100 g were similar to the traditional antidepressant Prozac.

  4. The Central Analgesic Mechanism of YM-58483 in Attenuating Neuropathic Pain in Rats.

    Science.gov (United States)

    Qi, Zeyou; Wang, Yaping; Zhou, Haocheng; Liang, Na; Yang, Lin; Liu, Lei; Zhang, Wei

    2016-10-01

    Calcium channel antagonists are commonly used to treat neuropathic pain. Their analgesic effects rely on inhibiting long-term potentiation, and neurotransmitters release in the spinal cord. Store-operated Ca(2+)channels (SOCCs) are highly Ca(2+)-selective cation channels broadly expressed in non-excitable cells and some excitable cells. Recent studies have shown that the potent inhibitor of SOCCs, YM-58483, has analgesic effects on neuropathic pain, but its mechanism is unclear. This experiment performed on spinal nerve ligation (SNL)-induced neuropathic pain model in rats tries to explore the mechanism, whereby YM-58483 attenuates neuropathic pain. The left L5 was ligated to produce the SNL neuropathic pain model in male Sprague-Dawley rats. The withdrawal threshold of rats was measured by the up-down method and Hargreaves' method before and after intrathecal administration of YM-58483 and vehicle. The SOCCs in the spinal dorsal horn were located by immunofluorescence. The expression of phosphorylated ERK and phosphorylated CREB, CD11b, and GFAP proteins in spinal level was tested by Western blot, while the release of proinflammatory cytokines (IL-1β, TNF-α, PGE2) was measured by enzyme-linked immunosorbent assay (ELISA). Intrathecal YM-58483 at the concentration of 300 μM (1.5 nmol) and 1000 μM (10 nmol) produced a significant central analgesic effect on the SNL rats, compared with control + vehicle (n = 7, P  0.05). YM-58483 also inhibited the release of spinal cord IL-1β, TNF-α, and PGE2, compared with control + vehicle (n = 5, #P < 0.001). The analgesic mechanism of YM-58483 may be via inhibiting central ERK/CREB signaling in the neurons and decreasing central IL-1β, TNF-α, and PGE2 release to reduce neuronal excitability in the spinal dorsal horn of the SNL rats. PMID:26514127

  5. Mobility training using a bionic knee orthosis in patients in a post-stroke chronic state: a case series

    Directory of Open Access Journals (Sweden)

    Byl Nancy N

    2012-07-01

    Full Text Available Abstract Introduction An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. Case presentation Three individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago. Immediately after training, all participants demonstrated improved gait speed (10 meter walk, stride length and walking endurance (6 minute walk compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm. Conclusions Lower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight

  6. Cannabinoids and centrak neuropathic pain. A review (Cannabinoidi e dolore neuropatico centrale. Una rassegna

    Directory of Open Access Journals (Sweden)

    Francesco Crestani

    2014-03-01

    Full Text Available Only recently, the medical community highlighted the pharmacological scientific bases of the effects of Cannabis. The most important active principle, Delta-9-tetrahydrocannabinol was identified in the second half of the last century, and receptors were subsequently identified and endogenous ligands, called endocannabinoids, were characterized. The effectiveness of the cannabinoids in the treatment of nausea and vomit due to anti-neoplastic chemotherapy and in the wasting-syndrome during AIDS is recognized. Moreover, the cannabinoids have shown analgesic properties, particularly interesting with regard to the central neuropathic pain. This article will review the current knowledge and will give practical guidance on how to proceed in prescribing cannabinoids.

  7. Invasive stimulation therapies for the treatment of refractory pain.

    Science.gov (United States)

    Nizard, Julien; Raoul, Sylvie; Nguyen, Jean-Paul; Lefaucheur, Jean-Pascal

    2012-10-01

    Invasive neurostimulation therapies may be proposed to patients with neuropathic pain refractory to conventional medical management, in order to improve pain relief, functional capacity, and quality of life. In this review, the respective mechanisms of action and efficacy of peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), and motor cortex stimulation (MCS) are discussed. PNS appears to be useful in various refractory neuropathic pain indications (as long as there is some preservation of sensation in the painful area), such as intractable chronic headache, pelvic and perineal pain, and low back pain, but evidence for its efficacy is not strongly conclusive, and large-scale randomized controlled studies are necessary to confirm the efficacy in the long term. Spinal cord stimulation (SCS) has been validated for the treatment of selected types of chronic pain syndromes, such as Failed Back Surgery Syndrome, and Complex Regional Pain Syndrome type I. When neuropathic pain is secondary to a brain lesion (especially following stroke) or a trigeminal lesion, stimulation of brain structures is required. Deep brain stimulation (DBS), which can be proposed with targets like the periventricular/periaqueductal gray matter or the sensory thalamus, is increasingly replaced by motor cortex stimulation (MCS), mainly because it is safer, more easily performed, and probably more effective in a wider range of indications (including central post-stroke pain). The respective places of DBS and MCS in some selected indications, such as peripheral neuropathic pain and phantom limb pain, have yet to be clearly delineated. Controlled trials, with the stimulator switched ON or OFF in a double-blind procedure, have demonstrated the efficacy of MCS in the treatment of peripheral and central neuropathic pain, although these trials included a limited number of patients and need to be confirmed by large, controlled

  8. Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson's disease and patients stable post stroke.

    Science.gov (United States)

    Byl, Nancy; Zhang, Wenlong; Coo, Sophia; Tomizuka, Masayoshi

    2015-12-01

    As the world's population ages, falls, physical inactivity, decreased attention and impairments in balance and gait arise as a consequence of decreased sensation, weakness, trauma and degenerative disease. Progressive balance and gait training can facilitate postural righting, safe ambulation and community participation. This small randomized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility, endurance, balance, strength and flexibility in older individuals greater than one year post stroke (Gobbi et al., 2009) or Parkinson's disease (PD) (Gobbi et al., 2009). Twenty-four individuals consented to participate. The participants were stratified by diagnosis and randomly assigned to a control (usual gait training (Gobbi et al., 2009)) or an experimental group (usual gait training plus kinematic feedback (Gobbi et al., 2009)). At baseline and 6 weeks post training (18 h), subjects completed standardized tests (mobility, balance, strength, range of motion). Gains were described across all subjects, by treatment group and by diagnosis. Then they were compared for significance using nonparametric statistics. Twenty-three subjects completed the study with no adverse events. Across all subjects, by diagnosis (stroke and PD) and by training group (control and experimental), there were significant gains in mobility (gait speed, step length, endurance, and quality), balance (Berg Balance), range of motion and strength. There were no significant differences in the gain scores between the control and experimental groups. Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences. In summary, during supervised gait training, dynamic visual kinematic feedback from wireless pressure and motion sensors had similar, positive effects as verbal, therapist feedback. A wireless kinematic feedback system could be

  9. Using of virtual reality technology in acute cerebral stroke and their influense on post-stroke affective disorders

    Directory of Open Access Journals (Sweden)

    Maslyuk О.А.

    2014-12-01

    Full Text Available Aim. The study of virtual reality technology in the rehabilitation of patients with cerebral stroke and influence on post stroke affective disorder. Materials and methods. The study included 88 patients with ischemic stroke: 59 men (67% and 29 women (33%. The average age of the patients was 62,05 ± 11,74 years. In the study group included 46 patients, 44 patients in the control group. The groups were matched by age, time from the begin of disease, severity of disease, the severity of motor, affective and cognitive impairments. In addition, in the study group to the program of early rehabilitation to use individual training with virtual reality technology (BTS NIRVANA. The duration of the training was 21 days, 3 times a week for 40 minutes. Results. On the background of rehabilitation in the study group patients had a significant reduced of neurological deficit (p <0,05. Significantly improved neurodynamic and executive cognitive function (p <0,01. In the study group was a statistically significant decrease symptoms of depression on a scale of BDI was 31,7% vs. 20.9% in the control group, anxiety on a scale of HADS was 18,46% (p <0,05 vs. 12,23% (p <0,05 in the control group. Increase motivation and decrease symptoms of apathy in the study group of patients on a scale of AES-C was 13,78% (p <0,05 vs. 1,01 % in the control group. On the background of rehabilitation patients in the study group was no difference between the rates of pathological muscle and mental fatigue. On the background there is rehabilitation of the quality of life due to mobility and activities of daily living. Conclusion. The study showed the positive effect of virtual reality technology for the correction of post-stroke mood disorders.

  10. Prevalence of post-stroke cognitive impairment in china: a community-based, cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Yanji Qu

    Full Text Available International hospital-based studies have indicated a high risk of cognitive impairment after stroke, evidence from community-based studies in China is scarce. To determine the prevalence of post-stroke cognitive impairment (PSCI and its subtypes in stroke survivors residing in selected rural and urban Chinese communities, we conducted a community-based, cross-sectional study in 599 patients accounting for 48% of all stroke survivors registered in the 4 communities, who had suffered confirmed strokes and had undergone cognitive assessments via the Montreal Cognitive Assessment (MoCA, Mini-Mental State Examination (MMSE, and Hachinski Ischemia Scale (HIS. Detection of PSCI was based on scores in these neuropsychological scales. Factors potentially impacting on occurrence of PSCI were explored by comparing demographic characteristics, stroke features, and cardiovascular risk factors between patients with and without PSCI. The overall prevalence of PSCI was 80.97% (95%CI: 77.82%-84.11%, while that of non-dementia PSCI (PSCI-ND and post-stroke vascular dementia (PSD was 48.91% (95%CI: 44.91%-52.92% and 32.05% (95%CI: 28.32%-35.79%, respectively. Prior stroke and complications during the acute phase were independent risk factors for PSCI. The risk of recurrent stroke survivors having PSCI was 2.7 times higher than for first-episode survivors, and it was 3 times higher for those with complications during the acute phase than for those without. The higher prevalence of PSCI in this study compared with previous Chinese studies was possibly due to the combined effects of including rural stroke survivors, a longer period from stroke onset, and different assessment methods. There is an urgent need to recognize and prevent PSCI in stroke patients, especially those with recurrent stroke and complications during the acute phase.

  11. LONG-TERM EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION IN CHRONIC POST-STROKE APHASIA: A PILOT STUDY

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    Lucilla Vestito

    2014-10-01

    Full Text Available Transcranial direct current stimulation (tDCS has been suggested to improve language function in patients with post-stroke aphasia. Most studies on aphasic patients, however, were conducted with a very limited follow-up period, if any. In this pilot, single-blind study on chronic post-stroke aphasic patients, we aimed to verify whether or not tDCS is able to extend its beneficial effects for a longer period of time (21 weeks after the end of stimulation. Three aphasic patients underwent anodal tDCS (A-tDCS, 20 min, 1.5 mA and sham stimulation (S-tDCS over the left frontal (perilesional region, coupled with a simultaneous naming training (on-line tDCS. Ten consecutive sessions (five days per week for two weeks were implemented. In the first five sessions we used a list of 40 figures, while in the subsequent five sessions we utilized a second set of 40 figures differing in word difficulty. At the end of the stimulation period we found a significant beneficial effect of A-tDCS (as compared to baseline and S-tDCS in all our subjects, regardless of word difficulty, although with some inter-individual differences. In the follow-up period, the percentage of correct responses persisted significantly better until the 16th week, when an initial decline in naming performance was observed. Up to the 21st week, the number of correct responses, though no longer significant, was still above the baseline level. These results in a small group of aphasic patients suggest a long-term beneficial effect of on-line A-tDCS.

  12. The Discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-02-01

    OBJECTIVES: Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of "nociceptive," "peripheral neuropathic," and "central sensitization" pain in patients with low back (+\\/- leg) pain disorders. METHODS: This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low back (+\\/- leg) pain were assessed using a standardized assessment protocol. After each assessment, patients\\' pain was assigned a mechanisms-based classification. Clinicians then completed a clinical criteria checklist indicating the presence\\/absence of various clinical criteria. RESULTS: Multivariate analyses using binary logistic regression with Bayesian model averaging identified a discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of "nociceptive," "peripheral neuropathic," and "central sensitization" pain, respectively. Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive\\/negative predictive values, positive\\/negative likelihood ratios). DISCUSSION: By identifying a discriminatory cluster of symptoms and signs predictive of "nociceptive," "peripheral neuropathic," and "central" pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

  13. Tetrahydrocannabinol (Delta 9-THC Treatment in Chronic Central Neuropathic Pain and Fibromyalgia Patients: Results of a Multicenter Survey

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    Janet Weber

    2009-01-01

    Full Text Available Central neuropathic pain is difficult to treat, but delta 9-Tetrahydrocannabinol (delta 9-THC may be a promising therapeutic agent. We administered in 172 patients on average 7.5 mg delta 9-THC over 7 months. Of these, 48 patients prematurely withdrew due to side effects, insufficient analgesia, or expense of therapy. Thus, 124 patients were assessed retrospectively in a multicenter telephone survey. Reported changes in pain intensity, recorded on a numeric rating scale (NRS, Pain Disability Index (PDI, Medical Outcomes Short-Form (SF-12, Quality of Life Impairment by Pain (QLIP, Hospital Anxiety Depression Scale (HADS, and amount of concomitant pain medication were recorded. Psychometric parameters (PDI, SF-12, QLIP, HADS and pain intensity improved significantly during delta 9-THC treatment. Opioid doses were reduced and patients perceived THC therapy as effective with tolerable side effects. About 25% of the patients, however, did not tolerate the treatment. Therapy success and tolerance can be assessed by a transient delta 9-THC titration and its maintained administration for several weeks. The present survey demonstrates its ameliorating potential for the treatment of chronic pain in central neuropathy and fibromyalgia. A supplemental delta 9-THC treatment as part of a broader pain management plan therefore may represent a promising coanalgesic therapeutic option.

  14. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with 'nociceptive', 'peripheral neuropathic' and 'central sensitisation' pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-04-01

    Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of \\'nociceptive\\' (NP), \\'peripheral neuropathic\\' (PNP) and \\'central sensitisation\\' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient\\'s pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai\\'s Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

  15. Insufficient pain relief after surgical neuroma treatment : Prognostic factors and central sensitisation

    NARCIS (Netherlands)

    Stokvis, Annemieke; Coert, J. Henk; van Neck, Johan W.

    2010-01-01

    Background: Treatment of patients with neuromatous pain is difficult. Numerous treatment methods have been described, but none has been completely effective in providing sufficient pain relief. Patient-specific prognostic factors, predicting pain after surgical neuroma treatment, can help clinicians

  16. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

    Directory of Open Access Journals (Sweden)

    Egen-Lappe V

    2013-03-01

    %, ambulatory care 48%. Oral muscle relaxants were prescribed to 13% of the patients. No patient received intrathecal baclofen or botulinum toxin.Conclusion: Claims data enabled analysis of the occurrence of stroke and post-stroke spasticity. These data provide insight into real-life treatment for spasticity in Germany. The proportion of patients who receive physiotherapy, which is the international guideline-recommended basic therapy after transition into ambulatory care, can be improved on. Botulinum toxin as an international guideline-based treatment option for focal spasticity has not been implemented in practice in Germany as yet.Keywords: health care utilization, physiotherapy, drug therapy, claims data

  17. Central pain mechanisms following combined acid and capsaicin perfusion of the human oesophagus.

    Science.gov (United States)

    Brock, Christina; Andresen, Trine; Frøkjaer, Jens Brøndum; Gale, Jeremy; Olesen, Anne Estrup; Arendt-Nielsen, Lars; Drewes, Asbjørn Mohr

    2010-03-01

    Visceral afferents originating from different gut-segments converge at the spinal level. We hypothesized that chemically-induced hyperalgesia in the oesophagus could provoke widespread visceral hypersensitivity and also influence descending modulatory pain pathways. Fifteen healthy volunteers were studied at baseline, 30, 60 and 90 min after randomized perfusion of the distal oesophagus with either saline or 180 ml 0.1M HCl+2mg capsaicin. Electro-stimulation of the oesophagus, 8 cm proximal to the perfusion site, rectosigmoid electrical stimulation and rectal mechanical and heat stimulations were used. Evoked brain potentials were recorded after electrical stimulations before and after oesophageal perfusion. After the perfusion, rectal hyperalgesia to heat (Pelectro-stimulation was observed in both the oesophagus (Pelectro-stimulation in oesophagus were reduced by 13% after perfusion (P=0.01). Evoked brain potentials to rectosigmoid stimulations showed decreased latencies and amplitudes of P1, N1 and P2 (P<0.05), whereas oesophagus-evoked brain potentials were unaffected after perfusion. In conclusion, modality-specific hyperalgesia was demonstrated in the lower gut following chemical sensitization of the oesophagus, reflecting widespread central hyperexcitability. Conversely, hypoalgesia to electrical stimulation, decreases in referred pain and latencies of evoked brain potentials was seen. This outcome may reflect a counterbalancing activation of descending inhibitory pathways. As these findings are also seen in the clinical setting, the model may be usable for future basic and pharmacological studies. PMID:19541517

  18. Neuroinflammatory contributions to pain after SCI: roles for central glial mechanisms and nociceptor-mediated host defense.

    Science.gov (United States)

    Walters, Edgar T

    2014-08-01

    Neuropathic pain after spinal cord injury (SCI) is common, often intractable, and can be severely debilitating. A number of mechanisms have been proposed for this pain, which are discussed briefly, along with methods for revealing SCI pain in animal models, such as the recently applied conditioned place preference test. During the last decade, studies of animal models have shown that both central neuroinflammation and behavioral hypersensitivity (indirect reflex measures of pain) persist chronically after SCI. Interventions that reduce neuroinflammation have been found to ameliorate pain-related behavior, such as treatment with agents that inhibit the activation states of microglia and/or astroglia (including IL-10, minocycline, etanercept, propentofylline, ibudilast, licofelone, SP600125, carbenoxolone). Reversal of pain-related behavior has also been shown with disruption by an inhibitor (CR8) and/or genetic deletion of cell cycle-related proteins, deletion of a truncated receptor (trkB.T1) for brain-derived neurotrophic factor (BDNF), or reduction by antisense knockdown or an inhibitor (AMG9810) of the activity of channels (TRPV1 or Nav1.8) important for electrical activity in primary nociceptors. Nociceptor activity is known to drive central neuroinflammation in peripheral injury models, and nociceptors appear to be an integral component of host defense. Thus, emerging results suggest that spinal and systemic effects of SCI can activate nociceptor-mediated host defense responses that interact via neuroinflammatory signaling with complex central consequences of SCI to drive chronic pain. This broader view of SCI-induced neuroinflammation suggests new targets, and additional complications, for efforts to develop effective treatments for neuropathic SCI pain. PMID:25017887

  19. Relationship between linguistic functions and cognitive functions in a clinical study of Chinese patients with post-stroke aphasia

    Institute of Scientific and Technical Information of China (English)

    YU Zeng-zhi; JIANG Shu-jun; BI Sheng; LI Jun; LEI Di; SUN Li-ling

    2013-01-01

    Background There has been a long debate among scholars surrounding the relationship between language and cognition.The worldwide study of aphasia is actively exploring the function of language from cognitive point of view.This study aimed to investigate the relationship between linguistic functions and cognitive functions in a clinical study of Chinese patients with post-stroke aphasia.Methods Cognitive functions of 63 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and their linguistic functions were tested with the Western Aphasia Battery (WAB) Scale,respectively.The correlation between the results observed on the LOTCA battery and those on the WAB was analyzed.Aphasia quotient,performance quotient,cortical quotient,and linguistic function of the patients were compared.Then,each language function was analyzed by way of dependent adopt multiple regression analysis.Results The total score of 63 patients as shown on the LOTCA battery was significantly correlated with the aphasia quotient,performance quotient,and cortical quotient observed on the WAB Scale (P <0.05,P <0.01).However,the correlation between visuomotor organization under LOTCA and repeat under WAB was not significant (P >0.05).The attention of LOTCA and WAB's spontaneous speech,repeat,naming,and aphasia quotient was not relevant either (P>0.05).In addition,correlations between the results observed on the LOTCA battery and the WAB were significant (P<0.05,P <0.01).Among the significant variables finally entered into the standardized canonical discriminant functions,main factors affected the aphasia.Multiple regression analysis showed that orientation,spatial perception,and visual perception had a notable influence on aphasia quotient and naming.Orientation and thinking operation was found to have a notable influence on spontaneous speech.Spatial perception and

  20. Thinking on Post-stroke Depression%关于卒中后抑郁的思考

    Institute of Scientific and Technical Information of China (English)

    袁勇贵

    2012-01-01

    Post-stroke depression(PSD) is the most common form of complications after stroke, which holds a high morbidity and brings downfall to the patients' quality of life. The mechanismfor PSD is far from clear, in which biological factors and social-psychological factors are believed to be involved. Drugtreatment is now arranged as the first class choice, while physical therapy and psycho -therapy can add to the treatmentoutcome.%卒中后抑郁是脑卒中后常见的并发症,其发病率高,明显降低患者生活质量.卒中后抑郁症的发病机制非常复杂.目前认为社会、心理、生物学因素等均在其中扮演一定的角色.卒中后抑郁的治疗应首选药物治疗,在单一药物疗效欠佳时可加用物理治疗和心理治疗.

  1. Measures of Cardiovascular Health and Physical Function after an Aerobic Exercise Intervention in a Patient Fifteen Days Post-Stroke.

    Science.gov (United States)

    Lentz, Angela A; Mattlage, Anna E; Ashenden, Abigail L; Rippee, Michael A; Billinger, Sandra A

    2012-01-01

    Study Design: Case Study Background: Changes in cardiorespiratory (CR) fitness post-stroke severely impact an individual's quality of life. The purpose of this case study was to demonstrate whether a moderate to high intensity aerobic exercise program would improve cardiovascular fitness, and physical performance measures in a participant following discharge from acute stroke rehabilitation. The participant is a 58 year-old female who experienced an ischemic stroke 15 days prior to beginning the exercise intervention. Case Description: The participant was provided a supervised 8-week exercise intervention on a Total Body Recumbent Stepper (TBRS). The exercise intervention consisted of three sessions per week; the first 4 weeks the participant exercised at a moderate intensity of 50-59% heart rate reserve (HRR) calculated from the baseline exercise test; the last 4 weeks the intensity was increased to 60-69% HRR. Exercise duration began at 20 minutes with the goal of reaching 30 minutes of continuous exercise at a specified workload. Outcomes: Following 8-weeks of intervention, the participant showed improvement in cardiovascular measures including: resting blood pressure (BP), resting heart rate (HR), VO2 peak, and the maximum distance walked (6-MWT). Conclusion: The use of a moderate to high intensity aerobic exercise intervention may be effective for participants in the sub-acute phase of stroke recovery in order to improve cardiovascular health and physical function. PMID:24772455

  2. Efficacy of early intervention of motor relearning program on post-stroke hemiplemia:A randomized controlled observation

    Institute of Scientific and Technical Information of China (English)

    Jia Xue; Liang Bai; Qingrong Guo; Chengrong Yang; Jie Lu

    2006-01-01

    BACKGROUND: Previous studies believed that the effect of rehabilitation training within 6 months after stroke (early rehabilitation training) is usually unsatisfactory. The rehabilitation training when acute stroke is stabilized may be better for the recovery of limb function.OBJECTIVE: To observe the effects of the rehabilitation training of motor relearning program plus Bobath technique on the motor function of limbs, nerve function and activities of daily life (ADL) in patients with acute stroke hemiplegia.DESIGN: A randomized controlled observation.SETTING: Department of Neurology, Yaan People's Hospital.PARTICrPANTS: A total of 150 patients with acute post-stroke hemiplegia were selected from the Department of Neurology, Yaan People's Hospital from March 2000 to October 2002. The patients were all accorded with the diagnostic standards about stroke set by the Fifth National Academic Meeting for Cerebrovascular Disease (1996), confirmed by CT and MRI, and they were all informed with the interventions and the items of evaluation. The enrolled patients were randomly divided into training group (n=78) and control group (n=72) at admission. METHODS: ① Interventions: All the patients were given routine treatments for stroke, including managin blood pressure, maintaining the balance of hydrolyte and electrolure, reducing intracranial pressure by dehydration,and venous injection of citicoline, besides those in the training group received rehabilitation training by motor relearning program and Bobath technique. The rehabilitation training began after the vital signs became stable within 24 hours to 3 days after attack for the patients with cerebral infarction and 48 hours to 5 days after attack for those with cerebral hemorrhage respectively, three times a day in the morning, at noon and in the evening respectively, 30 minutes for each time, they were trained for 1 month. Lying position: The patients should keep the anti-spasm posture in the supine position

  3. 脑卒中后抑郁状态的心理护理干预%The Effect of Psychologic Nursing on Post - stroke Depression

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To investigate the effect of psychologic nursing on the rehabilitation for post-stroke depression(PSD) patients. Method 62 patients of 98 PSD patients were divided into 31couples. According to age, sex, course of illness and statge of illness, the patients were divided into rehabilitation nursing ( interference group) and routine nursing ( control group) with CES - D ( Center of epidemi ological survey - depression Scale ) and CNFD ( Criterion of nervous function defect). Every couple was compared with each other. Result The score of two groups before treatment was not obviously different(p> 0. 05). Two scores in two groups after treatment were obviously better than those of before treatment. Two scores of interference group were significantly higher compared with control group ( p < 0. 05). Conclusion Interference of psychologic nursing is effective in treating post - stroke depression.

  4. Combined use of spatial restraint stress and middle cerebral artery occlusion is a novel model of post-stroke depression in mice

    OpenAIRE

    Gaocai Zhang; Li Chen; Lingli Yang; Xiaodong Hua; Beiqun Zhou; Zhigang Miao; Jizhen Li; Hua Hu; Michael Namaka; Jiming Kong; Xingshun Xu

    2015-01-01

    Post stroke depression (PSD) is one of the most common complications of ischemic stroke. At present, the underlying mechanisms are unclear, largely because there are no reliable, valid and reproducible animal models of PSD. Here we report a novel animal model of PSD that displays consistent and reliable clinical features of hemiplegic stroke. The animal model encompasses a combination of the middle cerebral artery occlusion (MCAO) and spatial restraint stress. We found that a 60-minute MCAO f...

  5. Serum leptin, neuron specific enolase and S-100B in relation to post-stroke depression in a prospective nested case-control study

    Directory of Open Access Journals (Sweden)

    Mei-ying ZHAO

    2015-04-01

    Full Text Available Objective To investigate the relationship between the serum levels of leptin, neuron-specific enolase (NSE and S-100B in patients of stroke and the incidence of post-stroke depression (PSD. Methods The clinical data of 121 cases of acute ischemic stroke, admitted to Zhengzhou Central Hospital affiliated to Zhengzhou University from Jun. 2010 to Dec. 2012, were retrospectively analyzed. After six months of follow-up 42 patients were diagnosed as suffering from PSD (Hamilton Depression Scale score ≥8. Another 42 participants with available matching data on onset time, age, gender and lesions of brain were selected. The serum samples were collected from all patients at time of discharge, and the concentrations of serum leptin, NSE and S-100B were analyzed by enzyme-linked immunosorbent assay (ELISA kit. Correlation and efficiency of diagnosing PSD among them was validated by receptor operator curve (ROC. Results The concentration of serum leptin, NSE, and S-100B in PSD group (25.84±13.80, 2.59±1.48 and 25.03±8.24μg/L, respectively was higher than that in the control group (8.67±6.17, 2.27±1.84 and 22.40±6.84μg/L, respectively. No obvious correlation was found between serum leptin and the NSE and S-100B in PSD patients. Based on the ROC curve, the area under the curve of serum leptin in PSD patients was 0.935 (95%CI 0.885-0.984, and the optimal cutoff value of serum leptin level was 16.17μg/L, which was an indicator for predicting of PSD with 81.0% sensitivity and 90.1% specificity. Conclusion Elevation of serum leptin level at admission was found to be associated with PSD, and it may act as a new marker for predicting the occurrence of PSD. DOI: 10.11855/j.issn.0577-7402.2015.03.11

  6. The pain matrix and clinical application in the central nervous system

    International Nuclear Information System (INIS)

    The pain reflex system is critical for life to defend itself from noxious stimuli. The objective assessment of pain has been difficult because pain is a subjective experience which has unpleasant sensation and affection. Many noninvasive imaging studies have clarified that the primary somatosensory cortex, secondary somatosensory cortex, insula, anterior cingulate cortex, and medial prefrontal cortex are involved in the representation of pain and that neural activities in these areas reflect the subjective intensity of pain. Especially, the anterior cingulate cortex and insula might be related to affective aspects of pain. In addition, noninvasive techniques have a huge potential for applying for treatments for chronic pain that contain affective aspects. Together, multidisciplinary treatment is effective in pain elimination and management. (author)

  7. Ischemia, Immunosuppression and Infection—Tackling the Predicaments of Post-Stroke Complications

    Directory of Open Access Journals (Sweden)

    Raymond Shim

    2016-01-01

    Full Text Available The incidence of stroke has risen over the past decade and will continue to be one of the leading causes of death and disability worldwide. While a large portion of immediate death following stroke is due to cerebral infarction and neurological complications, the most common medical complication in stroke patients is infection. In fact, infections, such as pneumonia and urinary tract infections, greatly worsen the clinical outcome of stroke patients. Recent evidence suggests that the disrupted interplay between the central nervous system and immune system contributes to the development of infection after stroke. The suppression of systemic immunity by the nervous system is thought to protect the brain from further inflammatory insult, yet this comes at the cost of increased susceptibility to infection after stroke. To improve patient outcome, there have been attempts to lessen the stroke-associated bacterial burden through the prophylactic use of broad-spectrum antibiotics. However, preventative antibiotic treatments have been unsuccessful, and therefore have been discouraged. Additionally, with the ever-rising obstacle of antibiotic-resistance, future therapeutic options to reverse immune impairment after stroke by augmentation of host immunity may be a viable alternative option. However, cautionary steps are required to ensure that collateral ischemic damage caused by cerebral inflammation remains minimal.

  8. Regular physical activity prevents development of chronic pain and activation of central neurons

    OpenAIRE

    Sluka, Kathleen A; O'Donnell, James M.; DANIELSON, JESSICA; Rasmussen, Lynn A.

    2012-01-01

    Chronic musculoskeletal pain is a significant health problem and is associated with increases in pain during acute physical activity. Regular physical activity is protective against many chronic diseases; however, it is unknown if it plays a role in development of chronic pain. The current study induced physical activity by placing running wheels in home cages of mice for 5 days or 8 wk and compared these to sedentary mice without running wheels in their home cages. Chronic muscle pain was in...

  9. Dopamine and 5-HT supersensitivity in nonorganic central pain and in morphine abstinence: fortuitous or renal analogy?

    Science.gov (United States)

    Sicuteri, F; Anselmi, B; Del Bianco, P L

    1980-01-01

    Unexplained pain, such as central panalgesia, might be the most common clinical expression of a deficiency, central in nature, of the endorphin system. Acute natural opioid deficiency is comparable to morphine withdrawal in addicts characterized by vegetative, psychic disorder and the appearance of pain. An impressive supersensitivity (up to 1000 fold) to dopamine and 5-HT of the smooth muscle (hand dorsal vein: venotest) is detected both in central panalgesia sufferers and in addicts during spontaneous (withdrawal) or pharmacological (naloxone) abstinence. A 5-HT and dopamine supersensitivity, of less intensity, however, (10-30 fold), is found during migraine attacks: on these occasions, morphine-like factors in CSF appear reduced or undetectable, reinforcing the chemical analogy between morphine abstinence and migraine attacks. In the present study, evidence of opiate receptors in the human vein is also provided: 5-HT venospasms, inhibited by morphine, promptly emerge when naloxone is inoculated locally. PMID:7395606

  10. Feasibility of the adaptive and automatic presentation of tasks (ADAPT system for rehabilitation of upper extremity function post-stroke

    Directory of Open Access Journals (Sweden)

    Choi Younggeun

    2011-08-01

    Full Text Available Abstract Background Current guidelines for rehabilitation of arm and hand function after stroke recommend that motor training focus on realistic tasks that require reaching and manipulation and engage the patient intensively, actively, and adaptively. Here, we investigated the feasibility of a novel robotic task-practice system, ADAPT, designed in accordance with such guidelines. At each trial, ADAPT selects a functional task according to a training schedule and with difficulty based on previous performance. Once the task is selected, the robot picks up and presents the corresponding tool, simulates the dynamics of the tasks, and the patient interacts with the tool to perform the task. Methods Five participants with chronic stroke with mild to moderate impairments (> 9 months post-stroke; Fugl-Meyer arm score 49.2 ± 5.6 practiced four functional tasks (selected out of six in a pre-test with ADAPT for about one and half hour and 144 trials in a pseudo-random schedule of 3-trial blocks per task. Results No adverse events occurred and ADAPT successfully presented the six functional tasks without human intervention for a total of 900 trials. Qualitative analysis of trajectories showed that ADAPT simulated the desired task dynamics adequately, and participants reported good, although not excellent, task fidelity. During training, the adaptive difficulty algorithm progressively increased task difficulty leading towards an optimal challenge point based on performance; difficulty was then continuously adjusted to keep performance around the challenge point. Furthermore, the time to complete all trained tasks decreased significantly from pretest to one-hour post-test. Finally, post-training questionnaires demonstrated positive patient acceptance of ADAPT. Conclusions ADAPT successfully provided adaptive progressive training for multiple functional tasks based on participant's performance. Our encouraging results establish the feasibility of ADAPT; its

  11. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

    Science.gov (United States)

    Park, J-S; Oh, D-H; Hwang, N-K; Lee, J-H

    2016-06-01

    Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients. PMID:26969528

  12. A Medication Combination for the Treatment of Central Poststroke Pain via the Adjuvant Use of Prednisone With Gabapentin: A Case Report.

    Science.gov (United States)

    Batlle, Luis; Mattie, Ryan; Irwin, Robert

    2016-03-01

    Central poststroke pain is a neuropathic pain syndrome that can occur from pathology of the brain. The case presented is of a woman with multiple comorbidities who was found to have an acute infarct in the left middle and anterior cerebral artery territories. She began to complain of worsening diffuse right upper and lower extremity pain, and central poststroke pain was diagnosed. First-line agents were contraindicated as the result of medical comorbidities, and chronic kidney disease only permitted the use of low-dose gabapentin. The patient's morbid obesity inspired the use of an adjunct medication protocol of a prednisone taper for proper treatment. After starting this treatment regimen, the patient experienced significant pain relief with eventual resolution. A steroid-based treatment protocol was used successfully in the early stages of central poststroke pain with proper side effect management and may have prevented difficult treatment management in the outpatient setting. PMID:26409194

  13. Double-Cone Coil TMS Stimulation of the Medial Cortex Inhibits Central Pain Habituation.

    Directory of Open Access Journals (Sweden)

    Federico D'Agata

    Full Text Available The aim of this study was to investigate whether Transcranial Magnetic Stimulation (TMS applied over the medial line of the scalp affects the subjective perception of continuous pain induced by means of electric stimulation. In addition, we wanted to identify the point of stimulation where this effect was maximum.Superficial electrical stimulation was used to induce continuous pain on the dominant hand. At the beginning of the experiment we reached a pain rating of 5 on an 11-point numeric rating scale (NRS; 0 = no pain and 10 = maximum tolerable pain for each subject by setting individually the current intensity. The TMS (five pulses at increasing intensities was applied on 5 equidistant points (one per session over the medial line of the scalp in 13 healthy volunteers using a double-cone coil to stimulate underlying parts of the brain cortex. In every experimental session the painful stimulation lasted 45 minutes, during which pain and distress intensities NRS were recorded continuously. We calculated the effect of adaptation and the immediate effect of the TMS stimulation for all locations. Additionally, an ALE (Activation Likelihood Estimation meta-analysis was performed to compare our results with the neuroimaging literature on subjective pain rating.TMS stimulation temporarily decreased the pain ratings, and pain adaptation was suppressed when applying the TMS over the FCz site on the scalp. No effect was found for distress ratings.The present data suggest that the medial cortex in proximity of the cingulated gyrus has a causal role in adaptation mechanisms and in processing ongoing pain and subjective sensation of pain intensity.

  14. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    Directory of Open Access Journals (Sweden)

    Laxmaiah Manchikanti, Kimberly A. Cash, Carla D. McManus, Vidyasagar Pampati

    2013-01-01

    Full Text Available Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.Study Design: A prospective evaluation.Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS, the Oswestry Disability Index 2.0 (ODI, employment status, and opioid intake with assessment at 3, 6

  15. [Post-stroke apathy].

    Science.gov (United States)

    López-Dóriga Bonnardeaux, Pedro; Andrino Díaz, Nuria

    2016-01-01

    Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy. PMID:26522489

  16. Effect of TENS on pain in relation to central sensitization in patients with osteoarthritis of the knee: study protocol of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Beckwée David

    2012-02-01

    Full Text Available Abstract Background Central sensitization has recently been documented in patients with knee osteoarthritis (OAk. So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of tens on osteoarthritis of the knee. The purpose of this study is to explore the pain inhibitory effect of burst tens in OAk patients and to explore the prognostic value of central sensitization on the pain inhibitory effect of tens in OAk patients. Methods Patients with knee pain due to OAk will be recruited through advertisements in local media. Temporal summation, before and after a heterotopic noxious conditioning stimulation, will be measured. In addition, pain on a numeric rating score, WOMAC subscores for pain and function and global perceived effect will be assessed. Patients will be randomly allocated to one of two treatment groups (tens, sham tens. Follow-up measurements will be scheduled after a period of 6 and 12 weeks. Discussion Tens influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of centrally sensitized OAk patients may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of tens. To increase treatment effectiveness it might be interesting to identify a subgroup of symptomatic OAk patients, i.e., non-sensitized patients, who are likely to benefit from burst tens. Trial Registration ClinicalTrials.gov: NCT01390285

  17. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    NARCIS (Netherlands)

    Bouwense, S.A.; Olesen, S.S.; Drewes, A.M.; Goor, H. van; Wilder-Smith, O.H.G.

    2015-01-01

    BACKGROUND: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs

  18. Serotonin Transporter Gene 5-HTTLPR Polymorphism as a Protective Factor Against the Progression of Post-Stroke Depression.

    Science.gov (United States)

    Zhao, Qiang; Guo, Yi; Yang, Dong; Yang, Tiansong; Meng, Xianghui

    2016-04-01

    Polymorphisms in the 5-HTT and BDNF genes are shown to affect their function at the molecular and serum level. Prior work has tried to correlate the polymorphisms with post-stroke depression (PSD), the results nevertheless remain indefinitive. A plausible reason accounting for the uncertainty relates to the small sample of each published trial. In this study, we have performed a comprehensive meta-analysis in order to evaluate the effects of 5-HTT and BDNF polymorphisms (5-HTTLPR, STin2 VNTR, 5-HTR2a 102 T/C, Val66Met) on genetic risk of PSD. Human case-control trials were identified by computer-assisted and manual searches. The article search was performed until October 2014. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using the fixed effects meta-analysis to measure the effects 5-HTT and BDNF polymorphisms exerted on PSD. We also performed test of heterogeneity, test of publication bias, and sensitivity analysis to examine the reliability and stability of combined effects. 5-HTTLPR was clearly associated with genetic risk of PSD. The association seemed to be more pronounced in the homozygous model (OR = 0.34, 95 % CI = 0.23-0.51, P Q-test = 0.63). Both the heterozygous model and the recessive model showed 50 % decreased risk of PSD (OR = 0.50, 95 % CI = 0.37-0.67, P Q-test = 0.91; OR = 0.50, 95 % CI = 0.36-0.70, P Q-test = 0.43, respectively). Such significant association was also detected for Caucasian and Asian. These results were reliable and stable based on related analyses. Taken together, 5-HTTLPR polymorphism of the 5-HTT gene seems to protect against the occurrence of PSD. Small sample size for the polymorphisms within 5-HTT and BDNF genes may have caused underestimated associations, and a larger study is required to further assess the relations. PMID:25700622

  19. 心理干预对脑卒中后抑郁患者的影响%Effect of psychotherapy on the patients with post - stroke depression

    Institute of Scientific and Technical Information of China (English)

    李丽平; 居丽晶; 周玉珍

    2009-01-01

    Objective To study the effect of psychotherapy on the patients with post - stroke depression. Methods 86 patients with post - stroke depression were randomly divided into psychotherapy and non psychotherapy groups. The scores of SDS, SF - 36 and clinical outcome were evaluated between the two groups. Results The score of SDS of psychotherapy group was significantly lower than that of control group, and the evaluation of clinical outcome was significantly better than that of control group ( P < 0. 05) . While the scores of SF - 36 of psychotherapy group were significantly better than those of control group except physiological function ( P < 0.01) . Conclusions Psychotherapy could obviously decrease the degree of depression and improve clinical outcome, physical function and quality of life in patients with post - stroke depression.%目的 探讨心理治疗对脑卒中后抑郁患者的干预效果及其对生活质量的影响.方法 将86例脑卒中后抑郁患者随机分为心理治疗组和对照组,评定并比较两组SDS,SF-36生活质量得分及其临床疗效.结果 心理治疗组SDS评分显著低于对照组,其临床疗效评定显著高于对照组(P<0.05);生活质量除生理机能外,其它指标心理治疗组均优于对照组(P<0.0).结论 心理治疗能显著降低脑卒中后抑郁患者的严重程度,并可提高临床疗效、躯体功能及生活质量.

  20. Outcome After Pituitary Radiosurgery for Thalamic Pain Syndrome

    International Nuclear Information System (INIS)

    Purpose: To evaluate outcomes after pituitary radiosurgery in patients with post-stroke thalamic pain syndrome. Methods and Materials: From 2002 to 2006, 24 patients with thalamic pain syndrome underwent pituitary radiosurgery at Tokyo Women's Medical University and were followed at least 12 months thereafter. The radiosurgical target was defined as the pituitary gland and its connection with the pituitary stalk. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was 35 months (range, 12-48 months). Results: Initial pain reduction, usually within 48 h after radiosurgery, was marked in 17 patients (71%). However, in the majority of cases the pain recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 5 patients (21%). Ten patients (42%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 1, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once. Conclusions: Pituitary radiosurgery for thalamic pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. It can be used as a primary minimally invasive management option for patients with post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases pain recurrence occurs within 1 year after treatment

  1. Role of microglia and astrocyte in central pain syndrome following electrolytic lesion at the spinothalamic tract in rats.

    Science.gov (United States)

    Naseri, Kobra; Saghaei, Elham; Abbaszadeh, Fatemeh; Afhami, Mina; Haeri, Ali; Rahimi, Farzaneh; Jorjani, Masoumeh

    2013-03-01

    Central pain syndrome (CPS) is a debilitating state and one of the consequences of spinal cord injury in patients. Many pathophysiological aspects of CPS are not well documented. Spinal glia activation has been identified as a key factor in the sensory component of chronic pain. In this study, the role of glial subtypes in the process of CPS induced by unilateral electrolytic lesion of spinothalamic tract (STT) is investigated. Male rats received a laminectomy at T8-T9 and then unilateral electrolytic lesion centered on the STT. Thermal and mechanical thresholds as well as locomotor function were measured on days 0, 3, 7, 14, 21, and 28 post-injuries by tail flick, von Frey filament, and open field tests, respectively. To investigate the spinal glial activation following denervation in STT-lesioned groups, Iba1 and GFAP were detected by immunohistochemistry and Western blotting at the same time points. Data showed that STT lesion significantly decreased thermal pain at day 3 in comparison with sham groups. Significant bilateral allodynia appeared in hind paws at day 14 after spinal cord injury and continued to day 28 (P < 0.05). Additionally, electrolytic spinal lesion attenuated locomotor function of injured animals after 7 days (P < 0.05). In both histological assessments and Western blotting, Iba1 increased at days 3 and 7 while increased GFAP occurred from day 14 to 28 after lesion. It appears that microglial activation is important in the early stages of pain development and astrocytic activation occurs later. These events may lead to behavioral outcomes especially central neuropathic pain. PMID:22722907

  2. 脑卒中后情感障碍的研究进展%Research Progress of Post-stroke Emotional Disorder

    Institute of Scientific and Technical Information of China (English)

    张艳芳; 乾栋梁; 王力群; 雒扬

    2013-01-01

    脑卒中后情感障碍是脑卒中常见的并发症之一,主要包括脑卒中后抑郁、焦虑或焦虑抑郁共病,严重影响脑卒中患者的功能康复,增加脑卒中后患者的病死率和致残率.关于脑卒中后情感障碍的发病机制,一种理论认为与心理社会因素(如残疾和社会支持)有关,而其他理论则强调与生物学机制,如生物胺、神经递质的紊乱和免疫炎性因子的释放有关.分析脑卒中的病变位置是为了试图建立病变部位和情感障碍之间的某种关系,但观察结果仍存在争议.该文就脑卒中后情感障碍的临床表现、流行病学、发病机制、病灶部位、药物治疗作一综述.%Stroke emotional problems, which contains post stroke depression, post stroke anxietyor, post-stroke anxiety combined with depression, is one of the common complications of stroke. STEP adversely affects rehabilitation and significantly increase risk of death and disability in the post-stroke period. One of the theoretical views on the determinants of STEP focuses on psychosocial factors like disability and social support. Others emphasize biologic mechanisms such as disruption of biogenic amine neurotransmission and release of proinflammatory cytokines. The " lesion location" perspective attempts to establish a relationship between localization of stroke and occurrence of depression,but empirical results remain contradictory. Here is to make a review on the clinical manifestations, epidemiology,pathogenesis, lesion location and pharmacotherapy of the stroke emotional problems.

  3. Influence of Xingnao Jieyu capsule on hippocampal and frontal lobe neuronal growth in a rat model of post-stroke depression★

    OpenAIRE

    Fan, Wentao; Wang, Qian; Yan, Yongmei

    2012-01-01

    The present study established a rat model of post-stroke depression using incomplete ischemia induced by unilateral carotid artery ligation in combination with solitary raising and subcutaneous injection of a small dose of reserpine. After intragastric perfusion with 45 mg/100 g, 15 mg/100 g, and 7.5 mg/100 g of Xingnao Jieyu for 7, 14 and 21 days, neuronal morphology in the frontal lobe and hippocampus was improved, depression state and voluntary behaviors were also effectively improved in r...

  4. A Comparative Analysis of 2D and 3D Tasks for Virtual Reality Therapies Based on Robotic-Assisted Neurorehabilitation for Post-stroke Patients.

    Science.gov (United States)

    Lledó, Luis D; Díez, Jorge A; Bertomeu-Motos, Arturo; Ezquerro, Santiago; Badesa, Francisco J; Sabater-Navarro, José M; García-Aracil, Nicolás

    2016-01-01

    Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length, or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding the success rates

  5. The association of post-stroke anhedonia with salivary cortisol levels and stroke lesion in hippocampal/parahippocampal region

    Directory of Open Access Journals (Sweden)

    Terroni L

    2015-02-01

    Full Text Available Luisa Terroni,1 Edson Amaro Jr,2 Dan V Iosifescu,3 Patricia Mattos,4 Fabio I Yamamoto,5 Gisela Tinone,5 Adriana B Conforto,5 Matildes FM Sobreiro,1 Valeri D Guajardo,1 Mara Cristina S De Lucia,7 Ayrton C Moreira,6 Milberto Scaff,5 Claudia C Leite,2 Renerio Fraguas1 1Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; 2Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; 3Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; 5Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; 6Department of Medicine, University of São Paulo, School of Medicine, Ribeirão Preto, Brazil; 7Division of Psychology, Central Institute, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil Background: Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume.Patients and methods: A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program

  6. Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation

    Science.gov (United States)

    Intiso, Domenico; Basciani, Mario; Santamato, Andrea; Intiso, Marta; Di Rienzo, Filomena

    2015-01-01

    Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP) results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX) as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders including post

  7. Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation.

    Science.gov (United States)

    Intiso, Domenico; Basciani, Mario; Santamato, Andrea; Intiso, Marta; Di Rienzo, Filomena

    2015-07-01

    Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP) results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX) as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders including post

  8. Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation

    Directory of Open Access Journals (Sweden)

    Domenico Intiso

    2015-06-01

    Full Text Available Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders

  9. Combined use of spatial restraint stress and middle cerebral artery occlusion is a novel model of post-stroke depression in mice.

    Science.gov (United States)

    Zhang, Gaocai; Chen, Li; Yang, Lingli; Hua, Xiaodong; Zhou, Beiqun; Miao, Zhigang; Li, Jizhen; Hu, Hua; Namaka, Michael; Kong, Jiming; Xu, Xingshun

    2015-01-01

    Post stroke depression (PSD) is one of the most common complications of ischemic stroke. At present, the underlying mechanisms are unclear, largely because there are no reliable, valid and reproducible animal models of PSD. Here we report a novel animal model of PSD that displays consistent and reliable clinical features of hemiplegic stroke. The animal model encompasses a combination of the middle cerebral artery occlusion (MCAO) and spatial restraint stress. We found that a 60-minute MCAO followed by spatial restraint stress for 2 h daily for 2 to 4 weeks from the fourth day after MCAO induced PSD-like depressive phenotypes in mice. Importantly, the mice showed exacerbated deficits of neurological functions and decreased body weights, which were accompanied with reduced levels of brain derived neurotrophic factor and neurotransmitters including serotonin and dopamine. In addition, we identified increased levels of serum cortisol in our PSD mice. Finally, we found that mice with PSD were responsive to the tri-cyclic antidepressant imipramine as evidenced by their attenuated depressive behaviors, increased body weights, recovered brain serotonin levels, and decreased serum cortisol levels. This mouse model replicates multiple features of human post-stroke depression and thus provides a new model for the investigation of PSD. PMID:26572587

  10. 卒中后抑郁新的病因假说--谷氨酸能障碍%Glutamate Dysfunctional Etiology Hypothesis of Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    岳莹莹; 袁勇贵; 张志

    2014-01-01

    卒中后抑郁(post-stroke depression,PSD)是卒中后常见的神经精神症状之一,以心境低落、兴趣下降为主要特征,不仅影响患者神经功能的康复,而且显著增加卒中病死率。其发病机制尚未明确,伴随离子型谷氨酸受体拮抗剂氯胺酮的快速抗抑郁作用的出现,谷氨酸(glutamate,Glu)能神经系统在抑郁症及PSD中的作用日益突出,也为抗抑郁治疗带来新的契机。%Post-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke that is characterized by depressed mood and loss interest. It can not only affect the neurological rehabilitation, but also signiifcantly increase the mortality of patients. However, the pathogenesis is not clear. Glutamate system plays an important role in depression and PSD and brings new opportunities for treatment along with the appearance of rapid antidepressant ketamine which is the antagonist of an ionotropic glutamate receptor.

  11. A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients

    Directory of Open Access Journals (Sweden)

    Kakuda Wataru

    2012-01-01

    Full Text Available Abstract Background Both low-frequency repetitive transcranial magnetic stimulation (rTMS and intensive occupational therapy (OT have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. Based on these reports, we developed an inpatient combination protocol of these two modalities for the treatment of such patients. The aims of this pilot study were to confirm the safety and feasibility of the protocol in a large number of patients from different institutions, and identify predictors of the clinical response to the treatment. Methods The study subjects were 204 post-stroke patients with upper limb hemiparesis (mean age at admission 58.5 ± 13.4 years, mean time after stroke 5.0 ± 4.5 years, ± SD from five institutions in Japan. During 15-day hospitalization, each patient received 22 treatment sessions of 20-min low-frequency rTMS and 120-min intensive OT daily. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere over the primary motor area. The intensive OT, consisting of 60-min one-to-one training and 60-min self-exercise, was provided after the application of low-frequency rTMS. Fugl-Meyer Assessment (FMA and Wolf Motor Function Test (WMFT were performed serially. The physiatrists and occupational therapists involved in this study received training prior to the study to standardize the therapeutic protocol. Results All patients completed the protocol without any adverse effects. The FMA score increased and WMFT log performance time decreased significantly at discharge, relative to the respective values at admission (change in FMA score: median at admission, 47 points; median at discharge, 51 points; p Conclusions The 15-day inpatient rTMS plus OT protocol is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis. The response to the treatment was not influenced by age or time after stroke onset. The

  12. 男性卒中后焦虑/抑郁症患者血清性激素水平变化研究%Altered serum sexual hormone in male post-stroke anxiety/depression patients

    Institute of Scientific and Technical Information of China (English)

    姚恺; 邬军锋; 张剑峰

    2011-01-01

    Objective To explore the relationship between male sexual hormone (estradiol, testosterone, progesterone) and post-stroke anxiety or post-stroke depression. Methods The serum estradiol, testosterone, progesterone levels were measured in 30 post-stroke anxiety or post-stroke depressive patients and 30 post-stroke patients without anxiety or depression. The degree of anxiety and depression was clinically assessed with Hamilton Anxiety Scale(HAMA) and Hamilton Rating Scale for depression(HAMD). Correlation analysis was conducted. Results The estradiol level of male poststroke anxiety or post- stroke depressive patients was significantly lower than that of controls (P < 0.05), and showed negative correlation with the scores of HAMA (r =-0. 540,P < 0.05) and HAMD (r =-0. 503, P < 0.05 ). The testosterone level of male post-stroke anxiety and male post-stoke depressive patients was significantly lower than that of controls (P < 0. 05), and showed negative correlation with the scores of HAMA (r=-0. 535,P<0. 05) and HAMD (r=-0. 602,P<0.05). The levels of progesterone between two groups were not significantly different (P > 0. 05). Conclusions The sexual hormone disturbance was found significantly in post-stroke anxiety and post-stroke depressive patients, which has close relationship with morbidity and development of stroke. The measurement of estradiol and testosterone level may be used as a biomarker for post-stroke anxiety and post-stroke depression.%目的 探讨男性性激素水平(雌二醇、睾酮、孕酮)与卒中后焦虑、抑郁症的关系.方法 检测和比较30例男性卒中后焦虑、抑郁症患者和30例非卒中后焦虑、抑郁症患者的血清雌二醇、睾酮、孕酮的水平,并应用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)对卒中后焦虑、抑郁症患者进行临床评分,同时作相关分析.结果 男性卒中后焦虑、抑郁症患者血清雌二醇水平均显著低于对照组(P0.05).结论

  13. Influence factors of post-stroke cognitive impairment%脑卒中后认知功能障碍的影响因素

    Institute of Scientific and Technical Information of China (English)

    秦晓明; 张新卿; 方向华

    2009-01-01

    脑卒中是危害人类健康的最主要的疾病之一,而脑卒中后的认知功能障碍(post-stroke cognitive impairment, PSCI)是其常见的并发症,发病率为11.6%~56.3%。PSCI按照严重程度可以分为非痴呆的认知功能障碍( cognitive impairment with no dementia, CIND)和脑卒中后痴呆(poststroke dementia, PSD).前者属于血管性轻度认知功能障碍的范畴(vascular mild cognitive impairment, VMCI),

  14. A Machine Learning Framework for Gait Classification Using Inertial Sensors: Application to Elderly, Post-Stroke and Huntington’s Disease Patients

    Directory of Open Access Journals (Sweden)

    Andrea Mannini

    2016-01-01

    Full Text Available Machine learning methods have been widely used for gait assessment through the estimation of spatio-temporal parameters. As a further step, the objective of this work is to propose and validate a general probabilistic modeling approach for the classification of different pathological gaits. Specifically, the presented methodology was tested on gait data recorded on two pathological populations (Huntington’s disease and post-stroke subjects and healthy elderly controls using data from inertial measurement units placed at shank and waist. By extracting features from group-specific Hidden Markov Models (HMMs and signal information in time and frequency domain, a Support Vector Machines classifier (SVM was designed and validated. The 90.5% of subjects was assigned to the right group after leave-one-subject–out cross validation and majority voting. The long-term goal we point to is the gait assessment in everyday life to early detect gait alterations.

  15. Clinical Application of Loewenstein Occupational Therapy Cognitive Assessment Battery-Second Edition in Evaluating of Cognitive Function of Chinese Patients with Post-stroke Aphasia

    Institute of Scientific and Technical Information of China (English)

    Zeng-zhi Yu; Shu-jun Jiang; Jun Li; Sheng Bi; Fei Li; Tao Xie; Rui Wang; Xiao-tan Zhang

    2013-01-01

    Objective To investigate the clinical application value of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery in Chinese patients with post-stroke aphasia. Methods Cognitive functions of 59 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of LOTCA battery and their linguistic functions were tested with the Western Aphasia Battery (WAB) Scale, respectively. The results of LOTCA were analyzed and compared across different groups, in the light of gender, age, educational background, the length of illness, and the degree of aphasia. Results Neither the score of subtests of the LOTCA nor the overall scores of LOTCA of aphasia patients with different gender and educational background differed (all P>0.05). In different age groups, apart from thinking operation (F=3.373, P=0.016), visuomotor organization (F=3.124, P=0.022), attention (F=3.729, P=0.009) and the total score (F=2.683, P=0.041), there was no difference in terms of the other subtest scores of LOTCA (all P>0.05). In the groups of different length of time with illness, apart from orientation (F=2.982, P=0.039) and attention (F=3.485, P=0.022), the score of other subtests and the total score of LOTCA were not different (all P>0.05). In the groups of different degree of aphasia, apart from attention (F=2.061, P=0.074), both the score of other subtests and the total score of LOTCA differed (all P Conclusion LOTCA might be suitable to assessing the cognitive ability of post-stroke Chinese patients with aphasia.

  16. Effects of interleukin-6, interleukin-18, and statin use, evaluated at acute stroke, on post-stroke depression during 1-year follow-up.

    Science.gov (United States)

    Kang, Hee-Ju; Bae, Kyung-Yeol; Kim, Sung-Wan; Kim, Joon-Tae; Park, Man-Seok; Cho, Ki-Hyun; Kim, Jae-Min

    2016-10-01

    Proinflammatory cytokines are associated with the development of post-stroke depression (PSD). Statins are thought to possess anti-inflammatory properties but their interactions with cytokines regarding the risk of PSD have yet to be investigated. Thus, the present study aimed to determine whether interleukin (IL)-6 and IL-18 were associated with the development of depression at 2 weeks and 1year after stroke using a longitudinal post-stroke cohort. Furthermore, this study examined the potential interactions between statin use and cytokines on PSD. For this study, 286 patients were evaluated 2 weeks after stroke and 222 patients were followed-up 1year later. Depression was diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and then categorized into no PSD or any PSD, which included diagnoses of both major and minor depression. The effects of IL-6 and IL-18 on PSD as well as their interaction with a statin at both examination time-points were investigated using a multivariate logistic regression model. Higher IL-6 and IL-18 levels were independently associated with depressive disorders within 2 weeks and at 1year after stroke. When stratified by statin use, these significant associations were more evident in patients who did not use a statin. Furthermore, there was a significant interaction between statin use and IL-6 on the presence of a depressive disorder at 1year. The present findings support the cytokine hypothesis of PSD and indicate that the preventive effects of statin use against PSD may be mediated by its interactions with IL-6. PMID:27428088

  17. Methylphenidate modulates activity within cognitive neural networks of patients with post-stroke major depression: A placebo-controlled fMRI study

    Directory of Open Access Journals (Sweden)

    Rajamannar Ramasubbu

    2008-10-01

    Full Text Available Rajamannar Ramasubbu1, Bradley G Goodyear21Departments of Psychiatry and Clinical Neurosciences; 2Department of Radiology and Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, AB, CanadaBackground: Methylphenidate (MP is a dopamine- and noradrenaline-enhancing agent beneficial for post-stroke depression (PSD and stroke recovery due to its therapeutic effects on cognition, motivation, and mood; however, the neural mechanisms underlying its clinical effects remain unknown. This study used functional magnetic resonance imaging (fMRI to investigate the effect of MP on brain activity in response to cognitive tasks in patients with PSD.Methods: Nine stroke outpatients with DSM IV defined major depression underwent fMRI during two cognitive tasks (2-back and serial subtraction on four occasions, on the first and third day of a three-day treatment of MP and placebo. Nine healthy control (HC subjects matched for age and sex scanned during a single session served as normative data for comparison. The main outcome measure was cognitive task-dependent brain activity.Results: For the 2-back task, left prefrontal, right parietal, posterior cingulate, and temporal and bilateral cerebellar regions exhibited significantly greater activity during the MP condition relative to placebo. Less activity was detected in rostral prefrontal and left parietal regions. For serial subtraction, greater activity was detected in medial prefrontal, biparietal, bitemporal, posterior cingulate, and bilateral cerebellar regions, as well as thalamus, putamen, and insula. Further, underactivation observed during the placebo condition relative to HC improved or reversed during MP treatment. No significant differences in behavioral measures were found between MP and placebo conditions or between patients and HC.Conclusions: Short-term MP treatment may improve and normalize activity in cognitive neuronal networks in patients with PSD

  18. [Treatment of central and neuropathic facial pain by chronic stimulation of the motor cortex: value of neuronavigation guidance systems for the localization of the motor cortex].

    Science.gov (United States)

    Nguyen, J P; Lefaucheur, J P; Le Guerinel, C; Fontaine, D; Nakano, N; Sakka, L; Eizenbaum, J F; Pollin, B; Keravel, Y

    2000-11-01

    Thirty two patients with refractory central and neuropathic pain of peripheral origin were treated by chronic stimulation of the motor cortex between May 1993 and January 1997. The mean follow-up was 27. 3 months. The first 24 patients were operated according to the technique described by Tsubokawa. The last 13 cases (8 new patients and 5 reinterventions) were operated by a technique including localization by superficial CT reconstruction of the central region and neuronavigator guidance. The position of the central sulcus was confirmed by the use of intraoperative somatosensory evoked potentials. The somatotopic organisation of the motor cortex was established peroperatively by studying the motor responses at stimulation of the motor cortex through the dura. Ten of the 13 patients with central pain (77%) and nine of the 12 patients with neuropathic facial pain had experienced substantial pain relief (75%). One of the 3 patients with post-paraplegia pain was clearly improved. A satisfactory result was obtained in one patient with pain related to plexus avulsion and in one patient with pain related to intercostal herpes zoster. None of the patients developed epileptic seizures. The position of the stimulating poles effective on pain corresponded to the somatotopic representation of the motor cortex. The neuronavigator localization and guidance technique proved to be most useful identifying the appropriate portion of the motor gyrus. It also allowed the establishment of reliable correlations between electrophysiological-clinical and anatomical data which may be used to improve the clinical results and possibly to extend the indications of this technique. PMID:11084480

  19. The influence of μ-opioid and noradrenaline reuptake inhibition in the modulation of pain responsive neurones in the central amygdala by tapentadol in rats with neuropathy

    OpenAIRE

    L. Gonçalves; Friend, L. V.; Dickenson, A. H.

    2015-01-01

    Treatments for neuropathic pain are either not fully effective or have problematic side effects. Combinations of drugs are often used. Tapentadol is a newer molecule that produces analgesia in various pain models through two inhibitory mechanisms, namely central μ-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition. These two components interact synergistically, resulting in levels of analgesia similar to opioid analgesics such as oxycodone and morphine, but with more tolerabl...

  20. On the G-Protein-Coupled Receptor Heteromers and Their Allosteric Receptor-Receptor Interactions in the Central Nervous System: Focus on Their Role in Pain Modulation

    OpenAIRE

    Kjell Fuxe; Tarakanov, Alexander O.; Luigi F. Agnati; Alicia Rivera; Kathleen Van Craenenbroeck; Wilber Romero-Fernandez; Dasiel O. Borroto-Escuela

    2013-01-01

    The modulatory role of allosteric receptor-receptor interactions in the pain pathways of the Central Nervous System and the peripheral nociceptors has become of increasing interest. As integrators of nociceptive and antinociceptive wiring and volume transmission signals, with a major role for the opioid receptor heteromers, they likely have an important role in the pain circuits and may be involved in acupuncture. The delta opioid receptor (DOR) exerts an antagonistic allosteric influence on ...

  1. Central P2Y12 receptor blockade alleviates inflammatory and neuropathic pain and cytokine production in rodents.

    Science.gov (United States)

    Horváth, Gergely; Gölöncsér, Flóra; Csölle, Cecilia; Király, Kornél; Andó, Rómeó D; Baranyi, Mária; Koványi, Bence; Máté, Zoltán; Hoffmann, Kristina; Algaier, Irina; Baqi, Younis; Müller, Christa E; Von Kügelgen, Ivar; Sperlágh, Beáta

    2014-10-01

    In this study the role of P2Y12 receptors (P2Y12R) was explored in rodent models of inflammatory and neuropathic pain and in acute thermal nociception. In correlation with their activity to block the recombinant human P2Y12R, the majority of P2Y12R antagonists alleviated mechanical hyperalgesia dose-dependently, following intraplantar CFA injection, and after partial ligation of the sciatic nerve in rats. They also caused an increase in thermal nociceptive threshold in the hot plate test. Among the six P2Y12R antagonists evaluated in the pain studies, the selective P2Y12 receptor antagonist PSB-0739 was most potent upon intrathecal application. P2Y12R mRNA and IL-1β protein were time-dependently overexpressed in the rat hind paw and lumbar spinal cord following intraplantar CFA injection. This was accompanied by the upregulation of TNF-α, IL-6 and IL-10 in the hind paw. PSB-0739 (0.3mg/kg i.t.) attenuated CFA-induced expression of cytokines in the hind paw and of IL-1β in the spinal cord. Subdiaphragmatic vagotomy and the α7 nicotinic acetylcholine receptor antagonist MLA occluded the effect of PSB-0739 (i.t.) on pain behavior and peripheral cytokine induction. Denervation of sympathetic nerves by 6-OHDA pretreatment did not affect the action of PSB-0739. PSB-0739, in an analgesic dose, did not influence motor coordination and platelet aggregation. Genetic deletion of the P2Y12R in mice reproduced the effect of P2Y12R antagonists on mechanical hyperalgesia in inflammatory and neuropathic pain models, on acute thermal nociception and on the induction of spinal IL-1β. Here we report the robust involvement of the P2Y12R in inflammatory pain. The anti-hyperalgesic effect of P2Y12R antagonism could be mediated by the inhibition of both central and peripheral cytokine production and involves α7-receptor mediated efferent pathways. PMID:24971933

  2. Burden of Illness Associated with Peripheral and Central Neuropathic Pain among Adults Seeking Treatment in the United States: A Patient-Centered Evaluation

    OpenAIRE

    Schaefer, Caroline; Mann, Rachael; Sadosky, Alesia; Daniel, Shoshana; Parsons, Bruce; Nieshoff, Edward; Tuchman, Michael; Nalamachu, Srinivas; Anschel, Alan; Stacey, Brett R.

    2014-01-01

    Objective The aim of this study was to evaluate patient-reported burden associated with peripheral and central neuropathic pain (NeP) by pain severity and NeP condition. Design Six hundred twenty-four subjects with one of six NeP conditions were recruited during routine office visits. Subjects consented to retrospective chart review and completed a one-time questionnaire (including EuroQol-5 dimensions, 12-item Short-Form Health Survey, Brief Pain Inventory-Short Form, Medical Outcomes Study ...

  3. The role of peripheral and central TRPV1 receptors in pain transmission and modulation

    Czech Academy of Sciences Publication Activity Database

    Paleček, Jiří

    Les Arcs : EWCBR, 2008. s. 54-54. [European winter conference on brain research /28./. 08.03.2008-15.03.2008, Les Arcs] R&D Projects: GA MŠk(CZ) LC554; GA ČR(CZ) GA305/06/1115 Grant ostatní: Myores(XE) 511978 Institutional research plan: CEZ:AV0Z50110509 Source of funding: R - rámcový projekt EK Keywords : spr2 * surgical pain * N-oleoyldopamine * hyperplasia Subject RIV: ED - Physiology

  4. Pain Assessment

    Science.gov (United States)

    Introduction Types of Pain Pain Assessment Pain Treatments Integrative Pain Therapy Pain Management Recommendations References September 04, 2016 Pain Assessment Effective pain management begins with a comprehensive ...

  5. The effectiveness of an augmented cognitive behavioural intervention for post-stroke depression with or without anxiety (PSDA: the Restore4Stroke-PSDA trial

    Directory of Open Access Journals (Sweden)

    Kootker Joyce A

    2012-07-01

    Full Text Available Abstract Background Post-Stroke Depression with or without Anxiety (PSDA is a common disorder in the chronic phase of stroke. Neuropsychiatric problems, such as PSDA, have a negative impact on social reintegration and quality of life. Currently, there is no evidence-based treatment available for reducing PSDA symptoms. In the recent literature on depression in the general population it has been shown that depression complaints can diminish by cognitive behavioural therapy (CBT. In the current study, the effectiveness of augmented, activation-based and individually tailored CBT on the reduction of depression and anxiety will be investigated in patients with PSDA. Additionally, the effects on various secondary outcome measures, such as quality of life, goal attainment and societal participation will be evaluated. This study is embedded in a consortium of 4 interrelated studies on quality of life after stroke (Restore4Stroke. Methods/design A multi-centre, assessor-blind, randomized controlled trial is conducted. A sample of 106 PSDA patients, as assessed with the Hospital Anxiety and Depression Scale (HADS depression subscale >7, will be recruited and randomly allocated to either an experimental or a control group. The experimental intervention consists of an augmented CBT intervention. The intervention is based on CBT principles of recognizing, registering, and altering negative thoughts and cognitions so that mood, and emotional symptoms are improved. CBT is augmented with direct in-vivo activation offered by occupational or movement therapists. Patients in the control group will receive a computerized cognitive training intervention. Outcomes will be assessed at baseline, immediately post intervention, and at 6 and 12 months follow up. Discussion This study is the first randomized clinical trial that evaluates the (maintenance of effects of augmented CBT on post-stroke depression with or without anxiety symptoms. Together with three other

  6. Spatial localization and distribution of the TMS-related 'hotspot' of the tibialis anterior muscle representation in the healthy and post-stroke motor cortex.

    Science.gov (United States)

    Sivaramakrishnan, Anjali; Tahara-Eckl, Lenore; Madhavan, Sangeetha

    2016-08-01

    Transcranial magnetic stimulation (TMS) is a type of noninvasive brain stimulation used to study corticomotor excitability of the intact and injured brain. Identification of muscle representations in the motor cortex is typically done using a procedure called 'hotspotting', which involves establishing the optimal location on the scalp that evokes a maximum TMS response with minimum stimulator intensity. The purpose of this study was to report the hotspot locations for the tibialis anterior (TA) muscle representation in the motor cortex of healthy and post stroke individuals. A retrospective data analyses from 42 stroke participants and 32 healthy participants was conducted for reporting TMS hotspot locations and their spatial patterns. Single pulse TMS, using a 110mm double cone coil, was used to identify the motor representation of the TA. The hotspot locations were represented as x and y-distances from the vertex for each participant. The mediolateral extent of the loci from the vertex (x-coordinate) and anteroposterior extent of the loci from the vertex (y-coordinate) was reported for each hemisphere: non-lesioned (XNLes, YNLes), lesioned (XLes, YLes) and healthy (XH, YH). We found that the mean hotspot loci for TA muscle from the vertex were approximately: 1.29cm lateral and 0.55cm posterior in the non-lesioned hemisphere, 1.25cm lateral and 0.5cm posterior in the lesioned hemisphere and 1.6cm lateral and 0.8cm posterior in the healthy brain. There was no significant difference in the x- and y-coordinates between the lesioned and non-lesioned hemispheres. However, the locations of the XNLes (p=0.01) and XLes (p=0.004) were significantly different from XH. The YNLes and YLes showed no significant differences from YH loci. Analyses of spatial clustering patterns using the Moran's I index showed a negative autocorrelation in stroke participants (NLes: Moran's I=-0.09, p<0.001; Les: Moran's I=-0.14, p=0.002), and a positive autocorrelation in healthy participants

  7. Imaging Pain.

    Science.gov (United States)

    Martucci, Katherine T; Mackey, Sean C

    2016-06-01

    The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI. PMID:27208709

  8. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  9. Spinal pain

    International Nuclear Information System (INIS)

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  10. Poststroke Pain – but Multiple Pain Mechanisms

    OpenAIRE

    Vinjamuri Chari; Eldon Tunks

    2010-01-01

    A 42-year-old man presented with acute left hemiplegia due to a right frontotemporal hemorrhagic stroke and left-sided pain. While the initial presentation suggested central poststroke pain, subsequent investigations also implicated heterotopic ossification of the left hip and amplification of previous low back pain by the new central pain. While heterotopic ossification has been commonly associated with brain injury, spinal cord injury or osseous injury, it is only rarely associated with str...

  11. Poststroke Pain – but Multiple Pain Mechanisms

    Directory of Open Access Journals (Sweden)

    Vinjamuri Chari

    2010-01-01

    Full Text Available A 42-year-old man presented with acute left hemiplegia due to a right frontotemporal hemorrhagic stroke and left-sided pain. While the initial presentation suggested central poststroke pain, subsequent investigations also implicated heterotopic ossification of the left hip and amplification of previous low back pain by the new central pain. While heterotopic ossification has been commonly associated with brain injury, spinal cord injury or osseous injury, it is only rarely associated with stroke. Poststroke pain may be multifactorial, and discovering the pain mechanisms has important implications for treatment.

  12. An Approach for Experimental Investigation of Muscle Activities of the Upper Limbs (Right versus Left Arm of Healthy Subjects and Post-stroke Patients - A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Rositsa Raikova

    2014-06-01

    Full Text Available The experimental estimation of muscle activities in post-stroke patients with limb motor deficit is often based on surface electromyography signals (EMGs. Besides EMGs processing and interpretation difficulties, the differences in motor control of dominant and non-dominant arm have to be taken into account since the stroke can injure either left or right limb. Different motor tasks (under static conditions - different postures, and dynamic ones, i.e. elbow flexions/extensions in the sagittal and in the horizontal planes were performed consecutively with the dominant and the non-dominant arm of two healthy volunteers and with the non-affected and the affected arm of two stroke patients. Surface EMGs of seven muscles were recorded using a Noraxon telemetric system. Two custom-made programs written in MATLAB were developed, separately for processing the data from static and dynamic motor tasks. At first the EMG signals were filtered, rectified and smoothed. For static tasks power-frequency analysis was performed, calculating different parameters (mean and median frequency, area under power function, mean values of the smoothed signals, which would be used as coefficients for normalization, etc.. For dynamic tasks one trial of flexion/extension motions was chosen for visual expectation through the saved video records. An analysis of synergistic and antagonistic muscle activities was performed.

  13. CLINICAL STUDY ON ACUPUNCTURE IN THE TREATMENT OF POST-STROKE DEPRESSION WITH THE METHOD OF ACTIVATING THE DU MERIDIAN AND CLEARING THE MIND

    Institute of Scientific and Technical Information of China (English)

    HE Xi-jun; LAI Xin-sheng; TAN Ji-lin; WANG Ben-guo

    2006-01-01

    Objective: To observe the therapeutic effect of acupuncture in the treatment of post-stroke depression (PSD) with the method of activating the Du Meridian and clearing the mind. Methods: Two hundred and thirty one cases of PSD were randomly divided into two groups, acupuncture and control groups. In acupuncture group, Baihui (百会 GV 20), Dazhui (大椎 GV 14), Neiguan (内关 PC 6), Taichong (太冲 LR 3) and Shenmen (神门 HT 7) were selected as the main points to invigorate flow of qi in the Du Meridian and clear the mind. Patients in the control group received Fluoxetine orally, 20 rng once per-day. In addition, the same routine treatments were given to both groups, strengthened with rehabilitation exercises as early as possible; 8 weeks constituted one therapeutic course. HAMD and severity of neuro-functional defect of each case were evaluated before and 8-week after the treatment. Results: The total effective rate of acupuncture group was 92.37%, the control group, 72.88%. According to x2 test, the difference between the two groups was remarkably significant (P<0.05). Conclusion: Acupuncture therapy of activating the Du Meridian and clearing the mind in the treatment of PSD was safe and effective.

  14. [Changes in the Functional Connectivity of Motor Zones in the Use of Multimodal Exoskeleton Complex "Regent" in the Neurorehabilitation of Post-Stroke Patients].

    Science.gov (United States)

    Saenko, I V; Morozova, S N; Zmeykina, E A; Konovalov, R N; Chervyakov, A V; Poydasheva, A G; Chernikova, L A; Suponeva, N A; Piradov, M A; Kozlovskaya, I B

    2016-01-01

    The article discusses the effect of a course of treatment with the use of multimodal complex exoskeleton (MCE) "Regent" on the reorganization of cortical locomotor zones in 14 patients with post-stroke hemiparesis, mainly atthe chronic stage of the disease. Before the course of treatment, we identified specific areas of activation in the primary sensorimotor and supplementary motor areas and the inferior parietal lobules in both affected and healthy hemispheres by means of functional MRI (fMRI) with the use of special passive sensorimotor paradigms. After the course of treatment with MCE, we observed an improvement of temporal characteristics of walking; it was accompanied by a decrease in the activation zones of inferior parietal lobules, especially in the healthy hemisphere, and by a significant increase in the activation zone of primary sensorimotor and supplementary motor areas. The analysis of the functional connectivity of studied zones before and after the course of treatment with MCE showed significant changes in intra- and interhemispheric interactions. PMID:27188148

  15. The influence of μ-opioid and noradrenaline reuptake inhibition in the modulation of pain responsive neurones in the central amygdala by tapentadol in rats with neuropathy.

    Science.gov (United States)

    Gonçalves, Leonor; Friend, Lauren V; Dickenson, Anthony H

    2015-02-15

    Treatments for neuropathic pain are either not fully effective or have problematic side effects. Combinations of drugs are often used. Tapentadol is a newer molecule that produces analgesia in various pain models through two inhibitory mechanisms, namely central μ-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition. These two components interact synergistically, resulting in levels of analgesia similar to opioid analgesics such as oxycodone and morphine, but with more tolerable side effects. The right central nucleus of the amygdala (CeA) is critical for the lateral spinal ascending pain pathway, regulates descending pain pathways and is key in the emotional-affective components of pain. Few studies have investigated the pharmacology of limbic brain areas in pain models. Here we determined the actions of systemic tapentadol on right CeA neurones of animals with neuropathy and which component of tapentadol contributes to its effect. Neuronal responses to multimodal peripheral stimulation of animals with spinal nerve ligation or sham surgery were recorded before and after two doses of tapentadol. After the higher dose of tapentadol either naloxone or yohimbine were administered. Systemic tapentadol resulted in dose-dependent decrease in right CeA neuronal activity only in neuropathy. Both naloxone and yohimbine reversed this effect to an extent that was modality selective. The interactions of the components of tapentadol are not limited to the synergy between the MOR and α2-adrenoceptors seen at spinal levels, but are seen at this supraspinal site where suppression of responses may relate to the ability of the drug to alter affective components of pain. PMID:25576174

  16. 西酞普兰通过免疫调节机制治疗脑卒中后抑郁状态%Citalopram in treatment of post stroke depression through its immunoregulatory mechanism

    Institute of Scientific and Technical Information of China (English)

    王姗姗; 姜磊

    2013-01-01

    Objective To study the expression of TNFα in hypothalamus of rats by observing post stroke depression and its pathogenesis after citalopram treatment .Methods Eighteen rats that underwent open field test were randomly divided into the control group (n=6) and experimental group (n= 12 ). The rats in experimental group were further divided into post stroke depression group (n=6) and citalopram treatment group (n= 6) after left middle cerebral artery occlusion . Behaviors in these two groups were observed by open field test and sugar-water test ,respectively . Expression of TNF-α mRNA in hypothalamus of rats was detected by quantitative polymerase dhain reaction .Results The levels of horizontal and vertical activities and the preference for sug -ar-water were significantly lower in post stroke depression group than in control group (P<0 .01) and significantly higher in citalopram treatment group than in post stroke depression group (P< 0.05). The TNF-α mRNA expression level in hypothalamus was significantly higher in post stroke depression group than in control group (P<0 .05) and significantly lower in post stroke depression group than in citalopram treatment group (P<0 .05 ) .Conclusion Citalopram exerts its therapeutic effect on post stroke depression by down-regulating the expression of TNF-α in hypothalamus of rats .%目的 本研究通过观察脑卒中后抑郁(post stroke depression,PSD)大鼠给予抗抑郁药物西酞普兰干预后,观察下丘脑TNF-α的表达变化,并探讨PSD发病机制和潜在的药物治疗机制.方法 经旷场实验筛选出18只大鼠,随机分为对照组6只,另12只大鼠经过单侧大脑中动脉线栓法后,又随机分为PSD组6只和西酞普兰组6只,经慢性不可预见性应激后,通过旷场实验和糖水实验观察各组大鼠的行为学改变,定量PCR检测各组大鼠下丘脑TNF-α mRNA的表达改变.结果 与对照组比较,PSD组的水平活动、直立探索和糖水喜好明显下

  17. Pain genes.

    Directory of Open Access Journals (Sweden)

    Tom Foulkes

    Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

  18. 首发脑卒中后抑郁与脑卒中部位的关系%The relationship between the first onset post-stroke depression and stroke position

    Institute of Scientific and Technical Information of China (English)

    何春艳; 杨平生; 伍苏方

    2014-01-01

    目的:探讨首发脑卒中患者卒中部位与卒中后抑郁的关系。方法选择78例首发脑卒中患者,按照是否发生抑郁症分为脑卒中后抑郁组(观察组)及脑卒中后无抑郁组(对照组),观察脑卒中后抑郁患病率及卒中部位与发生卒中后抑郁的关系。结果脑卒中后抑郁患病率为12.82%,与对照组比较,观察组发生在左侧、皮质部位的发生率明显增加,差异有统计学意义(P<0.05)。结论脑卒中患者卒中部位与卒中后抑郁具有相关性。%Objective To study the correlation between the first onset post-stroke depression and stroke position. Methods Selected 78 cases with the first onset stroke,according to whether depression onset or not,they were divided into post-stroke depression group (observe group),and post-stroke non depression group (control group),the correlation of prevalence of depression after stroke,parts of the stroke with poststroke depression were observed. Results Incidence rate of depression after stroke was 12.82%,compared with control group,observation group patients’ onset at left and cortex position obviously increased,the differences had statistical significance (P<0.05). Conclusion Among stroke pa-tients stroke position have correlation with post-stroke depression onset.

  19. Clinical analysis of post-stroke depression disorder%脑卒中后抑郁障碍的临床分析

    Institute of Scientific and Technical Information of China (English)

    周玉颖; 王艳; 王景华; 宁宪嘉

    2012-01-01

    Objective To analyze the relative pathiogenetic factors for post-stroke depression disor-der(PSDD). Methods Six hundred and ninety-seven cerebral stroke patients were enrolled in this study. Their gender, age .cerebral stroke type and foci,NIHSS score,Barthel index(BI) and Hamilton rating scale score were recorded. The incidence of different PSDD types was compared. Results The incidence of cerebral hemorrhage was significantly higher in PSDD patients than in cerebral infarction patients at admission(26. 6% vs 16. 3% , f = 6. 48, P = 0. 01). The NIHSS score was significantly higher while the BI was significantly lower in PSDD patients than in non-PSDD patients at admission(6. 00 +4. 60 vs 4. 52 + 3. 74,57. 40?6. 50 vs 68. 16 + 25. 76,P< 0. 01). The NIHSS score was positively related while the BI was negatively related with the occurrence of PSDD. Logistic regression analysis showed that the BI was a protective factor for PSDD(Oi? = 0. 98,95%C7:0. 98-0. 99,P<0. 01). Conclusion PSDD is related with the stroke type,NIHSS score and BI.%目的 分析脑卒中后抑郁障碍(post-stroke depression disorder,PSDD)的发病相关因素.方法 对入选的697例脑率中患者的性别、年龄、脑卒中类型、脑卒中病灶部位、美国国立卫生研究院脑卒中量表( National Institutes of Health Stroke Scale,NIHSS)神经功能缺损程度评分、Barthel指数(BI)、汉密尔顿抑郁量表评分(Hamilton Rating Scale for Depression,HAMD)进行记录,并对不同分类中PSDD发生率进行比较.结果 脑出血PSDD发生率明显高于脑梗死PSDD发生率(26.6% vs 16.3%,x2=6.48,P=0.01).PSDD患者入院时NIHSS评分明显高于无PSDD患者[(6.00±4.60)分vs (4.52±3.74)分],BI评分明显低于无PSDD患者[(57.40±26.54)分vs (68.16±25.76)分],差异有统计学意义(P<0.01).PSDD患者入院时NIHSS评分HAMD呈正相关(r=0.21,P<0.01),入院时BI评分与HAMD呈负相关(r=-0.18,P<0.01).logistic回归分析显示,入院时BI评分是抑郁

  20. 脑卒中后抑郁症的危险因素分析%The risk factors of post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    陈光军; 鲁世华

    2011-01-01

    目的 探讨脑卒中后抑郁症(PSD)的危险因素.方法 对196例脑卒中患者行头颅MRI或头颅CT检查以明确诊断,发病后6周内多次对患者进行汉密尔顿抑郁量表(HAMD)评分,共有65人确诊为PSD,分析PSD的发生与性别、年龄、文化程度、卒中性质、日常生活能力、独立行走和发病部位的关系.结果 日常生活能力明显障碍或不能独立行走的脑卒中患者PSD的发病率明显高于日常生活能力无明显障碍或能独立行走的患者(P<0.05).左侧额叶卒中患者PSD的发病率高于其他部位脑卒中患者(P<0.05).性别、年龄、文化程度、卒中性质不同的脑卒中患者PSD发生率差异无统计学意义.结论 急性期脑卒中患者PSD的发生与日常生活能力明显障碍、不能独立行走、左侧额叶卒中有关.%Objective To explore risk factors of post-stroke depression (PSD). Methods 196 stroke patients were diagnosed by MRI or CT. All patients were tested many times by the Hamilton Depression Scale ( HAMD) in six week after stroke and 65 patients with post-stroke depression were diagnosed. To analyze the relationship between PSD and the stroke patients with gender, age, culture level, stroke type, activity of dailing living, independent ambulation and lesion location. Results Patients with dependent ambulation or obviously disorder in activity of dailing living had higher incidence of PSD than that with independent ambulation or without obviously disorder in activity of dailing living (P < 0.05 ). Left frontal lobe lesion has higher incidence of PSD than the other location lesion in the brain (P<0.05). There was no difference in the incidence of PSD in stroke patients with different gender,age,culture level or stroke type (P≥0.05). Conclusion PSD is related to dependent ambulation,obviously disorder in activity and left frontal lobe lesion.

  1. Exploring the impact of laterality and polarity of tDCS on therapy for post-stroke anomia: A case study

    Directory of Open Access Journals (Sweden)

    Anna M. Woollams

    2015-05-01

    Full Text Available Anomia is a frequent and persistent symptom of post-stroke aphasia. Cortical neuroplasticity plays a significant role in language recovery following stroke and can be facilitated by behavioural speech and language therapy (e.g. Fridriksson et al., 2012. Existing research suggests that complementing therapy for anomia with neurostimulation techniques (such as transcranial Direct Current Stimulation, or tDCS can lead to greater therapeutic gains, with studies suggesting that applying anodal (excitatory tDCS to the left hemisphere and/or cathodal (inhibitory tDCS to the right hemisphere may be particularly beneficial (e.g. Baker et al., 2010; Rosso et al., 2014. However, the effects of varying both polarity and laterality of tDCS have yet to be systematically investigated. The primary aim of the current study was to determine the optimal tDCS parameters to increase naming ability in an 81 year old right-handed male (JS with chronic non-fluent post stroke anomia. Results of a pre-therapy screening assessment were used to create 12, 20-item therapy sets (6 treated and 6 untreated, matched across a range of psycholinguistic variables. JS completed two therapy runs over 7 months. The three therapy conditions within each run involved either anodal, cathodal or sham stimulation. Stimulation sites were determined on the basis of a previous MRI structural scan. In the first run, stimulation targeted the perilesional left inferior frontal gyrus (IFG and in the second run, stimulation targeted its right homologue. In all six cycles, JS received 20 minutes of 1mA tDCS (electrodes 5cm x 7cm on three consecutive days alongside computerised naming therapy. In the sham conditions, anodal stimulation was applied for one minute before being slowly turned off. The percentage of correctly named treated items increased in all conditions immediately following therapy. As shown in the Figure, for items consistently incorrect over both of the screening sessions, only the

  2. Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.

    Science.gov (United States)

    Berman, Jonathan S; Symonds, Catherine; Birch, Rolfe

    2004-12-01

    The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. All patients had intractable symptoms regardless of current analgesic therapy. Patients entered a baseline period of 2 weeks, followed by three, 2-week treatment periods during each of which they received one of three oromucosal spray preparations. These were placebo and two whole plant extracts of Cannabis sativa L.: GW-1000-02 (Sativex), containing Delta(9)tetrahydrocannabinol (THC):cannabidiol (CBD) in an approximate 1:1 ratio and GW-2000-02, containing primarily THC. The primary outcome measure was the mean pain severity score during the last 7 days of treatment. Secondary outcome measures included pain related quality of life assessments. The primary outcome measure failed to fall by the two points defined in our hypothesis. However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition. PMID:15561385

  3. Post-Stroke Depression Modulation and in Vivo Antioxidant Activity of Gallic Acid and Its Synthetic Derivatives in a Murine Model System

    Directory of Open Access Journals (Sweden)

    Seyed Fazel Nabavi

    2016-04-01

    Full Text Available Gallic acid (3,4,5-trihydroxybenzoic acid, GA is a plant secondary metabolite, which shows antioxidant activity and is commonly found in many plant-based foods and beverages. Recent evidence suggests that oxidative stress contributes to the development of many human chronic diseases, including cardiovascular and neurodegenerative pathologies, metabolic syndrome, type 2 diabetes and cancer. GA and its derivative, methyl-3-O-methyl gallate (M3OMG, possess physiological and pharmacological activities closely related to their antioxidant properties. This paper describes the antidepressive-like effects of intraperitoneal administration of GA and two synthetic analogues, M3OMG and P3OMG (propyl-3-O-methylgallate, in balb/c mice with post-stroke depression, a secondary form of depression that could be due to oxidative stress occurring during cerebral ischemia and the following reperfusion. Moreover, this study determined the in vivo antioxidant activity of these compounds through the evaluation of superoxide dismutase (SOD and catalase (Cat activity, thiobarbituric acid-reactive substances (TBARS and reduced glutathione (GSH levels in mouse brain. GA and its synthetic analogues were found to be active (at doses of 25 and 50 mg/kg in the modulation of depressive symptoms and the reduction of oxidative stress, restoring normal behavior and, at least in part, antioxidant endogenous defenses, with M3OMG being the most active of these compounds. SOD, TBARS, and GSH all showed strong correlation with behavioral parameters, suggesting that oxidative stress is tightly linked to the pathological processes involved in stroke and PSD. As a whole, the obtained results show that the administration of GA, M3OMG and P3OMG induce a reduction in depressive symptoms and oxidative stress.

  4. Post-Stroke Depression Modulation and in Vivo Antioxidant Activity of Gallic Acid and Its Synthetic Derivatives in a Murine Model System.

    Science.gov (United States)

    Nabavi, Seyed Fazel; Habtemariam, Solomon; Di Lorenzo, Arianna; Sureda, Antoni; Khanjani, Sedigheh; Nabavi, Seyed Mohammad; Daglia, Maria

    2016-01-01

    Gallic acid (3,4,5-trihydroxybenzoic acid, GA) is a plant secondary metabolite, which shows antioxidant activity and is commonly found in many plant-based foods and beverages. Recent evidence suggests that oxidative stress contributes to the development of many human chronic diseases, including cardiovascular and neurodegenerative pathologies, metabolic syndrome, type 2 diabetes and cancer. GA and its derivative, methyl-3-O-methyl gallate (M3OMG), possess physiological and pharmacological activities closely related to their antioxidant properties. This paper describes the antidepressive-like effects of intraperitoneal administration of GA and two synthetic analogues, M3OMG and P3OMG (propyl-3-O-methylgallate), in balb/c mice with post-stroke depression, a secondary form of depression that could be due to oxidative stress occurring during cerebral ischemia and the following reperfusion. Moreover, this study determined the in vivo antioxidant activity of these compounds through the evaluation of superoxide dismutase (SOD) and catalase (Cat) activity, thiobarbituric acid-reactive substances (TBARS) and reduced glutathione (GSH) levels in mouse brain. GA and its synthetic analogues were found to be active (at doses of 25 and 50 mg/kg) in the modulation of depressive symptoms and the reduction of oxidative stress, restoring normal behavior and, at least in part, antioxidant endogenous defenses, with M3OMG being the most active of these compounds. SOD, TBARS, and GSH all showed strong correlation with behavioral parameters, suggesting that oxidative stress is tightly linked to the pathological processes involved in stroke and PSD. As a whole, the obtained results show that the administration of GA, M3OMG and P3OMG induce a reduction in depressive symptoms and oxidative stress. PMID:27136579

  5. A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation.

    Science.gov (United States)

    Kumar, Deepesh; Das, Abhijit; Lahiri, Uttama; Dutta, Anirban

    2016-01-01

    A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers. PMID:27166666

  6. Comparing the production of complex sentences in Persian patients with ‎post-stroke aphasia and non-damaged people with normal speaking

    Directory of Open Access Journals (Sweden)

    Azar Mehri

    2016-01-01

    Full Text Available Background: Cerebrovascular disease leading to stroke is the most common cause of aphasia. Speakers with agrammatic non-fluent aphasia have difficulties in production of movement-derived sentences such as passive sentences, topicalized constituents, and Wh-questions. To assess the production of complex sentences, some passive, topicalized and focused sentences were designed for patients with non-fluent Persian aphasic. Afterwards, patients’ performance in sentence production was tested and compared with healthy non-damaged subjects.Methods: In this cross sectional study, a task was designed to assess the different types of sentences (active, passive, topicalized and focused adapted to Persian structures. Seven Persian patients with post-stroke non-fluent agrammatic aphasia (5 men and 2 women and seven healthy non-damaged subjects participated in this study. The computed tomography (CT scan or magnetic resonance imaging (MRI showed that all the patients had a single left hemisphere lesion involved middle cerebral artery (MCA, Broca`s area and in its white matter. In addition, based on Bedside version of Persian Western Aphasia Battery (P-WAB-1, all of them were diagnosed with moderate Broca aphasia. Then, the production task of Persian complex sentences was administered.Results: There was a significant difference between four types of sentences in patients with aphasia [Degree of freedom (df = 3, P < 0.001]. All the patients showed worse performance than the healthy participants in all the four types of sentence production (P < 0.050.Conclusion: In general, it is concluded that topicalized and focused sentences as non-canonical complex sentences in Persian are very difficult to produce for patients with agrammatic non-fluent aphasia. It seems that sentences with A-movement are simpler for the patients than sentences involving A`-movement; since they include shorter movements in compare to topicalized and focused sentences.

  7. Neuropathic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Re

    2009-02-01

    Full Text Available Neuropathic pain is the expression of a dysfunction or primary lesion of a nerve in the peripheral or central nervous system, or both, rather than the biological signal transmitted by the nerve following peripheral nociceptor activation. It represents about 20% of all painful syndromes, with an estimated prevalence of 1.5%, however is actual incidence is hard to pinpoint due to the difficulties encountered in distinguishing it from chronic pain, of which it represents a significant percentage, on account of the not infrequent concurrence of conditions. It is crucial to recognise the variety of symptoms with which it can present: these can be negative and positive and, in turn, motor, sensitive and autonomic. In public health terms, it is important to emphasise that the diagnosis of neuropathic pain does not in most cases require sophisticated procedures and does not therefore weigh on health expenditure. In clinical practice, a validated scale (the LANSS is mentioned is useful for identifying patients presenting neuropathic pain symptoms. Therapy is based on three categories of medication: tricyclic antidepressants, anti-epileptics and opioids at high doses: neuropathic pain has a bad reputation for often resisting common therapeutic approaches and responding less well that nociceptor pain to monotherapy. Therapeutic strategies are all the more adequate the more they are based on symptoms and therefore on the pain generation mechanisms, although the recommendations are dictated more by expert opinions that double-blind randomised trials.

  8. Dor: aspectos atuais da sensibilização periférica e central Dolor: aspectos actuales de la sensibilización periférica y central Pain: current aspects on peripheral and central sensitization

    Directory of Open Access Journals (Sweden)

    Anita Perpétua Carvalho Rocha

    2007-02-01

    conducción nerviosa central y periférica.BACKGROUND AND OBJECTIVES: Current research has focused on the biochemical and structural plasticity of the nervous system secondary to tissue injury. The mechanisms involved in the transition from acute to chronic pain are complex and involve the interaction of receptor systems and the flow of intracellular ions, second messenger systems, and new synaptic connections. The aim of this article was to discuss the new mechanisms concerning peripheral and central sensitization. CONTENTS: Tissue injury increases the response of nociceptors, known as sensitization or facilitation. These phenomena begin after the local release of inflammatory mediators and the activation of the cells of the immune system or specific receptors in the peripheral and central nervous system. CONCLUSIONS: Tissue and neuronal lesions result in sensitization of the nociceptors and facilitation of the central and peripheral nervous conduction.

  9. Peripheral Pain Mechanisms in Chronic Widespread Pain

    OpenAIRE

    Staud, Roland

    2011-01-01

    Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxiou...

  10. Altered pain perception in children with chronic tension-type headache: Is this a sign of central sensitisation?

    DEFF Research Database (Denmark)

    Soee, AL; Thomsen, LL; Kreiner, S;

    2013-01-01

    The aim of this article is to investigate if children (7-17 years) with frequent episodic tension-type headache (FETTH) or chronic TTH (CTTH) have an altered pain perception compared to healthy controls.......The aim of this article is to investigate if children (7-17 years) with frequent episodic tension-type headache (FETTH) or chronic TTH (CTTH) have an altered pain perception compared to healthy controls....

  11. 作业疗法对卒中后抑郁的疗效①%Effect of Occupational Therapy on Post Stroke Depression

    Institute of Scientific and Technical Information of China (English)

    由丽; 赵鹏; 刘莉; 饶江; 邵伟波

    2013-01-01

    Objective To explore the effect of occupational therapy (OT) on the depressive mood and activity of daily living (ADL) in patients with post stroke depression (PSD). Methods 42 patients with PSD were divided into OT group (n=21) and control group (n=21). Both 2 groups received routine therapy, and OT group received ADL training, selective recreation and sport and appreciation of music in ad-dition. They were evaluated by modified Bathel index (MBI) and Hamilton Self-rating Scale for Depression (HAMD) before and after treat-ment. Results The scores of MBI increased and the scores of HAMD decreased significantly after 4 weeks in both 2 groups (P<0.001), espe-cially in the OT group (P<0.01). Conclusion OT can improve not only ADL, but also the depressive mood in patients with PSD.%  目的探讨作业疗法对卒中后抑郁患者抑郁情绪及日常生活活动能力(ADL)的作用。方法42例卒中后抑郁患者分为作业组和对照组,各21例。在常规治疗基础上,作业组强化ADL训练,并针对性地进行文体活动和音乐欣赏。治疗前后采用改良Bathel指数(MBI)及汉密尔顿抑郁量表(HAMD)进行效果评价。结果4周后两组MBI评分显著提高,HAMD评分显著下降(P<0.001),且作业组改善明显优于对照组(P<0.01)。结论作业疗法不仅能提高卒中后抑郁患者的ADL,且有利于抑郁情绪的改善。

  12. 卒中后抑郁病人影像学分析及发病机制初步探讨%POST STROKE DEPRFSSION: ICONOGRAPHIC ANALYSIS AND PRELIMINARY APPROACH TO ITS MECHANISM

    Institute of Scientific and Technical Information of China (English)

    王彩霞; 李彬; 郭瑞友

    2011-01-01

    目的 了解卒中后抑郁病人的影像学特点,初步探讨脑卒中后抑郁的发病机制.方法 96例脑卒中病人采用汉密顿抑郁量表评分进行抑郁评定,依据卒中24 h后首次颅脑CT扫描结果进行影像学评估.结果 卒中后抑郁的发生率为61.46%.病灶多发、体积大、位于脑前部、有脑萎缩者易发生抑郁(x2=5.56~14.11,P<0.05).结论 卒中后抑郁影像学特点突出.病灶数量、体积及部位与脑卒中后抑郁的发生有密切关系.%Objective To understand the iconographic features of patients with post-stroke depression, and explore the pathogenesis of this condition. Methods Ninety-six post-stroke patients were assessed for depression by using Hamilton Depression Scale, and evaluation of ieonography was made based on the findings of the first CT scanning 24 hours after the attack of stroke. Results The incidence of depression in patients after the attack of stoke was 61.46%, which was easily occurred in those with multiple focus, big volume, located on anterior part of the brain, or cerebral atrophy (x2= 5.55-14. 11, P<0. 05).Conclusion The imaging characteristics of the post-stroke depression are outstanding. The number of focus, volume and location are closely related with the development of the condition.

  13. 西酞普兰与氟西汀治疗脑卒中后抑郁临床对照研究%Citalopram and fluoxetine in t he treatment of post-stroke depression clinical control study

    Institute of Scientific and Technical Information of China (English)

    段媛卿; 王文泽; 王继禹

    2010-01-01

    Objective Discussion of citalopram and fluoxetine in the treatment of post-stroke depression efficacy and safety of. Methods 82 cases of post-stroke depression were randomly divided into groups of citalopram and fluoxetine groups, treatment of 6 weeks, Hamilton Depression Rating Scale (HAMD) and Emergent Symptom Scale(TESS) in pre-treatment and treatment of 1,2,4,6 weekend separately assessed the efficacy and adverse reactions. Results Citalopram and fluoxetine group the overall effect of a considerable, citalopram group effect faster than the fluoxetine group of adverse reactions due to limited light. Conclusion Citalopram in the treatment of post-stroke depression are both effective and safe.%目的 探讨西酞普兰与氟西汀治疗脑卒中后抑郁的疗效和安全性.方法 82例脑卒中后抑郁患者,随机分为西酞普兰组和氟西汀组,治疗6周,采用汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)于治疗前和治疗1、2、4、6周末分别评定疗效和不良反应.结果 西酞普兰组和氟西汀组总体疗效相当,西酞普兰组起效较快,不良反应较氟西汀组少而轻.结论 西酞普兰治疗脑卒中后抑郁既有效又安全.

  14. Habituating pain

    DEFF Research Database (Denmark)

    Ajslev, Jeppe Zielinski Nguyen; Lund, Henrik Lambrecht; Møller, Jeppe Lykke;

    2013-01-01

    In this article, we investigate the relations between discursive practices within the Danish construction industry and the perceived pain, physical deterioration, and strain affecting the construction workers. Of central importance is the widely accepted hegemonic discourse on physical strain and...... musculoskeletal deterioration within construction work and also sheds light on some of the difficulties in addressing and changing occupational health and safety practices in the construction industry.......In this article, we investigate the relations between discursive practices within the Danish construction industry and the perceived pain, physical deterioration, and strain affecting the construction workers. Of central importance is the widely accepted hegemonic discourse on physical strain and...... pain as unavoidable conditions in construction work. Based on 32 semi-structured interviews performed in eight case studies within four different construction professions, workers’ descriptions of physical strain and its relation to the organizational and social context are analyzed through concepts of...

  15. Disfunción sexual asociada al uso de gabapentina en el tratamiento del dolor central Associated sexual dysfunction to the use of gabapentin in the treatment of the central pain

    Directory of Open Access Journals (Sweden)

    E. Calderón

    2006-06-01

    Full Text Available El dolor neuropático de origen central es uno de los síndromes dolorosos más complejos, su tratamiento es difícil y, en general, poco satisfactorio. Gabapentina (GBP es un anticonvulsivante usado en el tratamiento de la epilepsia, dolor neuropático, desórdenes bipolares, y es generalmente bien tolerado. Los anticonvulsivantes de segunda generación cuentan entre sus ventajas con una menor incidencia de efectos secundarios. No obstante, estamos hablando de fármacos relativamente nuevos, sobre todo para su utilización al margen de los trastornos no epilépticos, como es el caso del dolor neuropático, por lo que es necesario un estudio y seguimiento más completo de sus posibles efectos secundarios. Presentamos 2 casos de disfunción sexual en hombre y mujer en relación con la administración de gabapentina para control del dolor de origen central. El aumento de la concentración de serotonina podría ser la causa de las alteraciones sexuales relacionadas con el tratamiento con GBP a las dosis utilizadas en nuestros pacientes, superiores a 1.800 mg/día. Este efecto es dosis-dependiente y el tratamiento consiste en disminuir o ajustar la dosis para maximizar el intervalo de tiempo entre la toma previa y el acto sexual.The neuropathic central pain, is one of the more complex painful syndromes, its treatment is difficult and, in general, little satisfactory. Gabapentin (GBP, it is a anticon-vulsant used in the treatment of the epilepsy, neuropathic pain, disorder bipolar, and it is generally well tolerated The anticonvulsants of second generation count between their advantages with a smaller incidence of secondary effects. However, we are considering of relatively new drugs, mainly for its use to the margin of epilepsy, as it is the case of the neuropathic pain. For this reason it is necessary a study and more complete pursuit of its possible secondary effects. We presented 2 cases of sexual dysfunction in a man and a woman in relation to

  16. 音乐疗法对脑卒中后抑郁患者的干预研究%The Efficacy of Music Therapy on Patients with Post Stroke Depression

    Institute of Scientific and Technical Information of China (English)

    翁赛峥

    2012-01-01

    目的 探讨音乐疗法对脑卒中后抑郁患者的康复疗效.方法 60例脑卒中后抑郁患者随机分为对照组(30例)和试验组(30例),两组均进行常规治疗,试验组同时配合音乐疗法.治疗1个月前后,分别对患者进行汉密尔顿抑郁量表评分(HAMD)和神经功能缺损评分(CSS).结果 治疗1个月后,两组患者HAMD、CSS评分与治疗前比较均明显下降(t=3.75,P<0.01);两组间比较,试验组治疗1个月后HAMD、CSS评分均低于对照组(t=3.16,P<0.05;t=3.21,P<0.01).结论 音乐疗法干预脑卒中后抑郁患者可改善患者抑郁状态,为脑卒中患者的康复治疗提供了良好的条件.%Objective To explore the rehabilitated effect on patients of post stroke depression with music therapy. Methods A total of 60 cases of post stroke depression were divided into control group(30cases)and experimental group(30cases) ,all of the two groups accepted conventional treatment, and the experimental group accepted music therapy simultaneously. We made HAMD and CSS score before and after one month of therapy. Results Compared to pre-therapy ,HAMD and CSS scores of all the two groups reduced significantly(t= 3. 75,P<0. 01) (after therapy of one month,the HAMD and CSS scores of experimental group were less than control group(i=3. 16,P<0. 05 or t = 3. 21,P<0. 01). Conclusion Music therapy can improve the depression state of patients with post stroke depression, and provide favorable conditions for rehabilitated therapy of patients with post stroke depression.

  17. 高血压患者脑卒中后并发抑郁症的影响因素分析%The Influence Factors Analysis of Post-stroke Depression for Hypertensive Patients

    Institute of Scientific and Technical Information of China (English)

    宋德宽

    2016-01-01

    Objective:To study the influence factors of post-stroke depression for hypertensive patients. Method:A total of 113 cases of hypertension combined cerebral stroke were selected by convenient sampling method from our hospital,the clinical data were investigated by the questionnaire survey,the influence factors of post-stroke depression for hypertensive patients were analyzed by single factor and multi-factor Logistic regression analysis.Result:Post-stroke depression for hypertensive patients were 43 cases,accounted for 38.05%,mild depression were 29 cases(25.66%),moderate depression were 10 cases(8.85%),severe depressive were 4 cases(3.54%).The single factor analysis showed,post-stroke depression rate of female,hyperlipidemia, coronary heart disease,diabetes,high blood pressure duration>15 years,self-paying medical expense,no spouse,monthly income≤2000 yuan/month,education above high school level were significantly higher,the comparative differences were statistically significant(P15年、自费医疗、无配偶、人均月收入≤2000元、高中或以上文化程度的患者抑郁症发生率明显增高,比较差异均有统计学意义(P<0.05)。经多因素Logistic回归分析显示,自费医疗、无配偶、人均月收入≤2000元是高血压患者脑卒中后并发抑郁症的独立危险因素(OR=10.698、4.215、7.245,P<0.05)。结论:高血压患者脑卒中后并发抑郁症是性别、合并症、病程、医疗费用支付方式、婚姻状况、经济收入、文化程度等多种因素共同作用的结果。

  18. 卒中后抑郁细胞因子蛋白组学初探%Cytokines Proteomic Study in Post-Stroke Depression:A Preliminary Study

    Institute of Scientific and Technical Information of China (English)

    耿磊钰; 唐浩; 李文平; 钱方媛; 钱俊峰; 李凌江; 张志珺

    2014-01-01

    目的初步探讨急性缺血性卒中患者血浆120种细胞因子蛋白水平与卒中后抑郁(post-stroke depression,PSD)发生的关系。方法入组PSD及非PSD患者各12例,均为卒中发生后3 d内入院的急性缺血性卒中患者,随访至卒中后2周,对患者进行神经功能,认知功能及抑郁、焦虑严重程度评估。患者入院后1d[卒中后(1.5±0.9) d]清晨6∶30留取空腹时静脉血浆标本,利用人类细胞因子蛋白表达微阵列芯片进行120种细胞因子蛋白组学检测。结果与非PSD组相比,PSD组4个细胞因子血浆中点信号强度(spot signal intensity,SIs)显示降低,差异有显著性,分别为胰岛素样生长因子1受体(insulin-like growth factor 1 receptor, IGF-I SR)(P=0.021),巨噬细胞炎症蛋白-3β(macrophage inflammatory protein-3 beta,MIP-3 beta)(P=0.033),胎盘生长因子(placental growth factor,PIGF)(P=0.021),血管内皮生长因子(vascular endothelial growth factor,VEGF)(P=0.015),但均未通过错误发现率多重校正,多因素Logistic回归分析无阳性发现。血浆胰岛素样生长因子1受体蛋白SIs与患者入院时Barthel指数呈负相关(r=-0.641, P=0.025),与2周后PSD患者汉密尔顿抑郁量表评分(r=0.478,P=0.005)及汉密尔顿焦虑量表评分(r=0.674,P=0.016)呈正相关。结论本研究的数据尚未发现能独立预测卒中急性期PSD风险的血浆细胞因子,但3种生长因子水平的异常提示PSD可能存在突触可塑及神经再生障碍。%Objective To investigate the association between post-stroke depression (PSD) and the level of cytokines in plasma. Methods Plasma spot signal intensity (SIs) of 120 cytokines were measured by Human Cytokine Antibody Array G-Series 1000 in 12 patients with PSD and 12 non-PSD controls who admitted to the hospital within the ifrst 3 days after stroke onset. The diagnoses of PSD were made in

  19. Deep brain stimulation for chronic pain.

    Science.gov (United States)

    Boccard, Sandra G J; Pereira, Erlick A C; Aziz, Tipu Z

    2015-10-01

    Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex. However, this technique remains "off label" in the USA as it does not have Federal Drug Administration approval. Consequently, only a small number of surgeons report DBS for pain using current technology and techniques and few regions approve it. Randomised, blinded and controlled clinical trials that may use novel trial methodologies are desirable to evaluate the efficacy of DBS in patients who are refractory to other therapies. New imaging techniques, including tractography, may help optimise electrode placement and clinical outcome. PMID:26122383

  20. How effective is tetracaine 4% gel, before a peripherally inserted central catheter, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial [ISRCTN75884221

    Directory of Open Access Journals (Sweden)

    Blanchard Colline

    2006-05-01

    Full Text Available Abstract Background Procedural pain relief is sub-optimal in infants, especially small and vulnerable ones. Tetracaine gel 4% (Ametop®, Smith-Nephew provides pain relief in children and larger infants, but its efficacy in smaller infants and for peripherally inserted central catheters (PICC remains uncertain. The objective of this trial was to assess the safety and efficacy of tetracaine gel on the pain response of very low birth weight (VLBW infants during insertion of a PICC. Methods Medically stable infants greater than or equal to 24 weeks gestation, requiring a non-urgent PICC, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. The PICC was inserted according to a standard protocol. Pain was assessed using the Premature Infant Pain Profile (PIPP. A 3-point change in the pain score was considered clinically significant, leading to a sample size of 54 infants, with 90% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. Results Fifty-four infants were included, 27 +/- 2 weeks gestation, 916 +/- 292 grams and 6.5 +/- 3.2 days of age. Baseline characteristics were similar between groups. The mean PIPP score in the first minute was 10.88 in the treatment group as compared to 11.74 in the placebo group (difference 0.86, 95% CI -1.86, 3.58. Median duration of crying in non-intubated infants was 181 seconds in the tetracaine group compared to 68 seconds in the placebo group (difference -78, 95% CI -539, 117. Local skin erythema was observed transiently in 4 infants (3 in the treatment and 1 in the placebo group. No serious harms were observed. Conclusion Tetracaine 4% when applied for 30 minutes was not beneficial in decreasing procedural pain associated with a PICC in very small infants.

  1. Effect of electroacupuncture on P2X3 receptor regulation in the peripheral and central nervous systems of rats with visceral pain caused by irritable bowel syndrome

    OpenAIRE

    Weng, Z. J.; L. Y. Wu; Zhou, C. L.; Dou, C. Z.; Shi, Y; H. R. Liu; Wu, H. G.

    2015-01-01

    The aim of this study is to investigate the role of the purinergic receptor P2X3 in the peripheral and central nervous systems during acupuncture treatment for the visceral pain of irritable bowel syndrome (IBS). A total of 24 8-day-old Sprague–Dawley (SD) neonatal male rats (SPF grade) were stimulated using colorectal distention (CRD) when the rats were awake. The modeling lasted for 2 weeks with one stimulation per day. After 6 weeks, the rats were randomly divided into three groups of eigh...

  2. Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study

    DEFF Research Database (Denmark)

    Kupers, Rron; Svensson, Peter; Jensen, Troels Staehlin

    2004-01-01

    -muscle pain was associated with significant increases in regional cerebral blood flow (rCBF) in the dorsal-posterior insula (bilaterally), anterior cingulate and prefrontal cortices, right posterior parietal cortex, brainstem, cavernous sinus and cerebellum. No rCBF changes occurred in primary or secondary...

  3. 中医药治疗中风后抑郁症临床研究进展%Clinical Research Progress of Chinese Medicine Treatment on Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    楚彩云; 张元兴

    2012-01-01

    Post-stroke depression ( PSD )is considered as the most frequent and important neuropsyehiatry consequence of stroke, this condition can have an adverse effection on cognitive function, functional recovery and survival. Acupuncture coordinated with Chinese herbal medicine therapy has certain advantages of PSD. This article gives a systematic review on the prevalence and the epidemiology of PSD, outlines the merit of acupuncture coordinated with Chinese herbal medicine therapy on this disorder and debates on some issues of the current understanding of diagnosis and clinical management of Post-stroke depression. It is proposed that Chinese medicine treatment of PSD has obvious advantages, but there are still problems to be solved.%中风后抑郁是常见的脑中风后并发症,可以严重影响中风患者主动康复训练的积极性从而延缓恢复过程,中医药在治疗中风后抑郁症方面有一定优势.文章从病因病机、中医药及针灸治疗等方面将近年来有关中风后抑郁研究及文献进行综述,并对中医药治疗本病的优势及目前存在的一些问题进行讨论,提出今后研究思路与建议.

  4. Medication of post-stroke depression——the past,present and future%卒中后抑郁的药物治疗——过去、现在与未来

    Institute of Scientific and Technical Information of China (English)

    张琦祺; 高俊鹏

    2011-01-01

    Post-stroke depression (PSD) is one of the common complications of stroke, which has an obvious effect on the recovery of the body function. Epidemiologic researches showed that about 30 %stroke patients exist PSD, which hinders their recovery procedure, and prolongs their hospitalization time. This article summarized the clinical researches on treating PSD so as to probe into the curative effect,mechanism and further development of medication on PSD.%卒中后抑郁(post-stroke depression,PSD)是卒中的常见并发症之一.根据流行病学研究,近30%的卒中患者存在抑郁.卒中后抑郁可阻碍患者康复进程,延长患者住院时间,对患者的功能恢复可产生显著影响.本文综述了近年来药物治疗PSD的临床研究进展,旨在探讨其疗效、机制并展望未来发展方向.

  5. Metabolic changes of prefrontal cerebral lobe ,white matter and cerebellum in patients with post-stroke depression A proton magnetic resonance spectroscopy study

    Institute of Scientific and Technical Information of China (English)

    Qinggang Xu; Hong Cao; Qingwei Song; Jianlin Wu

    2008-01-01

    BACKGROUND:Proton magnetic resonance spectroscopy(1H-MRS)non-invasively detects changes in chemical substances in the brain,which reflects the pathological metabolism.OBJECTIVE:To investigate changes in N-acetyl-aspartate(NAA),choline(Cho),creatine(Cr),and myoinositol(MI)in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression(PSD)using 1H-MRS.DESIGN:A case control study.SETTING:The First Affiliated Hospital of the Dalian Medical University.PARTICIPANTS:A total of 38 patients with stroke(28 male and 10 female patients,aged 40 to 79 years)were selected from the Department of Neurology,1st Atfiliated Hospital,Dalian Medical University,from February to October in 2004.All subjects met the DSM-IV criteria for cerebrovascular disease and depression.The degree of depression was defined according to Hamilton criteria.38 patients with PSD were divided into two groups according to the time after ischemia,20 patients in the acute group with less than 10 days after ischemic attack(mild:16 patients,moderate/severe:4 patients)and 18 patients in the chronic group with more than 11 days after ischemic attack(mild:15 patients,moderate/severe:3 patients).Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group.The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht,and each participant signed an informed consent form.METHODS:Spectra were acquired by multi-voxel point-resolved spectroscopy(PRESS)sequence with GE signal.ST MP-di,localized in prefrontal cerebral lobe and cerebellum.Values of NAA,Cho,MI,and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS11.5.MAIN OUTCOME MEASURES:Metabolite concentration in different brain regions of interest.Difference in metabolites between distinctly graded PSD patients and control subjects.Exclusion of age

  6. Contemporary treatment neuropathic pain

    OpenAIRE

    Cvijanović Milan; Simić Svetlana; Banić-Horvat Sofija; Jovin Zita; Slankamenac Petar; Ilin Miroslav

    2011-01-01

    Introduction. Neuropathic pain, or pain associated with disease or injury to the peripheral or central nervous system, is a common symptom of a heterogeneous group of conditions, including diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia and spinal cord injury. Chronic neuropathic pain should not be thought of as a symptom. It should truly be thought of as a disease with a very complicated pathophysiology. Pathophysiology. The mechanisms involved in neuropathic pain are...

  7. Investigation on mood disorder and its influencing factors in post-stroke patients%卒中后患者情绪障碍及其影响因素调查

    Institute of Scientific and Technical Information of China (English)

    张树山; 朱陶; 熊健; 余巨明; 李健

    2015-01-01

    Objective To survey and analyze the mood disorder in post-stroke patients and to investigate its influencing factors. Methods The stratified sampling method was adopted to randomly extract 183 cases of stroke definitely diagnosed by the class 3A hospital in the Nanchong municipal administered communities and performed the questionnaire survey. The obtained data were analyzed by using the Hamilton depression scale and Hamilton anxiety scale. Results (1)The incidence rate of anxiety and depression in community post-stroke patients were 88.5%and 94.0%respectively;(2)the analysis results found that the factors of age,marital status and comorbidities significantly influenced the scores of anxiety and depression (P0.05);(3)Excluding the mutual influence of various factors by the further multivariate linear regression analysis found that the main factors influencing anxiety in community post-stroke patients were age and comorbidities,while which influencing depression were the marital status,age and comorbidities. Conclusion The incidence of anxiety and depression in community post-stroke patients are higher;the main factors of anxiety and depression occurrence in community post-stroke patients are advanced age and complicating multiple chronic diseases.%目的:调查分析卒中后患者情绪障碍并探索其影响因素。方法采用整群抽样法随机抽取南充市市辖社区由三甲医院确诊为卒中的患者183例,用调查问卷及汉密尔顿焦虑、抑郁量表进行分析。结果(1)南充市市辖社区卒中患者焦虑的发病率为88.5%,抑郁的发病率为94.0%;(2)经分析发现,年龄、婚姻状况和合并疾病因素对焦虑、抑郁得分影响显著(P<0.05);性别、学历、职业、病程、家庭月收入和是否接受健康教育等因素对焦虑、抑郁得分影响不明显(P>0.05);(3)进一步经多元线性回归分析,排除各因素间的相互影响后发现,影响社区卒中患

  8. [Physiological Basis of Pain Mechanisms for Pain Management].

    Science.gov (United States)

    Kawamata, Mikito

    2016-05-01

    Physician anesthesiologists should ensure a future leadership position in perioperative medicine and pain medicine. In order to establish the missions, anesthesiologists need to know how to relieve pain in surgical patients, critically ill patients and patients with cancer and non-cancer chronic pain. Thus, anesthesiologists should realize physiology of pain representation from pain management I will review physiological basis of pain mechanisms in this manuscript which includes 1) evolutional aspect of pain perception, 2) transduction of noxious stimuli, 3) the types of nociceptors and conduction of noxious stimuli, 4) the ascending pathway of pain and central modulation of pain, 5) the descending inhibitory pain system, and 6) various types of pain. Finally, anesthesiologists should manage pain from physiological basis of pain mechanisms. PMID:27319092

  9. The problem of pain.

    Science.gov (United States)

    Nicholson, Keith; Martelli, Michael F

    2004-01-01

    Pain problems, especially posttraumatic headache, are very common following head trauma. Pain may be the most significant problem, more disabling than any brain or other injuries, and interfering with aspects of cognition or other function. However, posttraumatic headache and most other chronic posttraumatic pain problems remain poorly understood. This article reviews fundamental issues that should be considered in understanding the nature of chronic pain including the distinction between acute and chronic pain; neurobiological distinctions between the lateral and medial pain system; nociceptive versus neuropathic or other central pain; sensitization effects; the widely accepted view of chronic pain as a multidimensional subjective experience involving sensory, motivational-affective and cognitive-behavioral components; the problem of mind-body dualism; the role of psychosocial factors in the onset, maintenance, exacerbation or severity of pain; plus issues of response bias and malingering. PMID:14732827

  10. Central Effect of Exogenous Histamine on Pain Induced by Sub-Plantar Injection of Formalin in Rabbits

    OpenAIRE

    Esmaeal Tamaddonfard

    2010-01-01

    In the present study, the effects of intracerebroventricular (ICV) administration of normal saline (control), histamine, mepyramine (a histamine H1-receptor antagonist) and ranitidine (a histamine H2-receptor antagonist) were investigated on the formalin-induced pain in rabbits. Subcutaneous (SC) injection of a formalin (100 μl, 5%) solution into the ventral surface of the right hind paw was performed, and the time durations spent licking and biting the injected paw were measured in 10 min bl...

  11. Effect of electroacupuncture on P2X3 receptor regulation in the peripheral and central nervous systems of rats with visceral pain caused by irritable bowel syndrome.

    Science.gov (United States)

    Weng, Z J; Wu, L Y; Zhou, C L; Dou, C Z; Shi, Y; Liu, H R; Wu, H G

    2015-09-01

    The aim of this study is to investigate the role of the purinergic receptor P2X3 in the peripheral and central nervous systems during acupuncture treatment for the visceral pain of irritable bowel syndrome (IBS). A total of 24 8-day-old Sprague-Dawley (SD) neonatal male rats (SPF grade) were stimulated using colorectal distention (CRD) when the rats were awake. The modeling lasted for 2 weeks with one stimulation per day. After 6 weeks, the rats were randomly divided into three groups of eight each: (1) the normal group (NG, n = 8); (2) the model group (MG, n = 8); and (3) the model + electroacupuncture group (EA, n = 8) that received electroacupuncture at a needling depth of 5 mm at the Shangjuxu (ST37, bilateral) and Tianshu (ST25, bilateral) acupoints. The parameters of the Han's acupoint nerve stimulator (HANS) were as follows: sparse-dense wave with a frequency of 2/100 Hz, current of 2 mA, 20 min/stimulation, and one stimulation per day; the treatment was provided for seven consecutive days. At the sixth week after the treatment, the abdominal withdrawal reflex (AWR) score was determined; immunofluorescence and immunohistochemistry were used to measure the expression of the P2X3 receptor in myenteric plexus neurons, prefrontal cortex, and anterior cingulate cortex; and, a real-time PCR assay was performed to measure the expression of P2X3 messenger RNA (mRNA) in the dorsal root ganglion (DRG) and spinal cord. After stimulation with CRD, the expression levels of the P2X3 receptor in the inter-colonic myenteric plexus, DRG, spinal cord, prefrontal cortex, and anterior cingulate cortex were upregulated, and the sensitivity of the rats to IBS visceral pain was increased. Electroacupuncture (EA) could downregulate the expression of the P2X3 receptor and ease the sensitivity to visceral pain. The P2X3 receptor plays an important role in IBS visceral pain. The different levels of P2X3 in the peripheral enteric nervous system and central nervous system mediate the

  12. 心理干预对急性脑卒中后抑郁患者康复疗效的影响%The effect of psychological intervention on the patients with acute post -stroke depression

    Institute of Scientific and Technical Information of China (English)

    逯传玲

    2009-01-01

    目的 探讨心理干预对脑卒中后抑郁患者康复疗效的影响.方法 采用随机对照的方法,选择住院的脑卒中后抑郁患者,对照组50例,入院后给予常规的药物及相应的物理康复治疗,治疗组50例,在对照组治疗的基础上,给予针对性的心理干预.对比两组患者的HAMD评分,Fugl-mey-er值及Barthd指数.结果 发病第5天两组HAMD评分,Fugl-meyer值及Barthel指数差异无统计学意义(P>0.05);发病30 d和60 d后,治疗组Fugl-meyer值、Barthel指数积分均明显高于对照组,且HAMD评分低于对照组,均具有显著性差异(P<0.01).结论 心理干预可明显改善或消除脑卒中患者的抑郁情绪,有利于患者在健康的心理状态下接受治疗,且操作方便.为治疗脑卒中后抑郁的较好方法.%Objective To investigate the effect of psychological intervention on rehabilitation of acute post-stroke depression patients. Methods 100 post-stroke depression were randomly divided into control and treatment groups, each group 50 cases. All the patients were treated with routine medicine and physical rehabilita-tion, and treatment group was received psychological intervention besides routine therapy. Hamilton depression scale, Fugl -Meyer and Barthel index of two groups were analyzed. Results Hamilton depression scale, Fugl -Meyer and Barthel index of two groups were different after treatment. Conclusions Psychological intervenetion were benefit to rehabilitation of post -stroke depression.

  13. 全身振动训练及其对脑卒中患者运动功能康复价值%Effect of whole-body vibration on post-stroke patients

    Institute of Scientific and Technical Information of China (English)

    张丽; 瓮长水

    2013-01-01

    脑卒中后运动功能障碍是康复治疗中难以解决的问题之一.文章对新型全身振动(WBV)训练在脑卒中后运动功能康复中的应用进行阐述.目前WBV训练已在运动热身、肌肉放松、力量训练,特别是在骨关节损伤康复、肌肉骨骼功能改善以及老年人健康预防等多个领域发挥着独特的优势,在帕金森病、多发性硬化、脑瘫等神经系统疾病的康复亦有报道.然而,WBV训练用于脑卒中偏瘫患者的基础和临床研究仍十分有限.目前还没有WBV训练的临床指南,对该疗法的作用机制和临床干预效果尚缺乏全面、系统的认识,进一步开展针对WBV训练的基础和临床研究可以作为今后脑卒中康复研究的方向之一.%There has been an increasing interest in the usage of whole-body vibration(WBV) as a therapeutic modality.The WBV exercise has been postulated to be effective in improving functional performance by enhancing flexibility,body balance,postural control,muscle strength and bone mineral density,and increasing the muscle blood flow to the lower extremity and serum levels of testosterone and growth hormone.And WBV exercise is safe and well tolerated in older or frail patients.Earlier studies proved that WBV has beneficial effects on neuromuscular performance in older adults and may be a viable treatment option for post-stroke patients.This review was aimed at determining whether WBV improves mobility performance,activities of daily living(ADL) and general health in patients with subacute or chronic stroke.The results showed that there was preliminary evidence to have proven the effectiveness of WBV in enhancing the mobility,balance and postural control ability,and quality of life (QOL) in post-stroke patients.However,more good-quality trials are needed to establish the clinical efficacy of WBV in improving mobility function and general health status in post-stroke patients.

  14. Clinical Observation of Acupuncture plus Hyperbaric Oxygen for Post-stroke Depression%针刺配合高压氧治疗脑卒中后抑郁症临床观察

    Institute of Scientific and Technical Information of China (English)

    林妙君; 关浩峰

    2015-01-01

    目的:观察针刺配合高压氧治疗脑卒中后抑郁症的疗效。方法将60例脑卒中后抑郁症患者随机分为治疗组30例和对照组30例,治疗组予针刺配合高压氧治疗,对照组予氟西汀胶囊(百优解)治疗。治疗前后采用汉密尔顿抑郁量表(HAMD)对患者进行评定,比较两组的疗效。结果治疗组总有效率明显高于对照组(P<0.01),治疗组治疗后 HAMD 评分明显低于对照组(P<0.01)。结论针刺配合高压氧治疗脑卒中后抑郁症能明显改善患者的抑郁症状,而且能促进神经功能的康复。%Objective To observe the therapeutic efficacy of acupuncture plus hyperbaric oxygen in treating post-stroke depression. Method Sixty patients with post-stroke depression were randomized into a treatment group of 30 cases and a control group of 30 cases. The treatment group was intervened by acupuncture plus hyperbaric oxygen, while the control group was by Fluoxetine. Before and after intervention, the Hamilton Depression scale (HAMD) was adopted for evaluation, and the efficacies were compared. Result The total effective rate of the treatment group was significantly higher than that of the control (P<0.01);after intervention, the HAMD score of the treatment group was markedly lower than that of the control (P<0.01). Conclusion Acupuncture plus hyperbaric oxygen can obviously improve the depression symptom and promote the recovery of neurologic function in patients with post-stroke depression.

  15. Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

    Institute of Scientific and Technical Information of China (English)

    Yan Dong; Bo Yang; Jingling Song; Lihua Yu

    2007-01-01

    BACKGROUND: Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine (TCM); meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression (PSD).OBJECTIVE: To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation.DESIGN: Contrast observation.SETTING: Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group.PARTICIPANTS: A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years.physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis,kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale (NDS; 45 points in total; the higher the scores were, the severer the deficit was), Fugl-Meyer assessment, (FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was),modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of

  16. Reabilitação de déficits comunicativos pós-acidente vascular cerebral Rehabilitation of post-stroke communication impairments

    Directory of Open Access Journals (Sweden)

    Gigiane Gindri

    2012-01-01

    do tratamento. Sugere-se que propostas de intervenção dos processamentos comunicativos sejam delineadas com bases teóricas e que sejam conduzidos e publicados estudos com este enfoque para verificação de efeito terapêutico.Discursive, lexical-semantic, pragmatic-inferential and/or prosodic communication processing may be impaired following a cerebrovascular accident. These deficits require intervention methods and programmes for effective communication rehabilitation. Within this context, the aim of this systematic review was to identify and describe methods used for neuropsychological rehabilitation of the communication of adults after a stroke, more specifically, systematic intervention approaches for each communication processing. Abstracts published in the last ten years were selected in PubMed, using keywords related to rehabilitation, stroke and communication. For the communication topic, we also used specific keywords related to the four communication processing components. Initially, 914 abstracts were found; after exclusion of the repeated studies, 460 were analyzed. Full texts were examined if the abstract evidenced that the study was empirical, included at least one post-stroke patient, focused in communication rehabilitation, presented pre- and post-intervention assessments, and if it was published in English, French or Portuguese within the last ten years. Only four empirical studies accomplished such criteria, being conducted mainly with aphasic or aprosodic patients. These findings might be considered surprising and alarming, since there is a lack of systematic studies about rehabilitation of communication components. It is important to highlight the need to search for a detailed description of intervention procedures with specific goals, allowing studies to be replicated and also contributing for monitoring the effects of treatment. Communicative processing intervention programmes should be developed based on theoretical approaches, and studies

  17. Central activation by histamine-induced itch: analogies to pain processing: a correlational analysis of O-15 H2O positron emission tomography studies.

    Science.gov (United States)

    Drzezga, A; Darsow, U; Treede, R D; Siebner, H; Frisch, M; Munz, F; Weilke, F; Ring, J; Schwaiger, M; Bartenstein, P

    2001-05-01

    The aim of this study was to identify the functional cerebral network involved in the central processing of itch and to detect analogies and differences to previously identified cerebral activation patterns triggered by painful noxious stimuli. Repeated positron emission tomography regional cerebral blood flow (rCBF) measurements using O15-labeled water were performed in six healthy right-handed male subjects (mean age 32 +/- 2 years). Each subject underwent 12 sequential rCBF measurements. In all subjects a standardized skin prick test was performed on the right forearm 2 min before each rCBF measurement. For activation, histamine was applied in nine tests in logarithmically increasing concentrations from 0.03 to 8%. Three tests were performed with isotonic saline solution serving as a control condition. Itch intensity and unpleasantness were registered with a visual analogue scale during each test. Subtraction analysis between activation and control conditions as well as correlation analysis with covariates were performed. Itch induced a significant activation in the predominantly contralateral somatosensory cortex and in the ipsilateral and contralateral motor areas (supplementary motor area (SMA), premotor cortex, primary motor cortex). Additional significant activations were found in the prefrontal cortex and the cingulate gyrus, but not in subcortical structures nor in the secondary somatosensory cortex. In correlation analyses, several cortical areas showed a graded increase in rCBF with the logarithm of the histamine concentration (bilateral sensorimotor areas and cingulate cortex; contralateral insula, superior temporal cortex and prefrontal cortex) and with itch unpleasantness (contralateral sensorimotor cortex, prefrontal cortex and posterior insula; ipsilateral SMA). Induction of itch results in the activation of a distributed cerebral network. Itch and pain seem to share common pathways (a medial and a lateral processing pathway and a strong projection

  18. Predicting the Risk for Central Pain Using the Sensory Components of the International Standards for Neurological Classification of Spinal Cord Injury.

    Science.gov (United States)

    Levitan, Yuval; Zeilig, Gabi; Bondi, Moshe; Ringler, Erez; Defrin, Ruth

    2015-11-01

    Central neuropathic pain (CP) after spinal cord injury (SCI) is excruciating and difficult to manage. Pre-emptive treatment could be initiated in patients at risk for CP providing that it can be predicted. A combination of psychophysical tests could predict CP, but the process necessitates sophisticated equipment and constant monitoring. A simple predictive tool for CP is required. The aim of this study was to test the predictability for CP of the sensory component of the International Standards for Neurological Classification of Spinal Cord Injury (SC-ISNCSCI), routinely performed on all SCI patients. In an historical-prospective study, the SC-ISNCSCI and background variables were extracted from medical records of 115 SCI patients. In a prospective study, 20 SCI patients underwent the SC-ISNCSCI at admission and were followed-up for 12 months. In both studies, pinprick (PP) and light touch (LT) scores from the SC-ISNCSCI and the difference between them (LT-PP) were compared between those who eventually developed CP and those who did not. Heat-pain and touch thresholds were measured and correlated with the SC-ISNCSCI to test its validity. In both studies, patients who developed CP had, prior to CP, lower PP than LT scores, and lower PP scores than those who did not develop CP. At-level delta LT-PP score>1 best predicted CP; the odds of developing CP with LT-PP>1 was 24.4 times that of the reverse category (LT-PP<1). Heat-pain and touch thresholds significantly correlated with PP and LT. We conclude that the SC-ISNCSCI can be used as a clinical biomarker of CP with high probability. PMID:26244708

  19. Groin pain

    Science.gov (United States)

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  20. Phospholipase D-mediated hypersensitivity at central synapses is associated with abnormal behaviours and pain sensitivity in rats exposed to prenatal stress.

    Science.gov (United States)

    Sun, Liting; Gooding, Hayley L; Brunton, Paula J; Russell, John A; Mitchell, Rory; Fleetwood-Walker, Sue

    2013-11-01

    Adverse events at critical stages of development can lead to lasting dysfunction in the central nervous system (CNS). To seek potential underlying changes in synaptic function, we used a newly developed protocol to measure alterations in receptor-mediated Ca(2+) fluorescence responses of synaptoneurosomes, freshly isolated from selected regions of the CNS concerned with emotionality and pain processing. We compared adult male controls and offspring of rats exposed to social stress in late pregnancy (prenatal stress, PS), which showed programmed behavioural changes indicating anxiety, anhedonia and pain hypersensitivity. We found corresponding increases, in PS rats compared with normal controls, in responsiveness of synaptoneurosomes from frontal cortex to a glutamate receptor (GluR) agonist, and from spinal cord to activators of nociceptive afferents. Through a combined pharmacological and biochemical strategy, we found evidence for a role of phospholipase D1 (PLD1)-mediated signalling, that may involve 5-HT2A receptor (5-HT2AR) activation, at both levels of the nervous system. These changes might participate in underpinning the enduring alterations in behaviour induced by PS. PMID:23932932

  1. An epidemiologic survey on nutritional status among post-stroke patients at community hospitals%社区脑卒中后患者营养现状的流行病学调查

    Institute of Scientific and Technical Information of China (English)

    杨江胜; 王少石; 郑天衡; 周晓宇; 沈月平

    2011-01-01

    目的 调查上海市虹口区社区医院住院的卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率以及进食情况.方法 采用横断面研究,以438例在社区医院住院的卒中后患者为研究对象,记录其人口学特征、洼田饮水试验评估结果、营养学指标(包括人体测量学指标和生化指标)和进食情况.结果 438例卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率分别为18.6%、42.7%和52.7%;376例患者经口进食,61例鼻饲肠内喂养,1例经皮内窥镜胃造瘘术.其中376例经口进食患者中32%进食量恢复正常,60%进食量为正常状态的一半以上,8%为正常状态的一半以下;62例肠内营养患者中46例能量需要量未按照"肠内肠外营养临床指南(2006版)"推荐的标准实施.结论 社区医院住院的卒中后患者中仍有相当大比例的患者存在吞咽障碍,低白蛋白血症及营养不良的检出率高;患者进食缺乏统一管理,饮食内容随意无序,进食缺乏监控;临床医生应关注卒中后患者的营养现状.%Objective To investigate the detection rate of dysphagia, hypoalbuminemia, malnutrition, and eating condition among post-stroke patients at community hospitals in Hongkou District of Shanghai. Methods A cross sectional study was carried out on 438 post- stroke patients who were admitted at community hospitals, information was gathered including demographic characteristics, the results of the assessment about water swallow test , nutrition assessment indices(anthropometry indices and nutritional biochemical indices) and eating situation. Results The detection rate of dysphagia, hypoalbuminemia and malnutrition were 18. 6%、42.7%and 52.7% respectively. There were 376 patients with oral feeding, 61 patients with nasal feeding and 1 patient with percutaneous endoscopic gastrostomy. The 32% of 376 patients with oral feeding returned to normal food intaking, 60% to more than half of

  2. 不同时期脑卒中后抑郁的心理分析治疗及护理对策%Psychoanalysis treatment on post-stroke depression in different periods and the nursing strategies

    Institute of Scientific and Technical Information of China (English)

    邓华; 段勇

    2013-01-01

    Objective To study the psychoanalysis treatment on post-stroke depression in different periodsand the nursing strategies. Methods36 cases of patients with post-stroke depression were treated and nursed with the method of psychoanalysis, and prescribed with appropriate antidepressant treatment. To compare the changes of pre and post treatment with the scores of Hamilton Depression Rating Scale (HAMD). Results23 cases were cured (63.89%), 11 cases were getting better (30.56%), and 2 cases were ineffective (5.55%). The total effective rate is 94.44%. ConclusionThe method of proper psychoanalysis treatment and nursing, accompanying with appropriate antidepressant treatment , can notably relieve the depressive symptoms and improve the patients’ activities of daily living.%目的:探讨不同时期脑卒中后抑郁的心理分析治疗及护理对策方法。方法对36例脑卒中后抑郁的病人进行心理分析治疗和护理,并且适当给予抗抑郁药物治疗,治疗前后用汉密尔顿抑郁量表(HAMD)评分对比变化。结果治愈23例(63.89%),好转11例(30.56%),无效2例(5.55%),总有效率94.44%。结论对脑卒中后抑郁的病人进行正确的心理分析治疗及护理,并适当抗抑郁药物治疗,能明显改善患者的抑郁症状,提高患者日常生活活动能力。

  3. Effect of different therapies of Chinese medicine on the expressions of c-Fos and c-Jun proteins in hippocampus of rats with post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Hongyan Wang; Mei Chen; Binhui Zhang

    2006-01-01

    BACKGROUND: c-fos and c-jun, the important immediate early genes (IEG), are regarded as the markers for the location and function of neuronal activity, as well as the third signal messengers, they couple the stress stimulation and the gene expression in neuron, and hippocampus is involved in the process of signal transmission after stress stimulation induced depression.OBJECTIVE: To observe the therapeutic effects of Bushen Yiqi (tonifying kidney to benefit qi), Huoxue Huayu (promoting blood circulation to dissipate blood stasis) and Ditan Kaiqiao (eliminating phlegm for resuscitation) on the expressions of c-Fos and c-Jun proteins in hippocampus and spontaneous behaviors of rats with post-stroke depression (PSD), and compare the results with those of fluoxetine, which is known to have definite effect on depression.DESIGN: A randomized controlled trial.SETrING: Zhejiang College of Traditional Chinese Medicine.MATERIALS: The trial was completed in Zhejiang College of Traditional Chinese Medicine from January to July in 2003. Fifty-six healthy adult Wistar male rats of clean grade, weighing (250±50) g, were randomly divided into 7 groups with 8 rats in each group: control group, model group, forced swimming group,Bushen Yiqi group; Huoxue Huayu, Ditan Kaiqiao group and fluoxetine group. The Bushen Yiqi Tang con tained Renshen, Huangqi, Heshouwu, Gouqi, Shudi, etc., crude drugs 1 800 g/L. The Huoxue Huayu Tang contained Danshen, Chuanxiong, Chishao, Yujin, etc., crude drugs 3 600 g/L. The Dian Kaiqiao Tang contained Banxia, Danxing, Changpu, Yuanzhi, etc., crude drug 1 000 g/L.METHODS: ① Except the control group and forced swimming group, rats in the other groups were made into PSD models by deligating the bilateral common carotid arteries permanently. ② Rats in the control group, model group and forced swimming group were intragastrically perfused by saline (3 mL for each time); those in the Bushen Yiqi group, Huoxue Huayu, Ditan Kaiqiao group and fluoxetine

  4. The measurement of pain.

    Science.gov (United States)

    Frampton, C L; Hughes-Webb, P

    2011-08-01

    Pain has been studied in depth for decades, yet the pain associated with cancer is still frequently under treated. The measurement of pain in patients with terminal cancer is imperative, because failure to carry it out is recognised as an important reason for inadequate treatment. Although pain is characterised as a symptom, it is a subjective personal experience or a perception. This perception is influenced by both nociceptive transmission and central nervous system modulation; and psychological, social and other environmental factors. It is a complex issue most simply described by the phrase 'Pain is whatever the experiencing person says it is, existing whenever he says it does'. With such complex interplays between pathophysiological and biopsychosocial factors, it is unsurprising that an objective assessment of pain remains elusive. Despite this, many subjective measures of pain have been developed that produce consistent and reliable results when used properly and appropriately. PMID:21571514

  5. Chemical Interventions for Pain.

    Science.gov (United States)

    Aronoff, Gerald M.; And Others

    1986-01-01

    Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

  6. Pain in Down's Syndrome

    Directory of Open Access Journals (Sweden)

    Federica Mafrica

    2006-01-01

    Full Text Available Pain is a homeostatic mechanism that intervenes to protect the organism from harmful stimuli that could damage its integrity. It is made up of two components: the sensory-discriminative component, which identifies the provenance and characteristics of the type of pain; and the affective-motivational component, on which emotional reflexes, following the painful sensation, depend.There is a system for pain control at an encephalic and spinal level, principally made up of the periaqueductal grey matter, the periventricular area, the nucleus raphe magnus, and the pain-inhibition complex situated in the posterior horns of the spinal cord. Through the activation of these pain-control systems, the nervous system suppresses the afference of pain signals. Endogenous opioids represent another analgesic system.In the course of various studies on pain transmission in Down patients, the reduced tolerance of pain and the incapacity to give a qualitative and quantitative description emerged in a powerful way. All of these aspects cause difficulty in evaluating pain. This is linked to several learning difficulties. However, it cannot be excluded that in these anomalies of pain perception, both the anatomical and the neurotransmitter alteration, typical of this syndrome, may hold a certain importance.This fact may have important clinical repercussions that could affect the choice of therapeutic and rehabilitative schemes for treatment of pathologies in which pain is the dominant symptom, such as postoperative pain. It could influence research on analgesics that are more suitable for these patients, the evaluation of the depth of analgesia during surgical operation, and ultimately, absence of obvious pain manifestations. In conclusion, alterations of the central nervous system, neurotransmitters, pain transmission, and all related problems should be considered in the management of pain in patients with Down's syndrome, especially by algologists and

  7. Flank pain

    Science.gov (United States)

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  8. Pain following stroke: a population-based follow-up study.

    Directory of Open Access Journals (Sweden)

    Henriette Klit

    Full Text Available BACKGROUND AND PURPOSE: Chronic pain is increasingly recognized as a consequence of stroke. This study aimed to describe the prevalence and pain types of new onset chronic pain ("novel pain" in patients with stroke compared with a randomly selected reference group from the general population and to identify factors associated with pain development in stroke patients. METHODS: In a population-based follow-up design, development of chronic pain after stroke was assessed by a questionnaire sent to consecutive stroke patients, registered in a Danish national stroke database, two years after their stroke. A randomly selected sex- and age-matched reference group from the same catchment area received a similar questionnaire about development of new types of chronic pain in the same time period. A total of 608 stroke patients and 519 reference subjects were included in the study. RESULTS: Development of novel pain was reported by 39.0% of stroke patients and 28.9% of reference subjects (OR 1.57, CI 1.21-2.04, and was associated with low age and depression in a multivariate model. Daily intake of pain medication for novel pain was reported by 15.3% and 9.4% of the stroke and reference population, respectively. Novel headache, shoulder pain, pain from increased muscle stiffness, and other types of novel pain were more common in stroke patients, whereas joint pain was equally common in the two groups. CONCLUSIONS: Development of chronic pain is more common in stroke patients compared with sex- and age-matched reference subjects. Evaluation of post-stroke pain should be part of stroke follow-up.

  9. La estimulación eléctrica de la corteza motora para el tratamiento del dolor central y dolor periférico por desaferentización Electrical stimulation of the motor cortex for the management of central pain and peripheral pain caused by desafferentiation

    Directory of Open Access Journals (Sweden)

    J. V. Pesudo

    2004-09-01

    Full Text Available El dolor central y el dolor periférico por desaferentización son de difícil tratamiento incluso con fármacos de última generación. La estimulación eléctrica sobre diversas estructuras ha demostrado en general ser poco efectiva. La estimulación sobre la corteza motora es una técnica relativamente nueva que parece ofrecer resultados prometedores en estos cuadros. Aunque desde el punto de vista quirúrgico es una técnica sencilla, no lo es tanto la localización adecuada de la corteza motora, lo cual es una condición importante para su efectividad. En este trabajo ofrecemos una revisión bibliográfica sobre ella. Sus indicaciones fundamentales actualmente son el dolor central fundamentalmente talámico, y el dolor trigeminal por desaferentización. La respuesta a barbitúricos sin respuesta a opioides, la conservación relativa de las vías motoras y sensitivas, y la respuesta a la estimulación magnética transcraneal predicen un buen resultado. Diversos métodos son utilizados para determinar la zona a estimular: PESS, estimulación intraoperatoria, neuronavegación, RNM funcional. Los parámetros de estimulación recomendados varían de unos autores a otros. Su mecanismo de actuación no es en la actualidad bien conocido aunque las teorías más aceptadas son la activación de zonas que modulan el dolor y la inhibición de la transmisión de los estímulos nociceptivos a nivel medular.Central pain and peripheral pain caused by desafferentation are difficult to treat even with last generation drugs. Electric stimulation of several structures has shown to be scarcely effective in general. Stimulation of motor cortex is a relatively new technique that seems to offer promising results in these disorders. While it is a simple technique from the surgical point of view, the adequate location of the motor cortex is not so easy, this being a significant condition for its effectiveness. In this paper we review the literature that has been

  10. 黄连冰刺激对脑卒中后吞咽障碍的护理干预观察%Observation of Iced Rhizoma Coptidis Decoction Stimulation for Intervention of Post-stroke Swallowing Disorder

    Institute of Scientific and Technical Information of China (English)

    谢梦姣

    2015-01-01

    【目的】观察黄连冰刺激对脑卒中后吞咽障碍的临床疗效。【方法】选择2012年6月至2014年6月在本院接受治疗的脑卒中后吞咽障碍患者62例,随机分为干预组和对照组各31例。对照组给予常规治疗,并进行冰刺激护理干预;干预组在常规治疗的基础上,给予黄连冰刺激护理干预。2组均每周治疗7 d,共治疗4周。观察2组改善吞咽能力的疗效和治疗前后吞咽障碍评分的变化情况。【结果】(1)干预组总有效率为87.09%,对照组为67.74%,干预组在改善吞咽能力方面的疗效优于对照组,2组比较差异有统计学意义(P<0.05)。(2)治疗后,2组患者的吞咽障碍评分均较治疗前提高,差异均有统计学意义(P<0.05),且干预组较对照组提高更明显,差异有统计学意义(P<0.05)。【结论】黄连冰刺激疗法对脑卒中后吞咽障碍进行干预治疗,能明显改善患者的吞咽功能。%Objective To observe the therapeutic effect of iced Rhizoma Coptidis decoction stimulation for post-stroke swallowing disorder. Methods Sixty-two post-stroke swallowing disorder patients admitted from June of 2012 to June of 2014 in Sanya Hospital of Traditional Chinese Medicine were enrolled into the study. The patients were evenly randomized into intervention group and control group. The control group was given conventional intervention and stomatological nursing with ice, and the intervention group was given conventional intervention and stomatological nursing with iced Rhizoma Coptidis decoction, once a day for 4 continuous weeks. After treatment, the therapeutic effect on swallowing disorder was evaluated, and the changes of scores of swallowing disorder before and after treatment were compared in the two groups. Results (1) The total effective rate of intervention group was 87.09%, and that of the control group was 67.74%, the difference being significant (P<0.05) . (2) After

  11. Therapeutic Effect of Citalopram Combined with Shenshuaining Pill in Treatment of Post-stroke Depression%西酞普兰合并神衰宁丸治疗脑卒中后抑郁症

    Institute of Scientific and Technical Information of China (English)

    程素满; 陈金峰; 李志榕

    2011-01-01

    目的:探讨西酞普兰合并神衰宁丸治疗脑卒中后抑郁的临床疗效.方法:将80例脑卒中后抑郁患者随机分为西酞普兰合并神衰宁丸的治疗组和西酞普兰对照组各40例,观察治疗6周.于治疗前及治疗1,2,4,6周末采用汉密顿抑郁量表(HAMD)进行抗抑郁疗效评定,用改良的爱丁堡-斯堪的纳维亚卒中量表(MESSS)进行神经功能康复评定,用治疗中出现的症状量表(TESS)评定药物不良反应.结果:HAMD和TESS评分显示,在第1和2周末治疗组和对照组区别显著(P <0.05);MESSS评分显示:在治疗6周末,治疗组(14.22 ± 4.53)比对照组(17.38±5.10)下降显著(P<0.05).结论:在治疗脑卒中后抑郁中,酞普兰合并神衰宁丸抗抑郁的起效更快,对神经功能的康复效果和患者的耐受性都较好.%Objective: To study the therapeutic effect of citalopram combined with Shenshuaining pill (SSNP) in the treatment of post-stroke depression. Method: Eighty post-stroke depression patients were randomly assigned into treated (citalopram combined with SSNP) and control (citalopram) groups (each n = 40 ) for 6 weeks. Anti-depression therapeutic effect, neural functional impairment and adverse reactions were assessed with the hamilton depression scale (HAMD), the modified Edinburgh-Scandinavia stroke scale (MESSS), and the Treatment Emergent Symptom Scale(TESS) respectively. Result: In the treatment group, the scores of the HAMD and TESS distinguished markedly at the end of the 1st and 2st weeks, and the total scores of the MESSS were 14. 22 ±4. 53 in treatment groups at the end of the 6th were, compared with control group( 17.38 ±5. 10), they decreased significantly distinguished ( P < 0. 05 ). Conclusion: Citalopram combined with SSNP had superior therapeutic effect for neural function recovery, and was a kind of rapid and safe drug in the treatment of post-stroke depression.

  12. Chronic Pain: Where the Body Meets the Brain

    OpenAIRE

    Crofford, Leslie J

    2015-01-01

    Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Central pain amplification is perceived pain that cannot be fully explained on the basis of somatic or neuropathic processes and is due to physiologic alterations in pain transmission or descending pain modulatory pathways. In any individual, central pain amplification may complicate nociceptive or neuropathic pain. Furthermore, patients with somatic symptom d...

  13. Neonatal pain management

    Directory of Open Access Journals (Sweden)

    Tarun Bhalla

    2014-01-01

    Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

  14. Persistent facial pain conditions

    DEFF Research Database (Denmark)

    Forssell, Heli; Alstergren, Per; Bakke, Merete;

    2016-01-01

    Persistent facial pains, especially temporomandibular disorders (TMD), are common conditions. As dentists are responsible for the treatment of most of these disorders, up-to date knowledge on the latest advances in the field is essential for successful diagnosis and management. The review covers...... TMD, and different neuropathic or putative neuropathic facial pains such as persistent idiopathic facial pain and atypical odontalgia, trigeminal neuralgia and painful posttraumatic trigeminal neuropathy. The article presents an overview of TMD pain as a biopsychosocial condition, its prevalence......, clinical features, consequences, central and peripheral mechanisms, diagnostic criteria (DC/TMD), and principles of management. For each of the neuropathic facial pain entities, the definitions, prevalence, clinical features, and diagnostics are described. The current understanding of the pathophysiology...

  15. On the mutual effects of pain and emotion: facial pain expressions enhance pain perception and vice versa are perceived as more arousing when feeling pain.

    Science.gov (United States)

    Reicherts, Philipp; Gerdes, Antje B M; Pauli, Paul; Wieser, Matthias J

    2013-06-01

    Perception of emotional stimuli alters the perception of pain. Although facial expressions are powerful emotional cues - the expression of pain especially plays a crucial role for the experience and communication of pain - research on their influence on pain perception is scarce. In addition, the opposite effect of pain on the processing of emotion has been elucidated even less. To further scrutinize mutual influences of emotion and pain, 22 participants were administered painful and nonpainful thermal stimuli while watching dynamic facial expressions depicting joy, fear, pain, and a neutral expression. As a control condition of low visual complexity, a central fixation cross was presented. Participants rated the intensity of the thermal stimuli and evaluated valence and arousal of the facial expressions. In addition, facial electromyography was recorded as an index of emotion and pain perception. Results show that faces per se, compared to the low-level control condition, decreased pain, suggesting a general attention modulation of pain by complex (social) stimuli. The facial response to painful stimulation revealed a significant correlation with pain intensity ratings. Most important, painful thermal stimuli increased the arousal of simultaneously presented pain expressions, and in turn, pain expressions resulted in higher pain ratings compared to all other facial expressions. These findings demonstrate that the modulation of pain and emotion is bidirectional with pain faces being mostly prone to having mutual influences, and support the view of interconnections between pain and emotion. Furthermore, the special relevance of pain faces for the processing of pain was demonstrated. PMID:23541426

  16. 21. Phantom pain.

    Science.gov (United States)

    Wolff, Andre; Vanduynhoven, Eric; van Kleef, Maarten; Huygen, Frank; Pope, Jason E; Mekhail, Nagy

    2011-01-01

    Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation. The reported incidence of phantom limb pain after trauma, injury or peripheral vascular diseases is 60% to 80%. Over half the patients with phantom pain have stump pain as well. Phantom pain can also occur in other parts of the body; it has been described after mastectomies and enucleation of the eye. Most patients with phantom pain have intermittent pain, with intervals that range from 1 day to several weeks. Even intervals of over a year have been reported. The pain often presents itself in the form of attacks that vary in duration from a few seconds to minutes or hours. In most cases, the pain is experienced distally in the missing limb, in places with the most extensive innervation density and cortical representation. Although there are still many questions as to the underlying mechanisms, peripheral as well as central neuronal mechanisms seem to be involved. Conservative therapy consists of drug treatment with amitriptyline, tramadol, carbamazepine, ketamine, or morphine. Based on the available evidence some effect may be expected from drug treatment. When conservative treatment fails, pulsed radiofrequency treatment of the stump neuroma or of the spinal ganglion (DRG) or spinal cord stimulation could be considered (evidence score 0). These treatments should only be applied in a study design. PMID:21447079

  17. The characteristic appearance and analysis of H reflex in lower extremity of hemiplegic patients with post-stroke%脑卒中后偏瘫患者下肢H反射的特征表现

    Institute of Scientific and Technical Information of China (English)

    李红玲; 徐凌娇; 潘拴珍; 王淑英

    2011-01-01

    目的:通过研究脑卒中后偏瘫患者下肢H反射的特征表现及其与偏瘫下肢肢体功能评定的关系,探讨H反射在脑卒中后偏瘫患者神经电生理评定中的应用价值.方法:选择脑卒中恢复期偏瘫患者40例,分别对患者双侧胫神经和腓总神经所支配的腓肠肌和胫骨前肌进行H反射检查,并对患侧下肢给予临床痉挛指数(CSI)评定.计算胫神经和腓总神经H反射的引出率,并对其所引出的H反射结果以及与CSI的相关性进行比较和分析.结果:患者双侧胫神经所支配的腓肠肌H反射引出率100%,胫骨前肌H反射引出率为10%.患侧胫神经H反射潜伏期平均为(30.09±1.87 )ms;非患侧胫神经H反射潜伏期平均为(31.99±2.31 )ms.患侧胫神经Hmax/Mmax比值均数中位数平均为0.476;非患侧胫神经Hmax/Mmax比值平均为0.189.患侧与非患侧相比,患侧H反射潜伏期缩短,Hmax/Mmax比值增大,且差异有显著性意义(P<0.05).将患侧下肢胫神经H反射潜伏期分别与CSI进行Spearman 秩相关检验,结果显示患侧下肢胫神经H反射潜伏期与CSI不相关,而患侧下肢胫神经Hmax/Mmax比值与CSI存在秩相关关系.结论:用H反射来评价脑卒中后偏瘫患者患侧痉挛的存在和严重程度,比CSI量表更客观、量化.其中Hmax/Mmax 比值是评估下运动神经元兴奋性的较好指标.%Objective: To investigate the value of application of H reflex in electrophysiological evaluation by studying relationship between the characteristic appearance of H reflex and functional assessment of affected lower extremity of hemiplegic patients post-stroke.Method: Forty hemiplegic inpatients in post-stroke convalescence stage were in various severities of limb dysfunction. The H reflex examination was administered on gastrocnemius (GS) innervated by tibial nerve and tibialis anterior (TA) innervated by common peroneal nerve of patients' extremities of both sides. At the same time, affected

  18. Successful use of stellate ganglion block and a new centrally acting analgesic with dual mode of action in a resistant temporomandibular joint pain

    OpenAIRE

    Jones, Gareth Peter; Tripathi, Shiva Shankar

    2014-01-01

    Stellate ganglion blocks have been shown to provide effective pain relief in a number of different conditions involving the upper body. This was demonstrated in a 65-year-old woman who had experienced severe debilitating pain in her left temporomandibular joint (TMJ) and the surrounding area of her face for over 10 years. The pain was unresponsive to indomethacin, carbamazepine, sodium valproate, gabapentin, lithium, melatonin and amitriptyline. She had also had four surgical procedures to th...

  19. Dor neuropática central após lesão medular traumática: capacidade funcional e aspectos sociais Dolor neuropático central después de lesión medular traumática: capacidad funcional y aspectos sociales Central neuropathic pain after traumatic spinal cord injury: functional capacity and social aspects

    Directory of Open Access Journals (Sweden)

    Janaina Vall

    2005-12-01

    Full Text Available Estudo de caso comparativo com o objetivo de avaliar a capacidade funcional e os aspectos sociais de dois pacientes, ambos com lesão medular traumática, sem e com dor neuropática central associada, respectivamente. Para avaliar a capacidade funcional, foi utilizado como instrumento o Functional Independence Measure ou Escala de Independência Funcional. E para avaliar os aspectos sociais foi construído o ecomapa de cada paciente, preconizado pelo modelo Calgary de avaliação de famílias. Ambos foram aplicados no domicílio do paciente. Os resultados mostraram que o paciente com dor neuropática central secundária à lesão medular possui baixa capacidade funcional e precária rede social de apoio, quando comparado com o paciente com as mesmas condições, porém sem dor associada.Estudio de caso comparativo con el objetivo de evaluar la capacidad funcional y los aspectos sociales de dos paciente, ambos con lesión medular traumática, sin y con el dolor neuropático central, respectivamente. Para evaluar la capacidad funcional, se usó como instrumento la Escala de Independencia Funcional. Y para evaluar los aspectos sociales, el ecomapa de cada paciente fue construido, preconizado por el modelo Calgary de evaluación de familias. Los dos furon aplicados en la casa del paciente. Los resultados mostraron que el paciente con dolor neuropatico central secundario a la lesión medular posee capacidad funcional baja y precaria red social de apoyo, cuando comparado con el paciente con las mismas condiciones, pero sin el dolor asociado.Comparative study of case with the aim of evaluating the functional capacity and social aspects of two patients, both with traumatic spinal cord injury, without and with central neuropathic pain associated, respectively. To evaluate the functional capacity it was used as instrument Functional Independence Measure. And to evaluate the social aspects the ecomap of each patient one it was built, extolled by the model

  20. The Pharmacology of Visceral Pain.

    Science.gov (United States)

    Johnson, Anthony C; Greenwood-Van Meerveld, Beverley

    2016-01-01

    Visceral pain describes pain emanating from the internal thoracic, pelvic, or abdominal organs. Unlike somatic pain, visceral pain is generally vague, poorly localized, and characterized by hypersensitivity to a stimulus such as organ distension. While current therapeutics provides some relief from somatic pain, drugs used for treatment of chronic visceral pain are typically less efficacious and limited by multiple adverse side effects. Thus, the treatment of visceral pain represents a major unmet medical need. Further, more basic research into the physiology and pathophysiology of visceral pain is needed to provide novel targets for future drug development. In concert with chronic visceral pain, there is a high comorbidity with stress-related psychiatric disorders including anxiety and depression. The mechanisms linking visceral pain with these overlapping comorbidities remain to be elucidated. However, persistent stress facilitates pain perception and sensitizes pain pathways, leading to a feed-forward cycle promoting chronic visceral pain disorders. We will focus on stress-induced exacerbation of chronic visceral pain and provide supporting evidence that centrally acting drugs targeting the pain and stress-responsive brain regions may represent a valid target for the development of novel and effective therapeutics. PMID:26920016

  1. Contemporary treatment neuropathic pain

    Directory of Open Access Journals (Sweden)

    Cvijanović Milan

    2011-01-01

    Full Text Available Introduction. Neuropathic pain, or pain associated with disease or injury to the peripheral or central nervous system, is a common symptom of a heterogeneous group of conditions, including diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia and spinal cord injury. Chronic neuropathic pain should not be thought of as a symptom. It should truly be thought of as a disease with a very complicated pathophysiology. Pathophysiology. The mechanisms involved in neuropathic pain are complex and involve both peripheral and central pathophysiologic phenomenon. The underlying dysfunction may involve deafferentation within the peripheral nervous system (e.g. neuropathy, deafferentation within the central nervous system (e.g. post-thalamic stroke or an imbalance between the two (e.g. phantom limb pain. Clinical characteristics. Neuropathic pain is non-nociceptive, in contrast to acute nociceptive pain, and it can be described as ”burning”, ”electric”, ”tingling”, and ”shooting” in nature. Treatment. Rational polypharmacy is often necessary and actually it is almost always the rule. It would be an exception if a patient was completely satisfied with his treatment. Treatment goals should include understanding that our patients may need to be titrated and managed with more than one agent and one type of treatment. There should be the balance of safety, efficacy, and tolerability. Conclusion. There are many new agents and new applications of the existing agents being currently studied which will most certainly lead to even more improved ways of managing this very complicated set of disorders.

  2. Eye pain

    Science.gov (United States)

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  3. Wrist pain

    Science.gov (United States)

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  4. Ankle pain

    Science.gov (United States)

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  5. Elbow pain

    Science.gov (United States)

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  6. Heel pain

    Science.gov (United States)

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  7. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...... also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree of...

  8. Does intermittent pneumatic compression reduce the risk of post stroke deep vein thrombosis? The CLOTS 3 trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Dennis Martin

    2012-03-01

    Full Text Available Abstract Background Approximately 80,000 patients each year are admitted to UK hospitals with an acute stroke and are immobile. At least 10% will develop a proximal Deep Vein Thrombosis in the first month and 1.5% a pulmonary embolus. Although hydration, antiplatelet treatment and early mobilisation may reduce the risk of deep vein thrombosis, there are currently no preventive strategies which have been clearly shown to be both effective and safe. Anticoagulation increases the risks of bleeding and compression stockings are ineffective. Systematic reviews of small randomized trials of intermittent pneumatic compression have shown that this reduces the risk of deep vein thrombosis in patients undergoing surgery, but that there are few data concerning its use after stroke. The CLOTS trial 3 aims to determine whether, compared with best medical care, best medical care plus intermittent pneumatic compression in immobile stroke patients reduces the risk of proximal deep vein thrombosis. Methods/Design CLOTS Trial 3 is a parallel group multicentre trial; with centralized randomisation (minimisation to ensure allocation concealment. Over 80 centres in the UK will recruit 2800 immobile stroke patients within the first 3 days of their hospital admission. Patients will be allocated to best medical care or best medical care plus intermittent pneumatic compression. Ultrasonographers will perform a Compression Duplex Ultrasound Scan to detect deep vein thrombosis in each treatment group at about 7-10 days and 25-30 days. The primary outcome cluster includes symptomatic or asymptomatic deep vein thrombosis in the popliteal or femoral veins detected on either scan. Patients are then followed up by postal or telephone questionnaire at 6 months from randomisation to detect later symptomatic deep vein thrombosis and pulmonary emboli and to establish their functional outcome (Oxford handicap scale and quality of life (EQ5D-3 L. The ultrasonographers performing the

  9. Pain management in cancer survivorship

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per

    2015-01-01

    BACKGROUND: The number of patients surviving cancer disease has increased in last decades. Consequently, an emerging population with different needs due to long-term or late effects of cancer disease and/or treatment, e.g. chronic pain, is of major concern. EPIDEMIOLOGY: Chronic pain is one of the...... ETIOLOGY: Neuropathic pain seems to be the major pain etiology in cancer survivors and therefore adjuvant analgesics should be the first choice of analgesic treatment. CONTEXT: This article addresses the central aspects of pain epidemiology, mechanisms and the frequent pain syndromes met in cancer...... main problems in this population and prevalence varies between 16% and 50%. Most information derives from breast cancer patients assessed by surveys from national or local institutional databases. A Danish population-based survey estimated that 41.5% of all cancer survivors reported chronic pain. PAIN...

  10. The effect of music therapy on patients with post-stroke depression%音乐疗法对脑卒中后抑郁患者的疗效观察

    Institute of Scientific and Technical Information of China (English)

    徐建忠; 彭辰; 马建强; 沈亚平

    2015-01-01

    Objective To observe the effect of music therapy on stroke patients with depression.Methods 70 post-stroke depression patients were divided into the observation group and the control group according to the hospitalized number,the control group received conventional therapy neurology without giving antidepressants;the observation group were given music therapy group basis.Both groups were at the time of enrollment and after treatment using the Hamilton Depression Rating Scale (HAMD),Self-rating Depression Scale (SDS) for the two groups of patients assessed the degree of depression.Results After the treatment,the HAMD score of the observation group was (23.57 ± 10.33)points,compared with the control group[(28.20 ± 8.83)points],the difference was statistically significant (t =2.02,P < 0.05);the SDS score of the observation group was (61.00 ± 10.67) points,compared with the control group [] (66.11 ± 10.38) points],the difference was statistically significant (t =-2.03,P < 0.05).Conclusion Music therapy for depression in patients with post-stroke recovery has a positive meaning.%目的 观察音乐疗法对脑卒中后抑郁患者的疗效.方法 将70例符合要求的卒中后抑郁患者按住院号随机分为观察组和对照组,各35例,对照组给予神经内科常规药物治疗但不给与抗抑郁药物;观察组在对照组基础上给予音乐疗法.两组均于入选时和疗程结束后采用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)对两组患者抑郁程度进行评定.结果 治疗后观察组HAMD评分(23.57±10.33)分,低于对照组的(28.20±8.83)分,差异有统计学意义(t=2.02,P<0.05);观察组SDS评分(61.00±10.67)分,低于对照组的(66.11±10.38)分,差异有统计学意义(t=-2.03,P<0.05).结论 音乐疗法对脑卒中后抑郁患者的恢复有积极意义.

  11. Observation of clinical efficacy of music therapy in treatment of post-stroke depression%音乐治疗应用于卒中后抑郁临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈先德; 王朔

    2013-01-01

    目的 调查研究音乐治疗应用于卒中后抑郁患者的临床疗效及其在患者社会功能恢复中的作用.方法 选取符合ICD-10卒中后抑郁诊断标准的患者98例,随机分为音乐治疗组(音乐治疗+抗抑郁药物治疗)和对照组(常规抗抑郁药物治疗),治疗前及治疗8周后采用汉密尔顿抑郁量表(HAMD)评定临床疗效、席汉残疾量表(SDS)评定社会功能恢复情况.结果 共95例完成研究,治疗8周末,两组汉密尔顿抑郁量表(HAMD)总分较治疗前显著下降(P < 0.05),音乐治疗组较对照组显著下降(P < 0.05);两组席汉残疾量表(SDS)均较治疗前显著降低(P < 0.05),音乐治疗组较对照组显著降低(P < 0.05).结论 音乐治疗联合抗抑郁剂治疗卒中后抑郁较单用抗抑郁剂治疗效果更显著,能有效改善患者的社会功能.%Objective To investigate the clinical efficacy of music therapy in the treatment of patients with pos-stroke depression and its role in the patients' social function recovery. Methods 98 patients meeting the diagnostic criteria of ICD-10 post-stroke depression were selected and randomly divided into the music therapy group (music therapy + an-tidepressant drug therapy) and the control group (conventional antidepressant drug therapy). Before the treatment and 8 weeks after the treatment, the clinical efficacy was evaluated by using the Hamilton Depression Rating Scale (HAMD) and the social function recovery was evaluated by using the Sheehan Disability Scale (SDS). Results A total of 95 patients finished the study, at the end of 8 weeks after the treatment, the total HAMD scores of both groups significantly decreased compared to those before the treatment (P < 0.05), and the music therapy group decreased more significantly than the control group (P < 0.05). The SDS scores of both groups significantly decreased compared to those before the treatment (P < 0.05), and the music therapy group decreased more significantly

  12. Effect of Psychological rehabilitation post-stroke depression in elderly patients%心理康复治疗对老年脑卒中后抑郁病人的影响

    Institute of Scientific and Technical Information of China (English)

    钟秋园

    2012-01-01

    OBJECTIVE To investigate the psychological rehabilitation of patients with ischemic strokes depression effect METHODS Random number table was used in our study. From September 2009 - September 2011. 78 cases of ischemic stroke patients were selected from department of Neurology in the general hospital were divided into control group and treatment group. The control group were treated with conventional therapy and exercise rehabilitation training, while the treatment group in the treatment of patients were used psychological rehabilitation and conventional therapy. The cases were evaluated by using self-compiled questionnaire, Hamilton depression Rating Scale (HAMD), exercise capacity (Fugl-Meye scale) and life skills (Bathel index) after 4 weeks of treatment. RESULTS After 4-week treatment, the psychological rehabilitation in patients treated with HAMD score were significantly lower than the control group, while the FMA score and MBI score was significantly higher (P < 0.01). CONCLUSION In the post-stroke depression in elderly patients with clinical treatment, physical therapy and psychological treatment were complementary and mutually reinforcing to make post-stroke depression in elderly rehabilitation pa-tienls to receive good results and shorten the treatment of patients time, and improve patient quality of life.%目的 探讨心理康复治疗对缺血性脑卒中后抑郁病人的作用.方法 运用随机数字表法对2009年9月~2011年9月在某市综合性医院神经内科78例缺血性脑卒中患者分为对照组和治疗组,对照组患者给予常规药物治疗加运动康复训练,治疗组患者则在上述治疗的基础上加用心理康复治疗,分别于入组时及治疗4周后使用自编问卷、汉密尔顿抑郁量表(HAMD)、运动能力(Fugl-Meye量表)及生活能力(Bathel指数)进行测评,评价2组患者的临床治疗效果.结果 经过为期4周的治疗后,心理康复治疗组患者的HAMD评分低于对照组,而其FMA

  13. 卒中后抑郁模型大鼠杏仁核神经元凋亡增加%Apoptosis increased in amygdala neurons of post-stroke depression model rats

    Institute of Scientific and Technical Information of China (English)

    刘昊; 王海涛; 徐爱军; 李世英; 张晋霞; 张蕊

    2011-01-01

    目的:探讨卒中后抑郁(post-stroke depression,PSD)模型大鼠杏仁核神经元凋亡现象。方法:将成年健康雄性SD大鼠随机分为对照组(15只)和模型组(15只)。采用颈总动脉线栓再灌注法制备局灶性脑缺血大鼠模型,结合孤养和慢性不可预见的温和性应激方法制备PSD大鼠模型。采用糖水实验、开场实验和Morris水迷宫检测行为学改变,TUNEL和流式细胞术检测杏仁核神经元凋亡和凋亡率。结果:模型组大鼠行为学发生明显改变。对照组和模型组凋亡细胞阳性率分别为3.91%±0.49%和25.04%±6.32%,凋亡率分别为3.50%±0.5%和18.75%±2.95%,差异均有统计学意义(P<0.01)。结论:PSD模型大鼠杏仁核存在明显的神经元凋亡,这可能是PSD患者杏仁核体积异常的原因之一。%Objective To observe the neuronal apoptosis in amygdala of post-stroke depression (PSD) model rats. Methods Male Wistar rats were randomly divided into control group and model group. The model of focal cerebral ischemia was set up by thread occlusion through arteria carotis interna and reperfusion. Then the rats were raised alone and given chronic unpredictable modest stress to establish the PSD model. The behavior was examined using sucrose preference test,open-filed test and Morris water maze. TUNEL-staining and double-labeled flow cytometry (FCM) were employed for the detection and quantification of the apoptotic cells in the amygdala. Results The consumption of sucrose and erect quantity of model group were lower than those of control group (P <0.05). The percentage of TUNEL-positive cell and the apoptotic cell rate of model group were higher than those of control group respectively ( P < 0.01). Conclusion Apoptosis is increased in amygdala neurons of PSD model rats,and might be one of reasons that induced the amygdala become smaller in PSD.

  14. 社会心理因素对卒中后抑郁发病的影响%Effect of Psychosocial Factors on Onset of Post-Stroke Depression

    Institute of Scientific and Technical Information of China (English)

    余政; 张梅英; 李梦倩; 袁也丰

    2012-01-01

    目的 研究卒中后抑郁的发生与生活事件、应对方式、社会支持及人格的关系.方法 对120例脑卒中患者进行汉密尔顿抑郁量表评定,HAMD≥8分者为抑郁组,HAMD<8分者为疾病对照组.所有患者应用生活事件量表、特质应对方式问卷、社会支持评定量表,艾森克个性问卷(成年)4个量表进行调查.结果 抑郁组的负性事件应激量和生活事件总应激量均较对照组高(P<0.01),消极应对得分高于对照组(P<0.01),主观支持度及对支持利用度评分都低于对照组(P<0.01).艾森克人格测验(成人)N值较对照组大,而E值较对照组小,差异均有统计学意义(P<0.01).结论 病前的负性生活事件量多、消极的应对方式、主观社会支持和对支持的利用度低、以及内向神经质的人格特质可能是影响卒中后抑郁发生的社会心理因素.%Objective To investigate the relationship of onset of post-stroke depression (PSD) to life events, coping style, social support and personality. Methods According to the Hamilton depression scale, 120 patients with stroke were divided into depression group (score≥8) and control group(score<8). All patients were accessed with life event scale(LES), trait coping style questionnaire ( TCSQ), social support rating scale (SSRS) and Eysenck personality inventory (EPQ). Results Compared with control group,the amount of negative life events,total amount of life events and passive coping score obviously increased,and subjective support and support using score significantly decreased in depression group(P<0. 01). The results of EPI showed an increase in N value and a decrease in E value in depression group compared with control group (P< 0. 01). Conclusion A large number of negative life events, passive coping style, low subjective support and social support,and introverted and neurotic personality may be the psychosocial risk factors for post-stroke depression.

  15. Pelvic Pain

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    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  16. Shoulder pain

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    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  17. European Palliative Care Research collaborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus?

    Science.gov (United States)

    Stone, Patrick; Minton, Ollie

    2011-07-01

    This is a systematic review examining the management of opioid-induced central side effects. It has been conducted as part of a larger European Palliative Care Research collaborative review into the use and role of opioids in cancer pain. The review process identified 26 studies that met the inclusion criteria. The overall quality of the data was low and the few recommendations that can be made are weak and require confirmatory studies. The main central side effects examined were sedation, cognitive failure, sleep disturbance and myoclonus. Overall there is limited evidence for the use of methylphenidate in counteracting opioid-induced sedation and cognitive disturbance. No clear recommendations can be made concerning other individual drugs for the management of any of the central side effects examined. Given the lack of available data from this review there need to be further prospective controlled trials to confirm or refute these findings. PMID:20870687

  18. Spinal cord injury pain: mechanisms and management.

    Science.gov (United States)

    Finnerup, Nanna Brix; Baastrup, Cathrine

    2012-06-01

    Patients with spinal cord injury (SCI) may experience several types of chronic pain, including peripheral and central neuropathic pain, pain secondary to overuse, painful muscle spasms, and visceral pain. An accurate classification of the patient's pain is important for choosing the optimal treatment strategy. In particular, neuropathic pain appears to be persistent despite various treatment attempts. In recent years, we have gained increasing knowledge of SCI pain mechanisms from experimental models and clinical studies. Nevertheless, treatment remains difficult and inadequate. In line with the recommendations for peripheral neuropathic pain, evidence from randomized controlled treatment trials suggests that tricyclic antidepressants and pregabalin are first-line treatments. This review highlights the diagnosis and classification of SCI pain and recent improvements in the understanding of underlying mechanisms, and provides an update on treatment of SCI pain. PMID:22392531

  19. POST-STROKE WRITING AND READING DISORDERS

    Directory of Open Access Journals (Sweden)

    Sinanović Osman

    2013-01-01

    Full Text Available The writing and reading disorders in stroke patients (alexias, agraphias and acalculias are more frequent than verified in routine exam, not only in the less developed but also in large neurological departments. Alexia is an acquired type of sensory aphasia where damage to the brain causes a patient to lose the ability to read. It is also called word blindness, text blindness orvisual aphasia. Alexia refers to an acquired inability to read caused by brain damage and must be distinguished from dyslexia, a developmental abnormality in which the individual is unable to learn to read, and from illiteracy, which reflects a poor educational back-ground. Most aphasics are also alexic, but alexia may occur in the absence of aphasia and may occasionally be the soledisability resulting from specific brain lesions. There are different classifications of alexias. Traditionally, the alexias are divided into three categories: pure alexia with agraphia, pure alexia without agraphia, and alexia associated with aphasia (“aphasic alexia”. Agraphia is defined as the disruption of previously intact writing skills by brain damage. Writing involves several elements—language processing, spelling, visual perception, visual-spatial orientation for graphic symbols, motor planning, and motor control of writing. A disturbance of any of these processes can impair writing. Agraphia may occur by itself or as association with aphasias, alexia, agnosia and apraxia. Agraphia can also result from “peripheral” involvement of the motor act of writing. Like alexia, agraphia must be distinguished from illiteracy, where writing skills were never developed. Acalculia is a clinical syndrome of acquired deficits in mathematical calculation, either mentally or with paper and pencil. This language disturbances can be classified differently, but there are three principal types of acalculia: acalculia associated with language disturbances, including number paraphasia, number agraphia, or number alexia; acalculia secondary to visual-spatial dysfunction with malalignment of numbers and columns, and a primary anarithmetria entailing disruption of the computation process.

  20. Impaired Hyperemic Response to Exercise Post Stroke

    OpenAIRE

    Durand, Matthew J.; Murphy, Spencer A.; Schaefer, Kathleen K.; HUNTER, SANDRA K.; Schmit, Brian D.; Gutterman, David D.; Hyngstrom, Allison S.

    2015-01-01

    Individuals with chronic stroke have reduced perfusion of the paretic lower limb at rest; however, the hyperemic response to graded muscle contractions in this patient population has not been examined. This study quantified blood flow to the paretic and non-paretic lower limbs of subjects with chronic stroke after submaximal contractions of the knee extensor muscles and correlated those measures with limb function and activity. Ten subjects with chronic stroke and ten controls had blood flow ...

  1. POST-STROKE WRITING AND READING DISORDERS

    OpenAIRE

    Sinanović Osman; Mrkonjić Zamir

    2013-01-01

    The writing and reading disorders in stroke patients (alexias, agraphias and acalculias) are more frequent than verified in routine exam, not only in the less developed but also in large neurological departments. Alexia is an acquired type of sensory aphasia where damage to the brain causes a patient to lose the ability to read. It is also called word blindness, text blindness orvisual aphasia. Alexia refers to an acquired inability to read caused by brain damage and must be distinguished fro...

  2. The characteristic appearance and analysis of H reflex in hemiplegic upper extremity patients with post-stroke%H反射在脑卒中后上肢偏瘫患者中的特征表现及分析

    Institute of Scientific and Technical Information of China (English)

    李红玲; 徐凌娇; 岳崴; 刘春辉; 潘拴针; 王淑英

    2012-01-01

    Objective: To investigate the valuable application of H reflex in electrophysiological evaluation by study of the relationship between the characteristic appearance of H reflex and muscular tone of affected side in upper extremity of hemiplegic patients post-stroke.Method: Forty-two hemiplegic inpatients with post-stroke in convalescence stage who fulfilled the study entry criteria were in various levels of upper extremity dysfunction. The H reflex examination was given to abductor polli- cis brevis (APB) dominanted by median nerve, abductor digiti minimi (ADM) dominanted by ulnar nerve, extensor digitorum communis dominanted by radial nerve of the patients' both affected and unaffected sides. At the same time, affected upper extremity was assessed by modified Ashworth scale (MAS), to determine whether H reflex could be easily obtained from all the nerves above mentioned. Then the changes in H reflex latencies and ratios of Hmax/Mmax of both sides were compared; the correlation between MAS and H reflex latency and Hmax/Mmax ratio in affected upper extremities were analysed.Result: H reflex was easily obtained from APB dominanted by median nerve, ADM dominanted by ulnar nerve of both sides, and the elicitation rates were 100%. But elicitation rate of extensor digitorum communis dominanted by radial nerve was only 7.14%. The mean (SD) H reflex latencies for medium nerve and ulnar nerve of affected sides were (25.89 ± 3.66)ms and (25.71 ± 3.26)ms respectirely, and those of unaffected sides were (26.60 ± 3.1 l)ms and (26.44 ± 2.87)ms recpectively. The medians of Hmax/Mmax ratio value for the median nerve and ulnar nerve of affected sides were 0.185 and 0.217 respectively, and those of unaffected sides were 0.126 and 0.112 respectively. The H reflex latency reduced and the Hmax/Mmax ratio increased in affected side comparing with unaffected side for median nerve and ulnar nerve, and the differences of both sides were statistically significant(P<0.05). By using

  3. Finger pain

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    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  4. Elbow pain

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    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is ... injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow . Golfers ...

  5. Testicle pain

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    ... pain include: Injury Infection or swelling of the sperm ducts ( epididymitis ) or testicles ( orchitis ) Twisting of the ... Cyst in the epididymis that often contains dead sperm cells ( spermatocele ) Fluid surrounding the testicle ( hydrocele ) Pain ...

  6. Pain Management

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    ... opiates such as morphine could relieve pain and chemist Felix Hoffmann developed aspirin from a substance in ... sensory and emotional experience associated with actual or potential tissue damage.” TODAY Pain affects more Americans than ...

  7. 音乐治疗对脑卒中后抑郁患者情绪影响的研究%Effect of music therapy on mood in post-stroke depression patients

    Institute of Scientific and Technical Information of China (English)

    潘田华

    2015-01-01

    Objective To investigate the effect of music therapy on depression and anxiety in patients with post-stroke depression (PSD).Methods 192 cases of PSD were randomly divided into music therapy group and control group.Patients in control group received routine physical and drug therapy,and patients in music therapy group received systematical music therapy on the basis of control group.Psychological status of all patients was evaluated with Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) before and after treatment.Results After treatment,BDI score and BAI score in music therapy group decreased more significantly compared with control group.BDI score in music therapy group before treatment was (16.7±6.4),that after treatment was (14.3±4.6),with statistically significant difference (P<0.05).Conclusion Music therapy has a positive effect on mood in PSD patients,which can be applied in clinical work to improve PSD patients' mood.%目的 研究音乐治疗对卒中后抑郁患者焦虑抑郁情绪的作用.方法 192名卒中后抑郁患者随机分至音乐治疗及对照组.给予音乐治疗组患者常规物理、药物治疗,及计划性音乐治疗,仅给予对照组患者常规物理及药物治疗.两组患者入组前后均采用贝克抑郁量表(BDI)和贝克焦虑量表(BAI)进行情绪评估.结果 音乐治疗后音乐治疗组患者BDI和BAI评分较对照组下降更为明显,但仅有音乐治疗组患者治疗前后BDI显著下降,治疗前BDI均分(16.7±6.4),治疗后BDI均分(14.3±4.6)(P<0.05).结论 音乐治疗对于卒中后抑郁患者情绪有改善作用,可用于卒中后抑郁患者临床治疗.

  8. 迷迭香精油吸嗅对PSD大鼠的神经行为学影响%Effects of rosemary on behavioral models related to post-stroke depression in rats

    Institute of Scientific and Technical Information of China (English)

    李键; 高晓平; 李光武; 陈和木; 窦云龙

    2012-01-01

    目的 探讨迷迭香吸入对脑卒中后抑郁(PSD)大鼠行为学的影响.方法 采用线栓法制备局灶性脑缺血大鼠模型后予以孤养、应激处理复合制备PSD大鼠模型,随机分为迷迭香组、文拉法辛组和对照组,观察PSD大鼠蔗糖水消耗量、旷野试验等行为学指标.结果 与对照组相比,迷迭香组和文拉法辛组PSD大鼠蔗糖水消耗量、旷野实验水平和垂直运动次数均有所增加(P<0.01);而两组效果亦有差异(P<0.01),文拉法辛组更为明显.结论 迷迭香吸入对PSD大鼠神经行为学变化有一定的改善.%Aim To observe the effect of rosemary on the changes of behaviors in post-stroke depression( PSD) rats. Methods The focal cerebral ischemia model was set up by blocking the middle cerebral artery ( MCAO). Then the model rats were separately raised and put into chronic unpredictable mild stress ( CUMS) to induce the PSD model. The rats were divided into control group, Rosemary group and venlafaxine group. The rats were examined dynamically at the 7th, 14th, 28th days by open-field test (OFT) and sucrose consumption test. Results There were no obvious differences of the baseline level in the three groups. In Rosemary group as well as venlafaxine group the behavior ability significantly improved compared with control group (P 〈0. 01) . The behavior scores of venlafaxine group were higher than those of Rosemary group (P 〈0. 01). Conclusions Rosemary can improve the behavior abnormality in PSD rats.

  9. Research on related factors of post-stroke depression and their relationship with prognosis%脑卒中后抑郁相关因素与患者预后分析研究

    Institute of Scientific and Technical Information of China (English)

    张国利; 曾湘良; 刘芳; 朱勇

    2012-01-01

    目的 探讨脑卒中后抑郁的相关因素及患者预后分析.方法选择2008年2月~2011年2月本院住院治疗的280例脑卒中患者,采用抑郁自评量表、汉密尔顿抑郁量表对患者进行评估.280例患者中确诊为卒中后抑郁者62例,将32例接受早期干预治疗的卒中后抑郁者为观察组,30例未接受早期干预者为对照组.对可能引起脑中后抑郁的相关因素进行分析,并采用改良Barthel指数评估患者日常生活能力(ADL),采用FMA运动功能评定肢体运动功能.结果统计学分析显示文化程度、家庭关系、病变部位、偏瘫严重程度与患者脑卒中后抑郁显著相关(P 0.05);治疗后1、3及6个月进行评估,结果显示观察组MBI评分及FMA评分显著优于对照组(P 0.05); MBI scores and FMA scores in experience group were much better than that in control group on 1, 3 and 6 months of post-treatment (P < 0.05). Conclusion Culture degree, family relationship, lesion site, the hemiplegic degree are the risk factors for post-stroke depression. The patients who receive early treatment have better prognosis. Early treatment should be performed in order to promote the recovery and improve the prognosis of patients.

  10. Youth post-stroke depression of patients with clinical observation of early psychological intervention%青年脑卒中后抑郁患者早期心理干预的临床观察

    Institute of Scientific and Technical Information of China (English)

    王建; 王俊; 李运明; 房妮妮; 王庆松

    2013-01-01

    Objective To investigate the rehabilitation outcome of early psychotherapy to young post-stroke depression of the youngelderly patients.Methods After aged young patients with stroke are hospitalized,they are filtered and graded by hamiliton depression rating scale (HRSD) in a week,for 67 patients with depression were divided into psychotherapy group (subject to normal rehabilitation therapy and psychotherapy)and normal group (only subject to normal rehabilitation) randomly.Both two group s are contrasted by spitzer quality of life inventory(QLI) and H RSD after 8-weeks.Results Through the early psychotherapy,the psychotherapy group is obviously superior to normal group in health,support of family and social support,and the understanding to prospect.OtherwiseFurthermore,the patients of in psychotherapy group are imp roved in with depress situation of depression (P < 0.01).Conclusion The early systemic psychotherapy is effective in cureing depression,fastening the comebackrecovering of everyneuronal function early,and improving the quality of life.%目的 探讨早期心理干预对青年脑卒中后抑郁(PSD)的治疗效果.方法 青年脑卒中患者在住院1w内采用汉密顿抑郁量表(HRSD)进行筛选评分,对符合抑郁状态诊断的患者67例随机分为干预组和常规组,常规组采用常规的药物治疗和护理,干预组同时给予早期心理干预,8w后采用Spitzer生存质量指数量表(QLI)和HRSD对两组进行评定.结果 经过早期心理干预后,干预组在健康感觉、家庭和社会的支持以及对前景的认识方面明显优于常规组,干预组患者的抑郁情况与常规组比较明显改善(P<0.01).结论 对青年脑卒中后抑郁患者早期系统的心理干预可明显改善抑郁,加快神经缺失功能恢复,提高生活质量.

  11. Relativity study between serum cortisol level and post-stroke depression in old patients with stroke%老年脑卒中患者血清皮质醇水平与卒中后抑郁的相关性研究

    Institute of Scientific and Technical Information of China (English)

    孟宪栋; 罗晓红; 樊红艳

    2009-01-01

    Objective To explore relativity between serum cortisol and post-stroke depression in old patients with stroke. Methods Serum cortisols of 41 stroke patients were examined two weeks after stroke, and they were all assessed through Hamilton Depression Scale and then happening rates of post-stroke depression observed in both normal cortisol group and enhanced cortisol group were tested through χ2 test. Meanwhile relativity between serum cortisol level and post-stroke depression were analysised. Results Happening rates of post-stroke depression had an evidently difference between both normal cortisol group and enhanced cortisol group(χ2=4.11;P <0.05). Mark of normal cortisol group was 15.29±7.28, enhanced cortisol group was 25.85±10.81, both groups had an evidently difference( P <0.01). Serum cortisols were not obviously relative to depression degree in normal cortisol group( r =0.295;P =0.194) while they were obviously relative in enhanced cortisol group( r =0.702;P =0.001). Conclusion Enhanced cortisol could forecast higher possibility of depression after the old post-stroke, and detecting cortisol could offer theory foundation for prevention and cure of post-stroke depression.%目的 探讨老年脑卒中患者血清皮质醇水平与卒中后抑郁(PSD)是否具有相关性.方法 对41例老年卒中患者在发病后2周进行血清皮质醇检测,并在发病后3月对患者进行抑郁量表评定,观察皮质醇正常组以及皮质醇增高组卒中后抑郁发生率,并进行卡方检验,同时对各组内皮质醇水平和抑郁程度进行相关性分析.结果 皮质醇正常组和皮质醇增高组PSD发生率差异有显著性(χ2=4.11;P <0.05),皮质醇正常组平均汉密尔顿分值为(15.29±7.28)分,皮质醇增高组为(25.85±10.81)分,2组差异有显著性( P <0.01).皮质醇正常组皮质醇水平与抑郁程度无明显相关( r =0.295;P =0.194),皮质醇增高组皮质醇水平与抑郁程度明显相关( r =0.702;P =0.001).结论 老

  12. Evaluation of analgesic effect of tapentadol, a central novel analgesic versus tramadol, a widely used opioid analgesic in treatment of low back pain: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zaki Anwar Zaman

    2013-08-01

    Full Text Available Background: The objective of the study was to compare efficacy and tolerability (safety of tapentadol with tramadol in the treatment of low back pain. Methods: The study was a prospective, randomized, single blinded, total 102 patients are recruited for study in which 44 patients are prescribed (50mgtwice daily tapentadol and 58 patients prescribed (50mg twice daily tramadol for 4 weeks. Follow-up was done on days 7, 14, 28 and 4 week after stoppage of treatment. Assessment of improvement were performed by Indian Health Assessment Questionnaire Disability Index (Indian HAQDI, Visual Analogue Scale (VAS, Numerical Rating Scale (NRS and measurement of Pain Relief Rate (PRR. Adverse events were recorded. Results: Scores in Indian HAQDI, VAS and NRS improved significantly in both groups in the last visit but more so with tapentadol. PRR was reasonably higher with tapentadol [27(n=4461.36%] patients experiencing significant to complete pain relief at the end of the study, compared to tramadol [25(n=58 43.10%]. Adverse effects was less in tapentadol group [15(n=4434.09%] versus 33(n=5856.89%], p<0.05]. Conclusion: Tapentadol has better sustained efficacy and tolerability than tramadol in low back pain. [Int J Basic Clin Pharmacol 2013; 2(4.000: 392-396

  13. Urination Pain

    Science.gov (United States)

    ... more often bad-smelling, bloody, or discolored urine (pee) fever or chills decreased appetite or activity irritability nausea or vomiting lower back pain or abdominal (belly) pain wetting accidents (in potty-trained kids) What to Do Call the doctor if your child has pain while urinating or can't ...

  14. Abdominal Pain

    Science.gov (United States)

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  15. Altered pain modulation in patients with persistent postendodontic pain.

    Science.gov (United States)

    Nasri-Heir, Cibele; Khan, Junad; Benoliel, Rafael; Feng, Changyong; Yarnitsky, David; Kuo, Fengshen; Hirschberg, Craig; Hartwell, Gary; Huang, Ching-Yu; Heir, Gary; Korczeniewska, Olga; Diehl, Scott R; Eliav, Eli

    2015-10-01

    Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion. PMID:26098442

  16. The controlled study on psychosocial factors for post-stroke depression%卒中后抑郁患者心理社会影响因素的对照研究

    Institute of Scientific and Technical Information of China (English)

    康岚; 王希林; 刘粹; 廖金敏; 黄成兵; 黄悦勤; 孙丽君; 谷朝霞

    2014-01-01

    Objective To investigate psychosocial factors for post-stroke depression (PSD). Methods 405 in-pa-tients with stroke were first screened for depression using Comprehensive International Diagnostic Interview-3.0. 22 pa-tients with depression were recruited as the depression group. From 383 patients without depression, 44 patients were se-lected and served as the non depression controlled group according to the sex and age paired with 1:2. Both groups were measured by using questionnaires including Life Event Scale, Simplified Coping Style Questionnaire, Social Support Rat-ing Scale, Activities of Daily Living Scale and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. Re-sults The score of passive coping was significantly higher in depression group than in non depression group [(1.2 ± 0.5) vs. (0.8±0.7), P<0.05]. The score of subjective support was significantly lower in depression group than in non depression group [(17.5±4.0) vs. (20.7±4.6), P<0.05]. Logistic regression analysis showed, minority nationality (OR=2.564, 95%CI:1.039~6.327) and passive coping style (OR=2.223, 95%CI:1.052~5.192) were risk factors for PSD, while subjective sup-port was protective factor for PSD (OR=0.884, 95%CI:0.793~0.986). Conclusions Passive coping style and low subjec-tive support may be the important psychosocial factors of PSD.%目的:探讨卒中后抑郁(post-stroke depression,PSD)的主要心理社会影响因素。方法应用复合性国际诊断问卷-3.0中文版对405例住院脑卒中患者进行筛查与诊断,其中符合抑郁障碍诊断标准的22例患者为抑郁组,在383例无抑郁障碍的患者中按性别、年龄匹配原则以1:2比例抽取44例作为非抑郁组。采用生活事件量表、简易应对方式问卷、社会支持评定量表、日常生活活动能力量表和简明幸福与生活质量满意度问卷对两组进行测评。结果抑郁组的简易应对方式问卷中消极应

  17. Donepezil in the treatment of early post-stroke aphasia:a randomized controlled trial%多奈哌齐治疗早期卒中后失语:随机对照研究

    Institute of Scientific and Technical Information of China (English)

    吴小琴; 刘晓加; 邢一兰; 王心宇

    2013-01-01

    Objective To investigate the effectiveness of donepezil in the treatment of early post-stroke aphasia (PSA).Methods PSA patients within one month after onset were randomly assigned into either a donepezil group or a control group.On the basis of conventional medication,the donepezil group was given hydrochloride donepezil 5 mg/d.The patients were followed-up after 4 week.The efficacy was evaluated by the Aphasia Battery of Chinese (ABC),the National Institute of Health Stroke Scale (NIHSS),the Stroke Aphasic Depression Questionnaire (SADQ),Chinese version,and the Treatment Emergent Symptom Scale (TESS) before and after treatment.Results A total of 48 PSA patients were enrolled in the study.Both the donepezil group and the control group had 24 patients and they all completed the study.There were no significant differences in age,years of education,NIHSS score,SADQ score,stroke duration,as well as the proportions of male,hypertension,diabetes,hyperlipidemia,heart disease,previous stroke or history of transient ischemic attack,smoking alcohol consumption,type of stroke,and lesion site (all P < 0.01).There were significant differences in each language score before and after treatment both in the donepezil group and in the control group (all P <0.01).The difference values of listening comprehension (47.8 ± 24.7 vs.22.0 ± 15.4; t =4.342,P =0.000)and reading comprehension (20.5 ± 14.0 vs.8.1 ± 10.5; t =3.483,P <0.01) scores before and after treatment in the donepezil group were significantly higher than those in the control group,while there were no significant differences in the information quantity of speech,fluency,series language,repetition,naming,and reading scores (all P >0.05).As compared with the control group,there were significant differences in the difference values of the SADQ scores before and after treatment in the donepezil group (6.2 ±6.0 vs.2.5 ±3.0; t =2.717,P=0.009).No serious adverse reactions were observed in both groups.Conclusions On

  18. Multimodal pain stimulation of the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Asbjφrn Mohr Drewes; Hans Gregersen

    2006-01-01

    Understanding and characterization of pain and other sensory symptoms are among the most important issues in the diagnosis and assessment of patient with gastrointestinal disorders. Methods to evoke and assess experimental pain have recently developed into a new area with the possibility for multimodal stimulation (e.g.,electrical, mechanical, thermal and chemical stimulation)of different nerves and pain pathways in the human gut. Such methods mimic to a high degree the pain experienced in the clinic. Multimodal pain methods have increased our basic understanding of different peripheral receptors in the gut in health and disease. Together with advanced muscle analysis, the methods have increased our understanding of receptors sensitive to mechanical,chemical and temperature stimuli in diseases, such as systemic sclerosis and diabetes. The methods can also be used to unravel central pain mechanisms, such as those involved in allodynia, hyperalgesia and referred pain. Abnormalities in central pain mechanisms are often seen in patients with chronic gut pain and hence methods relying on multimodal pain stimulation may help to understand the symptoms in these patients.Sex differences have been observed in several diseases of the gut, and differences in central pain processing between males and females have been hypothesized using multimodal pain stimulations. Finally, multimodal methods have recently been used to gain more insight into the effect of drugs against pain in the GI tract.Hence, the multimodal methods undoubtedly represents a major step forward in the future characterization and treatment of patients with various diseases of the gut.

  19. Evaluation of analgesic effect of tapentadol, a central novel analgesic versus tramadol, a widely used opioid analgesic in treatment of low back pain: a randomized controlled trial

    OpenAIRE

    Zaki Anwar Zaman; Deepak Kumar

    2013-01-01

    Background: The objective of the study was to compare efficacy and tolerability (safety) of tapentadol with tramadol in the treatment of low back pain. Methods: The study was a prospective, randomized, single blinded, total 102 patients are recruited for study in which 44 patients are prescribed (50mgtwice daily) tapentadol and 58 patients prescribed (50mg twice daily) tramadol for 4 weeks. Follow-up was done on days 7, 14, 28 and 4 week after stoppage of treatment. Assessment of improvement ...

  20. Ocular neuropathic pain.

    Science.gov (United States)

    Rosenthal, Perry; Borsook, David

    2016-01-01

    As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to these nociceptive pathways are determined by the type and location of its pathological elements and can range from the spectrum known as dry eye disease to the centalised oculofacial neuropathic pain syndrome characterised by a striking disparity between the high intensity of symptoms and paucity of external signs. These changes parallel those observed in somatic neuropathic pain. When seen through the neuroscience lens, diseases responsible for inadequately explained chronic eye pain (including those described as dry eye) can take on new meanings that may clarify long-standing enigmas and point to new approaches for developing preventive, symptomatic and disease-modifying interventions for these currently refractory disorders. PMID:25943558

  1. Finding pain between minds and bodies.

    Science.gov (United States)

    Sullivan, M D

    2001-06-01

    Physicians and patients alike find it easy to divide pain into mental pain and physical pain. But close examination of this distinction shows that it fails on clinical and philosophical grounds. The body is not a passive conduit for information about tissue damage. Nociception is modified and analyzed throughout the nervous system. The mind is not a central theater where pain is finally apprehended. Pain perception cannot be understood as the private observation of a pain sensation. Pain must have mental (e.g., aversion) and physical (e.g., location) elements if it is to qualify as pain. We understand our pain as well as the pain of others in terms of socially categorized pain behavior. Pain thus originates, not in mind or body, but between minds and bodies. The dualism of mental and physical pain cannot be overcome if the biological individual is considered in isolation. Mental and physical pain can only be reconciled if their common interpersonal roots are understood. This interpersonal view of pain can help clarify some clinical and moral dilemmas in the care of patients with pain. PMID:11444716

  2. Heightened cold pain and pressure pain sensitivity in young female adults with moderate-to-severe menstrual pain.

    Science.gov (United States)

    Slater, Helen; Paananen, Markus; Smith, Anne J; OʼSullivan, Peter; Briggs, Andrew M; Hickey, Martha; Mountain, Jenny; Karppinen, Jaro; Beales, Darren

    2015-12-01

    This study investigated the association between menstrual pain severity and psychophysical measures of cold and pressure pain sensitivity. A cross-sectional design was used with young women (n = 432) from the Western Australian Pregnancy Cohort (Raine) Study. Menstrual pain severity and oral contraception use was obtained from questionnaires at 20 and 22-year follow-ups. A visual analog scale (VAS; range from 0 [none] to 10 [unbearable]) was used to measure menstrual pain severity at both 20 and 22 years over the 3-year period, with 3 groups created: (1) no pain or mild pain (VAS 0-3), (2) at least moderate pain at a minimum of 1 of the 2 time points (hereafter named "mixed)", and (3) severe pain (VAS 8-10). Cold pain sensitivity (dorsal wrist) and pressure pain sensitivity (lumbar spine, upper trapezius, dorsal wrist, and tibialis anterior) were assessed using standardised quantitative sensory testing protocols. Confounding variables included number of musculoskeletal pain sites, oral contraceptive use, smoking, physical activity, body mass index, psychological distress, and sleep. Severe menstrual pain and mixed menstrual pain were positively associated with heightened cold pain sensitivity (distant from menstrual pain referral site) and pressure pain sensitivity (local to menstrual pain referral site). These associations remained significant after adjusting for potential confounding variables including multisite musculoskeletal pain. Our findings suggest peripheral and central neurophysiological mechanisms contributing to heightened pain sensitivity in young women with moderate and severe menstrual pain. These data highlight the need for innovative management approaches to attenuate the negative impact of severe menstrual pain in young women. PMID:26262827

  3. Pain Management in Functional Gastrointestinal Disorders

    OpenAIRE

    Vigano, Antonio; Bruera, Eduardo

    1995-01-01

    Pain is a common feature in functional gastrointestinal disorders (FGID). An abnormally low visceral sensory threshold, as well as a number of central, spinal and peripheral pain-modulating abnormalities, have been proposed for this syndrome. Clinical aspects of pain associated with irritable esophagus, functional dyspepsia, biliary dysmotility, inflammatory bowel syndrome and proctalgia fugax are reviewed. Because of its unclear pathophysiology, pain expression is the main target for the suc...

  4. Phantom limb pain

    Science.gov (United States)

    ... shooting pain Achy pain Burning pain Cramping pain Phantom limb pain will lessen over time for most people. ... Elsevier; 2012:chap 44. Bang MS, Jung SH. Phantom limb pain. In: Frontera, WR, Silver JK, eds. Essentials ...

  5. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of ...

  6. Recent Advances in Postoperative Pain Management

    OpenAIRE

    Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

    2010-01-01

    Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensiti...

  7. Imaging Brain Mechanisms in Chronic Visceral Pain

    OpenAIRE

    Mayer, Emeran A.; Gupta, Arpana; Kilpatrick, Lisa A.; Hong, Jui-Yang

    2015-01-01

    Chronic visceral pain syndromes are important clinical problems with largely unmet medical needs. Based on the common overlap with other chronic disorders of visceral or somatic pain, mood and affect, and their responsiveness to centrally targeted treatments, an important role of central nervous system in their pathophysiology is likely. A growing number of brain imaging studies in irritable bowel syndrome, functional dyspepsia and bladder pain syndrome/interstitial cystitis has identified ab...

  8. Autoantibody pain.

    Science.gov (United States)

    Goebel, Andreas

    2016-06-01

    As autoantibodies bind to target tissues, Fc-region dependent inflammation can induce pain via mediators exciting nociceptors. But recently another possibility has emerged, where autoantibody binding to nociceptors can directly cause pain, without inflammation. This is thought to occur as a result of Fab-region mediated modification of nerve transduction, transmission, or neuropeptide release. In three conditions, complex regional pain syndrome, anti-voltage gated potassium channel complex autoimmunity, and chronic fatigue syndrome, all associated with no or only little inflammation, initial laboratory-, and clinical trial-results have suggested a potential role for autoantibody-mediated mechanisms. More research assessing the pathogenic roles of autoantibodies in these and other chronic pain conditions is required. The concept of autoantibody-mediated pain offers hope for the development of novel therapies for currently intractable pains. PMID:26883460

  9. Phantom pain

    OpenAIRE

    Duca, Kristina; Muscat, Richard

    2016-01-01

    Almost anyone with a limb amputation experiences phantom sensations. Moreover, the majority of amputees experience pain. This phenomenon is known as ‘Phantom pain’ and is described as the pain felt from a body part, usually a limb, which is no longer present. Several mechanisms have been proposed in attempt to explain this phenomenon with some being more prevalent than others. Cortical remapping seems to explain a substantial part of the occurrence of phantom pain and will be focu...

  10. OPTIMIZING OVERALL FUNCTION OF THE UPPER LIMB IS EFFECTIVE TREATMENT FOR SHOULDER PAIN IN INDIVIDUALS WITH STROKE: A RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Mohamed E Khallaf, PhD PT

    2014-04-01

    Full Text Available Background: Shoulder pain is frequent after stroke and interferes with the rehabilitative process and functional outcomes. Treatments used for post-stroke shoulder pain are limited and largely ineffective. Objectives: This randomized controlled study was conducted to study the effect of optimizing overall function of upper limb on the basis of pathomechanics and motor relearning as a treatment of hemiparetic shoulder pain. Subjects and methods: Thirty patients with first ever stroke suffering shoulder pain on movement and at rest were included in this study. Pain was measured by the Visual Analogue Scale (VAS and Chedoke-McMaster Stroke Assessment (CMSA was used for measuring motor recovery and functional level. Shoulder abduction, flexion and external rotation ranges of motion (ROM were also measured. The participants were randomly assigned into two equal groups (G1 and G2. Those in G1 received an exercise therapy based on optimizing overall function of upper limb as a treatment of hemiparetic shoulder pain. Shoulder range of motion exercises were done for the patients represented G2. Treatments were applied for twelve weeks 5 times per week for 60 minutes. Results: shoulder pain and motor recovery scores improved significantly in addition to a significant increase in the shoulder ROMs (p < 0.05. Conclusion: These results suggest that exercise therapy which emphasize interrelationship of all areas of the upper limb to optimize overall function exerts positive effects on shoulder pain and functional recovery in participants with stroke.

  11. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

    Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache

  12. Correlation of video fluoroscopic swallowing study and clinical swallowing function of patients with post-stroke dysphagia%卒中后吞咽障碍荧光透视与临床吞咽功能的相关性

    Institute of Scientific and Technical Information of China (English)

    陈妙; 余梅; 黄建平; 朱文宗; 支英豪

    2014-01-01

    Objective To investigate the correlation between clinical presentations and the findings of video fluoroscopic swallowing study (VFSS)in patients with post-stroke dysphagia. Methods A total of 56 consecutive patients with post-stroke dysphagia admitted to Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from June 2012 to May 2014 were enrolled. Four different kinds of food were selectively used to complete clinical assessment of swallowing function and VFSS respectively. The SPSS 20. 0 statistical software was used to perform univariate and multivariate Logistic regression analyses for all observed indexes of the 2 methods. Results there were significant correlations in the point correspondence relation among the clinical manifestations and VFSS in food residue in the mouth and abnormal closure of lips in the oral phase (95%CI 1. 430-101. 468;P=0. 022);poor soft palate elevation and food residue in the mouth (95%CI 1. 476-102. 033;P=0. 020);graded swallowing and piecemeal deglutition with delayed oral transit (95% CI 2. 616 -182. 897;P = 0. 004);tongue movement disorders,poor soft palate elevation and tongue dyskinesia with poor bolus formation (95%CI 1. 468-50. 795,1. 220-13. 825;P=0. 017,0. 023);food leak from the corner of mouth,dysphagia,bolus falling to the epiglottis from the base of tongue or trachea (95%CI 1. 146-125. 459,1. 657-174. 400;P=0.038,0. 017). The weakened pharyngeal reflex with weak laryngeal elevation in the pharyngeal phase (95%CI 1. 150-92. 815;P =0. 037);dysphagia and delayed swallowing with prolonged triggering of swallowing reflex (95%CI 2. 123-37. 770,1. 233-114. 176;P=0. 003,0. 032);graded swallowing,hard swallowing, choking sensation,and poor laryngeal elevation with prolonged pharyngeal transit (95%CI 1. 619-223. 316,1. 061-31. 445,2. 834 -132. 707;P =0. 019,0. 042,and 0. 003);dysphagia and the opening of cricopharyngeal muscle insufficiency (95%CI 1. 037 -24. 115;P =0. 045);weak

  13. 中西医结合治疗在脑卒中后疲劳康复中的效果观察%Observation on Integrated Traditional Chinese and Western Medicine in Post-Stroke Fatigue Rehabilitation

    Institute of Scientific and Technical Information of China (English)

    李兰华; 郑健

    2014-01-01

    Objective:To observe the effect of TCM therapy in fatigue rehabilitation after stroke.Methods:Ninety one patients with stroke fatigue treated in our hospital from June 2010 to July 2013 was selected and randomly divided into control group (n =45)and treatment group (n =46).Patients in the control group received conventional western medicine treatment including oxygen support,blood glucose control,blood pressure,anticoagulation,proper diet,correct body water and electrolyte balance,anti-infective,anti-complications as well as scientific rehabilitation guidance to patients.Patients in the treatment group received extra “moxibustion,intermediate frequen-cy electric acupoint massage”therapy treatment apart from the same therapies as the control group applied.Fifteen days was one treat-ment course.After 2 courses of treatment,the patients clinical symptoms were compared,and the syndrome score improvement and chan-ges with fatigue severity scale (FSS)and the Quality of Life Scale dedicated stroke (SS-QOL)of patients with post-stroke fatigue were evaluated.The therapeutic effects of the two groups were compared.Results:The response rate of the control group was 73.3%,and that of the treatment group was 91.3%,and the difference between the groups was statistically significant (P 0.05);after treatment,fatigue severity scale (FSS)of patients of the both groups were decreased,and quality of life scale before special stroke (SS-QOL)increased,and patients in treatment group got better outcomes (P <0.05).Conclusion:The appli-cation of moxibustion and intermediate frequency electrical acupoint massage combined with western medicine treating post stroke fatigue is a feasible and effective treatment option.It can nourish the yuan qi and consolidate the root,sooth and benefit qi,activate blood so as to effectively relieve clinical symptoms mainly manifested with fatigue,improve quality of life and hence treat both the tip and root of the disease.The therapy shall good

  14. Segmental hypersensitivity and spinothalamic function in spinal cord injury pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Sørensen, Leif Hougaard; Biering-Sørensen, Fin; Johannesen, Inger L.; Jensen, Troels Staehelin

    2007-01-01

    thermal detection thresholds below injury level. SCI patients with central pain had sensory hypersensitivity in dermatomes corresponding to the lesion level more frequently than SCI patients without pain, but this may in part be explained by the exclusion of at-level spontaneous pain in the pain...

  15. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

    Directory of Open Access Journals (Sweden)

    Samantha D. Outcalt, PhD

    2014-07-01

    Full Text Available Chronic pain and posttraumatic stress disorder (PTSD co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF Veterans with chronic pain only (n = 173 were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68. Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality, and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.

  16. The role of sensitization in musculoskeletal shoulder pain

    OpenAIRE

    John Borstad; Christopher Woeste

    2015-01-01

    Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. Method: This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. Results: All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studie...

  17. Face pain

    Science.gov (United States)

    ... begin in other places in the body. Abscessed tooth (ongoing throbbing pain on one side of the lower face that ... chap 18. Digre KB. Headaches and other head pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap ...

  18. Painful shoulder

    Directory of Open Access Journals (Sweden)

    Benno Ejnismann

    2008-03-01

    Full Text Available Many factors can be involved in the painful shoulder. Beyond articularcauses other pathologies such as artrosis, periarticular diseases as rotadorcuff tears, long head of the biceps tendinitis, adhesive capsulitis, calcifyingtendinitis, degenerative arthritis of the acromioclavicular joint, cervicalradiculopathy and nervous injuries can cause pain in the shoulder.

  19. Pain frequency moderates the relationship between pain catastrophizing and pain

    Science.gov (United States)

    Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

  20. Pain frequency moderates the relationship between pain catastrophizing and pain

    Directory of Open Access Journals (Sweden)

    Heidi eKjøgx

    2014-12-01

    Full Text Available Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students and a clinical (223 pain patients sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed.Conclusions This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations.

  1. To centralize or not to centralize?

    OpenAIRE

    Campbell, Andrew; Kunisch, Sven; Müller-Stewens, Günter

    2011-01-01

    The CEO's dilemma-were the gains of centralization worth the pain it could cause?-is a perennial one. Business leaders dating back at least to Alfred Sloan, who laid out GM's influential philosophy of decentralization in a series of memos during the 1920s, have recognized that badly judged centralization can stifle initiative, constrain the ability to tailor products and services locally, and burden business divisions with high costs and poor service.1 Insufficient centralization can deny bus...

  2. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization. A randomized controlled trial

    DEFF Research Database (Denmark)

    Petersen, Tom; Larsen, Kristian; Nordsteen, Jan; Olsen, Steen; Fournier, Gilles; Jacobsen, Soren

    2011-01-01

    ABSTRACT: Study design. Randomized controlled trial.Objective. To compare the effects of the McKenzie-method performed by certified therapists with spinal manipulation performed by chiropractors when used adjunctive to information and advice.Summary of Background Data. Recent guidelines recommend a...... showed clinically meaningful improvements in this study. At two months follow-up, the McKenzie treatment was superior to manipulation with respect to the number of patients who reported success following treatment (71% and 59% respectively) (odds ratio 0.58, 95% confidence interval (CI) 0.36 to 0.91, P...... back pain for more than six weeks presenting with centralization or peripheralization of symptoms, we found the McKenzie method to be slightly more effective than manipulation when used adjunctive to information and advice....

  3. Complex regional pain syndrome.

    Science.gov (United States)

    Bruehl, Stephen

    2015-01-01

    Complex regional pain syndrome is a chronic pain condition characterized by autonomic and inflammatory features. It occurs acutely in about 7% of patients who have limb fractures, limb surgery, or other injuries. Many cases resolve within the first year, with a smaller subset progressing to the chronic form. This transition is often paralleled by a change from "warm complex regional pain syndrome," with inflammatory characteristics dominant, to "cold complex regional pain syndrome" in which autonomic features dominate. Multiple peripheral and central mechanisms seem to be involved, the relative contributions of which may differ between individuals and over time. Possible contributors include peripheral and central sensitization, autonomic changes and sympatho-afferent coupling, inflammatory and immune alterations, brain changes, and genetic and psychological factors. The syndrome is diagnosed purely on the basis of clinical signs and symptoms. Effective management of the chronic form of the syndrome is often challenging. Few high quality randomized controlled trials are available to support the efficacy of the most commonly used interventions. Reviews of available randomized trials suggest that physical and occupational therapy (including graded motor imagery and mirror therapy), bisphosphonates, calcitonin, subanesthetic intravenous ketamine, free radical scavengers, oral corticosteroids, and spinal cord stimulation may be effective treatments. Multidisciplinary clinical care, which centers around functionally focused therapies is recommended. Other interventions are used to facilitate engagement in functional therapies and to improve quality of life. PMID:26224572

  4. La estimulación eléctrica del sistema nervioso central con finalidad analgésica The electrical stimulation of the central nervous system for pain control

    Directory of Open Access Journals (Sweden)

    J. A. López-López

    2006-06-01

    Full Text Available Esta revisión pretende orientar al lector sobre los procedimientos empleados para el control del dolor crónico, preferentemente neuropático, por medio de la electricidad. Historia de la utilización de la electricidad con finalidad analgésica, con descripción de los usos primitivos en el siglo XVIII y su evolución. Estimulación eléctrica medular: Se describen los mecanismos de acción, la selección de los pacientes, las técnicas de implante, la forma de realización de los diferentes procedimientos y sus complicaciones y el manejo de las mismas. Estimulación cerebral: Se sigue el mismo esquema que en el apartado anterior, diferenciándose en dos apartados: la estimulación cerebral profunda y la estimulación de la corteza prefrontal.Different procedures using electricity for pain control (mainly neuropathic are described in this review. History of the so-called utility of electricity for pain control, describing the early attempts at the XVIII century and their evolution. Spinal cord stimulation: How does it works, patient’s selection, implant techniques, how to do the different procedures and complications and their management are described. Brain stimulation: The same scheme as above, concerning both Deep Brain Stimulation and Motor Cortex Stimulation.

  5. Which treatment for low back pain? A factorial randomised controlled trial comparing intravenous analgesics with oral analgesics in the emergency department and a centrally acting muscle relaxant with placebo over three days [ISRCTN09719705

    Directory of Open Access Journals (Sweden)

    Koreny Maria

    2001-11-01

    Full Text Available Abstract Background About two thirds of adults suffer from backpain at some time during their life. In the emergency room many patients with acute back pain are treated with intravenous non-steroidal analgesics. Whether this treatment is superior to oral administration of non-steroidal analgesics is unknown. Intravenous administration, however, requires considerable amounts of resources and accounts for high workload in busy clinics. In the further course centrally acting muscle relaxants are prescribed but the effectiveness remains unclear. The objective of this study is on the one hand to compare the effectiveness of intravenous with oral non-steroidal analgesics for acute treatment and on the other hand to compare the effectiveness of a centrally active muscle relaxant with placebo given for three days after presentation to the ED (emergency department. Methods/Design This study is intended as a randomised controlled factorial trial mainly for two reasons: (1 the sequence of treatments resembles the actual proceedings in every-day clinical practice, which is important for the generalisability of the results and (2 this design allows to take interactions between the two sequential treatment strategies into account. There is a patient preference arm included because patients preference is an important issue providing valuable information: (1 it allows to assess the interaction between desired treatment and outcome, (2 results can be extrapolated to a wider group while (3 conserving the advantages of a fully randomised controlled trial. Conclusion We hope to shed more light on the effectiveness of treatment modalities available for acute low back pain.

  6. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  7. Complex Regional Pain Syndrome (CRPS/RSD and Neuropathic Pain: Role of Intravenous Bisphosphonates as Analgesics

    Directory of Open Access Journals (Sweden)

    Jennifer Yanow

    2008-01-01

    Full Text Available Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology remains elusive and whose available treatment options remain few. While an exact animal model for CRPS doesn't yet exist, there are several animal models of neuropathic pain that develop behaviors of hypersensitivity, one of the hallmark signs of neuropathic pain in humans.

  8. [Spiritual pain].

    Science.gov (United States)

    Sato, Satoru

    2011-09-01

    We defined a spiritual pain as feelings of failure and regret at end-of-life, followed by hopelessness and worthlessness in patient's own life. In Japanese, spiritual pain should be assessed in patient's dignity, psycho-social factor, and prognostic stage, not only in religious context. And patient's spirituality should be supported with providing pain and symptom relief based on human relationships. "Sterbebegleitung" is a German proverb, introduced by Alfons Deeken, and seemed to be a suggestive word for such hope-recovering relationships. PMID:21950035

  9. Painful TV

    OpenAIRE

    Pahlen, Kai Graf von

    2011-01-01

    There is a new and profitable market for the infliction of real pain on television, most notably in the British reality television shows ‘Balls of Steel’ and ‘Dirty Sanchez’, which involve two men, known as the ‘Pain Men’, who deliberately inflict consensual pain on each other in order to entertain their television audience. The law says that the consent of the ‘victim’ to an infliction of actual bodily harm does not usually prevent criminal liability of the ‘perpetrator’. The leading case au...

  10. What a Pain! Kids and Growing Pains

    Science.gov (United States)

    ... Here's Help White House Lunch Recipes What a Pain! Kids and Growing Pains KidsHealth > For Kids > What a Pain! Kids and ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

  11. EAU guidelines on pain management.

    Science.gov (United States)

    Francesca, Francesco; Bader, Pia; Echtle, Dieter; Giunta, Francesco; Williams, John

    2003-10-01

    Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic. Caregivers are to face pain in two main settings: after surgery and in cancer patients. These tasks require a multidisciplinary team, able to properly assess and treat pain. Postoperative pain is to be treated early and aggressively. Several drug options are available, to be tailored on the surgical procedure and the patient. Pain in cancer patients consists of different aspects: it can be caused by the cancer itself or may be secondary to muscular spasm or cancer treatments. The management involves mainly pharmacotherapy, but also primary treatments as surgery, radiochemotherapy or even antibiotics can provide an adequate relief. Analgesics are to be employed according to an ascending scale, but other options can be combined to improve the outcome when a satisfactory balance between relief and side effects is not achieved; they include invasive techniques, physical and psychological therapy. The mainstay of pain management entails a interdisciplinary cooperation; it requires a full knowledge of the methods of evaluation and treatment of this condition. PMID:14499670

  12. Do glial cells control pain?

    OpenAIRE

    Suter, Marc R; Wen, Yeong-Ray; Decosterd, Isabelle; Ji, Ru-Rong

    2007-01-01

    Management of chronic pain is a real challenge, and current treatments focusing on blocking neurotransmission in the pain pathway have only resulted in limited success. Activation of glia cells has been widely implicated in neuroinflammation in the central nervous system, leading to neruodegeneration in many disease conditions such as Alzheimer’s and multiple sclerosis. The inflammatory mediators released by activated glial cells, such as tumor necrosis factor-α and interleukin-1β can not onl...

  13. Chronic Pelvic Pain

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  14. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Programs Resource Guide to Chronic Pain Treatments Pain Awareness Toolkits Partners for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is ...

  15. 脑卒中后焦虑患者健康相关生存质量及其相关因素%Health-related quality of life and its related factors in Patients with Post-stroke anxiety

    Institute of Scientific and Technical Information of China (English)

    郝贵峰; 王帅华; 郑晓明; 朱崇田

    2014-01-01

    目的:探讨脑卒中后焦虑(PSA)患者健康相关生存质量(HRQOL)及其相关因素。方法:对317例不同临床类型缺血性脑卒中患者进行临床神经功能缺损程度、脑卒中专门化生存质量量表(SS-QOL)评分,对符合 PSA 诊断的患者进行 Hamilton 焦虑量表评分;分析与 HRQOL 相关的因素。结果:PSA 发生率为45.11±(143例);不同卒中类型患者 PSA 发生率差异无统计学意义,SS-QOL 评分由低到高依次为完全前循环梗死型、部分前循环梗死型、后循环梗死型及腔隙性梗死型,各型间差异有统计学意义(P ﹤0.05)。除语言因子外,PSA 组 SS-QOL 总分及其他各因子明显低非 PSA 组(P ﹤0.05或0.01);焦虑程度重、女性、﹤60岁、未婚或丧偶、高中以上文化程度、家庭月收入﹤2000元、神经功能缺损程度重和住院期间由护工照顾与 HRQOL 呈相关性。结论:PSA 发生率较高,性别、年龄、婚姻状况、文化程度、家庭月收入、神经功能缺损程度、照顾者及焦虑程度是影响 PSA 患者 HRQOL 的因素。%To investigate the health-related quality of life(HRQOL)and its influence fac-tors in patients with post-stroke anxiety(PSA). Method:Three hundred and seventeen patients with differ-ent clinical types ischemic stroke were assessed by the egree of clinical neural function defect scale and stroke-specific quality of life(SS-QOL)scale. The patients conformed PSA diagnostic criteria were evaluated by Ham-ilton anxiety scale. The associated factors of HRQOL were analyzed. Results:The PSA incidence among those patients was 45. 11±(143 cases),which among the different types of stroke was not significantly different. The scores from low to high were anterior circulation infarct,partial anterior circulation infarct,posterior circulation infarction and lacunar infarction and which had significant differences among the different types of stroke(P ﹤0. 05

  16. Joint pain

    Science.gov (United States)

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: gout (especially ...

  17. Penis pain

    Science.gov (United States)

    Pain - penis ... Bites, either human or insect Cancer of the penis Erection that does not go away (priapism) Genital herpes Infected hair follicles Infected prosthesis of the penis Infection under the foreskin of uncircumcised men ( balanitis ) ...

  18. Chronic Pain

    Science.gov (United States)

    ... who have chronic pain may also have low self-esteem, depression, and anger. Causes & Risk Factors What causes ... as stretching and strengthening activities) and low-impact exercise (such as walking, swimming, or biking) can help ...

  19. Abdominal pain

    Science.gov (United States)

    ... What makes the pain better? For example, drinking milk, having a bowel movement, or taking an antacid? What medications are you taking? OTHER MEDICAL HISTORY Have you had a recent injury? Are you ...

  20. Chronic Pain

    Science.gov (United States)

    ... NINDS). NINDS Trigeminal Neuralgia Information Page Trigeminal Neuralgia (tic doloreaux) information compiled by NINDS, the National Institute ... Complex Regional Pain Syndromes (CRPS): State-of-the-Science A workshop on Reflex Sympathetic Dystrophy/ Complex Regional ...

  1. Heel Pain

    Science.gov (United States)

    ... improperly fitted or excessively worn shoes, or obesity. Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective ...

  2. Shoulder pain

    Science.gov (United States)

    Pain - shoulder ... The shoulder is the most movable joint in the human body. A group of 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or ...

  3. Persistent postsurgical pain: risk factors and prevention

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Jensen, Troels Staehelin; Woolf, Clifford J.

    2006-01-01

    Acute postoperative pain is followed by persistent pain in 10-50% of individuals after common operations, such as groin hernia repair, breast and thoracic surgery, leg amputation, and coronary artery bypass surgery. Since chronic pain can be severe in about 2-10% of these patients, persistent...... chronic pain. Based on information about the molecular mechanisms that affect changes to the peripheral and central nervous system in neuropathic pain, several opportunities exist for multimodal pharmacological intervention. Here, we outline strategies for identification of patients at risk and for...

  4. Pain in fibromyalgia and related conditions

    Directory of Open Access Journals (Sweden)

    G. Cassisi

    2014-06-01

    Full Text Available Pain is the hallmark symptom of fibromyalgia (FM and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as “central pain”, “neuropathic pain”, “nonnociceptive pain” or “central sensitivity syndromes”. The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.

  5. Cancer pain: Classification and pain syndromes

    Directory of Open Access Journals (Sweden)

    Grujičić Danica

    2004-01-01

    Full Text Available In spite the new information's about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of which vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullar pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors. Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.

  6. Pain Sensitisation in Women with Active Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Vladimirova, Nora; Jespersen, Anders; Bartels, Else Marie;

    2015-01-01

    Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitis......Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain...... sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA (DAS28 > 2.6) and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on...... the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p < 0.01) and pain tolerance (p < 0.01) than HC. The mean temporal summation- (TS-) index in RA patients...

  7. Treatment Considerations for Cancer Pain: A Global Perspective.

    Science.gov (United States)

    Pergolizzi, Joseph V; Gharibo, Christopher; Ho, Kok-Yuen

    2015-11-01

    Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. Reasons for undertreating cancer pain include attitudes of patients, clinicians, and factors associated with healthcare systems. The consequences of not treating cancer pain may include reduced quality of life for patients with cancer (who now live longer than ever), functional decline, and increased psychological stress. Early analgesic intervention for cancer pain may reduce the risk of central sensitization and chronification of pain. To manage pain in oncology patients, clinicians should assess pain during regular follow-up visits using validated pain measurement tools and follow prescribing guidelines, if necessary referring patients with cancer to pain specialists. Many patients with cancer require opioids for pain relief. Pain associated with cancer may also relate to cancer treatments, such as chemotherapy-induced peripheral neuropathy. Many patients with cancer are what might be considered "special populations," in that they may be elderly, frail, comorbid, or have end-stage organ failure. Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes. PMID:25469726

  8. Pain relief can be painful

    Directory of Open Access Journals (Sweden)

    Ashish Bindra

    2015-01-01

    Full Text Available Mandibular nerve block is periodically used procedure used to treat neuralgic pain in the distribution of trigeminal nerve. It is a commonly performed block in outpatient settings at our institute. We present a case of an elderly edentulous patient with trigeminal neuralgia who suffered recurrent temporomandibular joint (TMJ dislocation following mandibular nerve block. The patient presented with complaints of severe pain, inability to close mouth, and eat food since 2 days. Anterior closed reduction of TMJ resulted in reduction of joint and immediate pain relief. However, the maneuver failed due to recurrent dislocation of the joint. A Barton dressing was applied to prevent another dislocation. This was followed by autologous blood injection into the joint. This case focuses on the preponderance of clinical evaluation and accentuates the need for additional forethought to be taken during pain procedures, particularly in the geriatric population.

  9. Orofacial pain management: current perspectives.

    Science.gov (United States)

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  10. Motor Cortex Stimulation for the Treatment of Chronic Facial, Upper Extremity, and Throat Pain.

    Science.gov (United States)

    2016-02-22

    Trigeminal Neuralgia (Burchiel Type I); Trigeminal Neuralgia (Burchiel Type II); Trigeminal Neuropathic Pain; Trigeminal Deafferentation Pain; Complex Regional Pain Syndrome (Types I and II, Involving the Upper Extremity); Glossopharyngeal Neuralgia; Upper Extremity Pain Due to Deafferentation of the Cervical Spine; Central Pain Syndromes

  11. Neuropathic pain due to malignancy: Mechanisms, clinical manifestations and therapy

    Directory of Open Access Journals (Sweden)

    Pjević Miroslava

    2004-01-01

    Full Text Available Introduction Neuropathic pain in cancer patients requires a focused clinical evaluation based on knowledge of common neuropathic pain syndromes. Definition Neuropathic pain is a non-nociceptive pain or "differentiation" pain, which suggests abnormal production of impulses by neural tissue that is separated from afferent input. Impulses arise from the peripheral nervous system or central nervous system. Causes of neuropathic pain due to malignancy Neuropathic pain is caused directly by cancer-related pathology (compression/infiltration of nerve tissue, combination of compression/infiltration or by diagnostic and therapeutic procedures (surgical procedures, chemotherapy, radiotherapy. Mechanisms Pathophysiological mechanisms are very complex and still not clear enough. Neuropathic pain is generated by electrical hyperactivity of neurons along the pain pathways. Peripheral mechanisms (primary sensitization of nerve endings, ectopically generated action potentials within damaged nerves, abnormal electrogenesis within sensory ganglia and central mechanisms (loss of input from peripheral nociceptors into dorsal horn, aberrant sprouting within dorsal horn, central sensitization, loss of inhibitory interneurons, mechanisms at higher centers are involved. Diagnosis The quality of pain presents as spontaneous pain (continuous and paroxysmal, abnormal pain (allodynia, hyperalgesia, hyperpathia, paroxysmal pain. Clinical manifestations Clinically, neuropathic pain is described as the pain in the peripheral nerve (cranial nerves, other mononeuropathies, radiculopathy, plexopathy, paraneoplastic peripheral neuropathy and relatively infrequent, central pain syndrome. Therapy Treatment of neuropathic pain remains a challenge for clinicians, because there is no accepted algorithm for analgesic treatment of neuropathic pain. Pharmacotherapy is considered to be the first line therapy. Opioids combined with non-steroidal antiinflammatory drugs are warrented. If

  12. Pain characteristics in fibromyalgia: understanding the multiple dimensions of pain.

    Science.gov (United States)

    Plazier, Mark; Ost, Jan; Stassijns, Gaëtane; De Ridder, Dirk; Vanneste, Sven

    2015-04-01

    Fibromyalgia is a common disease with a high economic burden. The etiology of this disease remains unclear, as there are no specific abnormalities on clinical or technical examinations. Evidence suggests that central pain sensitization at the brain pain matrix might be involved. Understanding the pain characteristics of this disease is of importance both for diagnosis and treatment. The authors present their findings of pain characteristics in a Belgium population of fibromyalgia patients. Data of 65 patients (57 male and 8 female patients) were analyzed in this study (mean age 46.86, SD = +8.79). Patients filled out the following questionnaires: visual analogue scale, fibromyalgia impact questionnaire, pain-catastrophizing scale, pain vigilance and awareness questionnaire, modified fatigue impact scale, the Beck depression inventory, the short form 36 and the Dutch shortened profile of mood states. Statistical analysis was performed making use of a factor analysis and a hierarchical cluster analysis. We were able to define pain characteristics in this group of patients. The reciprocal effects of mood and fatigue on pain experience could be identified within the data, catastrophizing scores show a high correlation with overall life quality and pain experience. We have performed a cluster analysis on the fibromyalgia patients, based on the four main principal components defining the overall disease burden. Mood explained most of the variance in symptoms, followed by mental health state, fatigue, and catastrophizing. Three clusters of patients could be revealed by these components. Clusters: 1 high scores on mood disorders, pain, and decreased mental health, 2 high scores on fatigue and physical health, and 3 a mixture of these two groups. This data suggest that different subgroups of fibromyalgia patients could be identified and based on that, treatment strategies and results might be adapted. PMID:25048743

  13. Phantom Limb Pain: Mechanisms and Treatment Approaches

    OpenAIRE

    Bishnu Subedi; George T. Grossberg

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neuron...

  14. Elucidating an Affective Pain Circuit that Creates a Threat Memory.

    Science.gov (United States)

    Han, Sung; Soleiman, Matthew T; Soden, Marta E; Zweifel, Larry S; Palmiter, Richard D

    2015-07-16

    Animals learn to avoid harmful situations by associating a neutral stimulus with a painful one, resulting in a stable threat memory. In mammals, this form of learning requires the amygdala. Although pain is the main driver of aversive learning, the mechanism that transmits pain signals to the amygdala is not well resolved. Here, we show that neurons expressing calcitonin gene-related peptide (CGRP) in the parabrachial nucleus are critical for relaying pain signals to the central nucleus of amygdala and that this pathway may transduce the affective motivational aspects of pain. Genetic silencing of CGRP neurons blocks pain responses and memory formation, whereas their optogenetic stimulation produces defensive responses and a threat memory. The pain-recipient neurons in the central amygdala expressing CGRP receptors are also critical for establishing a threat memory. The identification of the neural circuit conveying affective pain signals may be pertinent for treating pain conditions with psychiatric comorbidities. PMID:26186190

  15. Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

    DEFF Research Database (Denmark)

    Vase, Lene; Nikolajsen, Lone; Christensen, Bente;

    2011-01-01

    Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after...... amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty......-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients' level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick...

  16. Foot pain

    OpenAIRE

    Formosa, Aaron

    2005-01-01

    Foot complaints are very common in general practice and their incidence increases with age. Three out of four people complain of foot pain during the course of a lifetime, while approximately 20% of people aged 65 years or older complain of non-traumatic foot problems.

  17. Knee pain

    Science.gov (United States)

    ... time, overuse, or injury. Dislocation of the kneecap Fracture of the kneecap or other bones Iliotibial band syndrome . Injury to the thick band that runs from your hip to the outside of your knee. Pain in the front of your knee around ...

  18. Pain Control

    Science.gov (United States)

    ... you are able. Any movement, such as light walking, will help. ■■ Call your doctor if you have not had a bowel movement in 2 days or more. Drowsiness Some opioids cause drowsiness. Or, if your pain has kept you from sleeping, you may sleep more at first when you ...

  19. Pain (PDQ)

    Science.gov (United States)

    ... intravenous chemotherapy. Mucositis (sores or inflammation in the mouth or other parts of the digestive system ) caused by chemotherapy or targeted therapy. Skin pain, rash, or hand-foot syndrome (redness, tingling, or burning in the palms of the hands and/or ...

  20. A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis.

    Science.gov (United States)

    Langford, R M; Mares, J; Novotna, A; Vachova, M; Novakova, I; Notcutt, W; Ratcliffe, S

    2013-04-01

    Central neuropathic pain (CNP) occurs in many multiple sclerosis (MS) patients. The provision of adequate pain relief to these patients can very difficult. Here we report the first phase III placebo-controlled study of the efficacy of the endocannabinoid system modulator delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (USAN name, nabiximols; Sativex, GW Pharmaceuticals, Salisbury, Wiltshire, UK), to alleviate CNP. Patients who had failed to gain adequate analgesia from existing medication were treated with THC/CBD spray or placebo as an add-on treatment, in a double-blind manner, for 14 weeks to investigate the efficacy of the medication in MS-induced neuropathic pain. This parallel-group phase of the study was then followed by an 18-week randomized-withdrawal study (14-week open-label treatment period plus a double-blind 4-week randomized-withdrawal phase) to investigate time to treatment failure and show maintenance of efficacy. A total of 339 patients were randomized to phase A (167 received THC/CBD spray and 172 received placebo). Of those who completed phase A, 58 entered the randomized-withdrawal phase. The primary endpoint of responder analysis at the 30 % level at week 14 of phase A of the study was not met, with 50 % of patients on THC/CBD spray classed as responders at the 30 % level compared to 45 % of patients on placebo (p = 0.234). However, an interim analysis at week 10 showed a statistically significant treatment difference in favor of THC/CBD spray at this time point (p = 0.046). During the randomized-withdrawal phase, the primary endpoint of time to treatment failure was statistically significant in favor of THC/CBD spray, with 57 % of patients receiving placebo failing treatment versus 24 % of patients from the THC/CBD spray group (p = 0.04). The mean change from baseline in Pain Numerical Rating Scale (NRS) (p = 0.028) and sleep quality NRS (p = 0.015) scores, both secondary endpoints in phase B, were also statistically

  1. Physiopathology of pain in rheumatology

    Directory of Open Access Journals (Sweden)

    M. Cazzola

    2014-06-01

    Full Text Available Pain is the main manifestation of many rheumatic diseases (be they overtly inflammatory such as rheumatoid arthritis or dysfunctional such as fibromyalgia but, at least initially, the mechanisms involved in the genesis, amplification and chronicisation of the persistent pain characterising the various conditions can be very different. The main peripheral mechanism underlying acute nociceptive pain is a change in the activity of the nociceptors located in the affected anatomical structures (joints, tendons and ligaments, which makes them more sensitive to normally painful stimuli (hyperalgesia or normally non-painful stimuli (allodynia. This physiopathological mechanism of peripheral sensitisation plays a primary role in rheumatic diseases characterised by acute inflammation, such as the arthritides due to microcrystals. In the case of chronic rheumatic diseases that do not regress spontaneously, functional and structural central nervous system changes cause a generalised reduction in the pain threshold that is not limited to the anatomical structures involved, thus leading to the appearance of hyperalgesia and allodynia in many, if not all body districts. This is the physiopathological basis of chronic, widespread musculoskeletal pain.

  2. American Pain Society

    Science.gov (United States)

    ... Adjuvant Analgesic for Cancer Pain Drug Treatments for Heroin Addiction Heighten Pain Sensitivity Genetic Alteration Predicts Pain Recovery After Sexual Assault Health Care Reforms Will Change How Pain Is Assessed ...

  3. What Is Chronic Pain?

    Medline Plus

    Full Text Available Already a member? Log In or Sign Up Home About Us Support the ACPA Contact Us Shop ... for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is Chronic Pain? ...

  4. Employees with Chronic Pain

    Science.gov (United States)

    ... Home | Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information ... at http://AskJAN.org/soar. Information about Chronic Pain How prevalent is chronic pain? Chronic pain has ...

  5. Abdominal Pain or Cramping

    Science.gov (United States)

    ... Body & lifestyle changes > Abdominal pain or cramping Abdominal pain or cramping E-mail to a friend Please ... signs of severe pain. What causes mild belly pain in pregnancy? There are different causes for mild ...

  6. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... ACPA Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  7. When Sex Is Painful

    Science.gov (United States)

    ... AQ FREQUENTLY ASKED QUESTIONS GYNECOLOGIC PROBLEMS FAQ020 When Sex Is Painful • How common is painful sex? • What causes pain during sex? • Where is pain during sex felt? • When should ...

  8. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  9. Alternative medicine - pain relief

    Science.gov (United States)

    Acupuncture - pain relief; Hypnosis - pain relief; Guided imagery - pain relief ... you repeat a positive statement over and over. Hypnosis may help relieve pain for: After surgery or labor Arthritis Cancer Fibromyalgia ...

  10. Pain Catastrophizing is Associated with Dental Pain in a Stressful Context

    Science.gov (United States)

    Lin, C.-S.; Niddam, D.M.; Hsu, M.-L.; Hsieh, J.-C.

    2013-01-01

    Pain is associated with anxiety in a dental setting. It has remained unclear how cognitive-affective factors modulate pain and anxiety in a stressful context, such as receiving dental procedures. We hypothesized that both the situational factor (unpredictability about painful stimuli) and the trait factor (pain catastrophizing, i.e., the tendency to interpret pain in negative orientation) account for dental pain. Fifteen healthy participants were recruited to perform an associative learning task. They were asked to learn the pairing between visual cues and the intensity of incoming painful stimuli delivered at the right upper central incisor. Brain activation associated with pain was recorded by functional magnetic resonance imaging (fMRI). The participants reported increased anxiety and pain in the stressful context, where stimuli intensity was not predicted by the preceding cue. The score of the Pain Catastrophizing Scale was positively correlated with the increased pain modulated by unpredictability. Brain activation at the right posterior hippocampus, a region critically related to associative learning of aversive stimuli and context, was correlated with the individual catastrophizing level. Our findings suggest that both the situational factor (unpredictability) and the trait factor (catastrophizing) influence dental pain, highlighting the role of cognitive-affective factors in pain control of dental patients. PMID:23232145

  11. Shoulder pain

    OpenAIRE

    Dorinson, S. Malvern

    2010-01-01

    “Topics in Primary Care Medicine” presents articles on common diagnostic or therapeutic problems (such as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections) encountered in primary care practice that generally do not fall into well-defined subspecialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests...

  12. Nutrition Effect Comparison of Percutaneous Endoscopic Gastrostomy and Nasogastric Feeding in Post-Stroke Patients with Dysphagia%卒中后吞咽障碍患者胃造瘘与鼻饲肠内营养效果比较

    Institute of Scientific and Technical Information of China (English)

    秦延京; 李巍; 吴东宇; 王海玲

    2011-01-01

    Objective To compare the enteral nutrition efficiency of percutaneous endoscopicgastrostomy(PEG) with nasogastric feeding(NGF) in post-stroke patients with dysphagia.Methods Seventy-six patients with post-stroke dysphagia were divided into 2 groups:PEG enteralnutrition group(n=36) and nasogastric feeding(NGF) group(n=40). Patients in both groups werefed with same nutrient fluids. Complications such as pulmonary infections, reflux esophagitis,gastrointestinal hemorrhage, hypoalbuminemia and electrolyte disturbances were also compared.Results The incidences of above complications were 7.5%、 7.5%、 5%、 5% and 2.5% for thePEG group, 25%、 27.8%、 22.2%、 22.2% and 16.7% for the NGF group. The incidences of allcomplications in PEG enteral nutrition group were significantly lower than those in NGF group(allP<0.05, respectively).Conclusion PEG enteral nutrition had an advantage over NGF in improving nutritional status ofpatients and in reducing complications, and it may be a better way to improve the nutrition state inpatients with post-stroke dysphagia.%目的 探讨卒中后吞咽障碍患者胃造瘘与鼻饲肠内营养的效果.方法 将卒中后吞咽障碍76例患者,分为经皮胃造瘘术(percutaneous endoscopic gastrostomy,PEG)组40例和鼻胃管饲(nasogastric feeding,NGF)组36例.给予相同的营养液,比较2组患者肺部感染、反流性食管炎、消化道出血、低蛋白血症、电解质紊乱等并发症的发生情况.结果 PEG组治疗后肺部感染、反流性食管炎、消化道出血、低蛋白血症、电解质紊乱发生率分别为7.5%、7.5%、5%、5%、2.5%.NGF组肺部感染反流性食管炎、消化道出血、低蛋白血症、电解质紊乱发生率分别为25%、27.8%、22.2%、22.2%、16.7%.PEG组治疗后各种并发症的发生率均小于NGF组(均P<0.05).结论 PEG肠内营养在减少并发症方面优于经鼻胃管管饲营养.

  13. Pain Management: Post-Amputation Pain

    Science.gov (United States)

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print page Save and share ... by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of the most ...

  14. Chronic widespread pain in spondyloarthritis

    Directory of Open Access Journals (Sweden)

    F. Atzeni

    2014-06-01

    Full Text Available The pain associated with spondyloarthritis (SpA can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP that characterises fibromyalgia (FM. The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

  15. Taking Sides with Pain – Lateralization aspects Related to Cerebral Processing of Dental Pain

    OpenAIRE

    Mike Brügger; Ettlin, Dominik A; Thierry Keller; Roger Luechinger; Ashley Barlow

    2011-01-01

    The current fMRI study investigated cortical processing of electrically induced painful tooth stimulation of both maxillary canines and central incisors in 21 healthy, right-handed volunteers. A constant current, 150% above tooth specific pain perception thresholds was applied and corresponding online ratings of perceived pain intensity were recorded with a computerized visual analog scale during fMRI measurements. Lateralization of cortical activations was investigated by a region of interes...

  16. Chronic pain disrupts the reward circuitry in multiple sclerosis.

    Science.gov (United States)

    Seixas, Daniela; Palace, Jacqueline; Tracey, Irene

    2016-08-01

    Pain commonly affects multiple sclerosis (MS) patients, and has the potential to become chronic and burden an already damaged central nervous system. Imaging studies are providing insights into brain restructuring associated with chronic pain and different chronic pain conditions seem to evoke distinct plasticity patterns. Our objective was to study the structural and functional brain changes of chronic neuropathic pain of MS. Employing structural and resting functional magnetic resonance imaging we compared MS patients with chronic central pain with MS patients without pain matched with respect to age, gender, subtype and duration of MS and disability. Mean duration of pain was 7.6 years. Comparing the pain and no-pain groups, brain functional default-mode network differences were found. There was decreased coactivation in the caudate nucleus and nucleus accumbens bilaterally. Also, for the relapsing-remitting subgroup of patients, grey matter thickness changes predominated in the pain group in the mesial region of the temporal lobes, caudate, putamen, thalami and the fronto-parietal cortex; in the group without pain, changes predominated in the frontopolar and orbitofrontal cortices and in the occipital areas. A dysfunction in the reward system in chronic pain of MS was found, particularly in the brain areas involved in its motivational aspects, as such probably reflecting the maladaptive physiology of chronic pain, and possibly the signature of pain in MS, in a disease where reward impairment seems to be already one of its features. PMID:27178661

  17. To Observe the Effect of Music Therapy plus SW Insomnia Brain Reflection Treating Apparatus in the Treatment of Post Stroke%音乐疗法加SW脑反射治疗仪治疗脑卒中后失眠的疗效观察

    Institute of Scientific and Technical Information of China (English)

    杨玉秀; 姚美英

    2014-01-01

    目的:对音乐疗法加SW脑反射治疗仪治疗脑卒中后失眠的疗效进行观察。方法选取从2007年2月至2009年2月收治的60例脑卒中患者,所有患者都采取CT检查或者是MRI检查进行确诊。随机的将所有患者分成对照组与治疗组,对照组患者进行药物的常规治疗,治疗组患者采取音乐疗法加SW脑反射治疗的方式,将两组患者的治疗效果进行对比。结果治疗以前,两组患者之间的PSQI没有明显的差异,P>0.05,其差异没有统计学意义,通过治疗,两组患者的PSQI都有所降低,P<0.05,两组之间的差异具有统计学意义。结论对于脑卒中后失眠的患者来说,采取音乐疗法结合SW反射治疗仪治疗,临床疗效较为理想,有临床应用价值。%Objective To insomnia music therapy plus SW brain reflection treating apparatus in the treatment of post stroke were observed. Methods From 60 stroke patients were 2007.2-2009.2, and al patients were taken CT scan or MRI examination for diagnosis. Randomized al patients were divided into control group and treatment group, the control group were treated with routine therapy, the patients in the treatment group take music therapy plus SW brain reflection treating method, comparing the two groups of patients. Results Before the treatment, there was no significant difference between two groups of patients with PSQI, P>0.05, the difference was not statistical y significant, through treatment, two groups of patients with PSQI were decreased, P<0.05, there were significant differences between the two groups. Conclusion For patients with post stroke insomnia, take music therapy combined with SW reflex therapy, clinical curative effect is more ideal, is worthy of clinical application.

  18. Observation on the curative effect of paroxetine hydrochloride combined with sweet dream capsule in treatment of post stroke depression%盐酸帕罗西汀联合甜梦胶囊治疗脑卒中后抑郁疗效观察

    Institute of Scientific and Technical Information of China (English)

    戴军; 谈伟

    2016-01-01

    目的:探讨帕罗西汀联合甜梦胶囊治疗脑卒中后抑郁的疗效。方法:对照组主要给予对症治疗,对治疗组给予帕罗西汀同时辅助甜梦胶囊治疗。治疗前、治疗后第4、8及12周末分别评定其疗效和不良反应。结果:治疗组治疗后4、8、12周HAMD、NIHSS评分明显低于对照组(P<0.01);治疗组的临床疗效明显优于对照组(P<0.01)。帕罗西汀联合甜梦胶囊组在治疗过程中无不良反应。结论:帕罗西汀联合甜梦胶囊治疗卒中后抑郁,疗效满意。%Objective:To investigate the curative effect of paroxetine combined with sweet dream capsule in treatment of post stroke depression.Methods:The control group was given symptomatic treatment.The treatment group was treated with paroxetine hydrochloride combined with sweet dream capsule at the same time.The efficacy and adverse reactions were evaluated at fourth, eighth and twelfth week after treatment respectively.Results:The HAMD and NIHSS scores of the treatment group were significantly lower than those in the control group at fourth week,eighth week,twelfth week after treatment(P<0.01).The clinical efficacy of the treatment group was significantly better than that of the control group(P<0.01).Patients in the paroxetine hydrochloride combined with sweet dream capsule group had no adverse reactions during the treatment.Conclusion:Paroxetine hydrochloride combined with sweet dream capsule in the treatment of post stroke depression achieved satisfactory curative effect.

  19. Neuroplasticity Underlying the Comorbidity of Pain and Depression

    Directory of Open Access Journals (Sweden)

    Lisa Doan

    2015-01-01

    Full Text Available Acute pain induces depressed mood, and chronic pain is known to cause depression. Depression, meanwhile, can also adversely affect pain behaviors ranging from symptomology to treatment response. Pain and depression independently induce long-term plasticity in the central nervous system (CNS. Comorbid conditions, however, have distinct patterns of neural activation. We performed a review of the changes in neural circuitry and molecular signaling pathways that may underlie this complex relationship between pain and depression. We also discussed some of the current and future therapies that are based on this understanding of the CNS plasticity that occurs with pain and depression.

  20. Systemic lidocaine therapy for poststroke pain.

    Science.gov (United States)

    Edmondson, E A; Simpson, R K; Stubler, D K; Beric, A

    1993-10-01

    Poststroke pain syndrome is commonly regarded as an intractable disease. We describe four patients who responded to an intravenous lidocaine infusion for relief of central pain after a stroke. The infusion was administered over a 48-hour period after an initial bolus of 50 to 100 mg intravenously over 40 to 120 seconds. Pain intensity and pain relief were measured by visual analog and numeric scales. All patients reported some relief within the first 12 hours of infusion. All patients were subsequently given a trial of mexiletine, an oral congener of lidocaine. Two have continued taking the drug and report excellent relief at 12 months' follow-up; the other two had side effects that precluded further use of the drug. We conclude that lidocaine can reduce poststroke pain, and we propose a treatment algorithm based on our experience with 40 additional patients treated for other neuropathic pain states. PMID:8211322

  1. Neuropathic pain therapy: from bench to bedside.

    Science.gov (United States)

    Backonja, Miroslav Misha

    2012-07-01

    Neuropathic pain is a result of complex interactions between peripheral and central mechanisms with multiple potential therapeutic targets. However, the complexity of these mechanisms and relative youth of translational pain research, which is in its infancy, have prevented translation of successful basic bench research to human therapy. Most of the clinically available neuropathic pain treatments are borrowed from other therapeutic areas, such as antidepressants and antiepileptics, or involve application of older therapy, such as opioids. Exceptions are ziconotide, tapentadol, and the high-concentration capsaicin patch. Similar to all other analgesic agents, these provide only partial pain relief in subsets of patients. The standard of care for patients with chronic neuropathic pain is multimodal and multidisciplinary. For most patients to achieve and maintain satisfactory pain relief a combination of therapeutic agents is necessary, providing the empiric basis for rational polypharmacy, which has become a standard approach as well. PMID:23117951

  2. Fibromyalgia and Chronic Pain Syndromes

    Science.gov (United States)

    Choy, Ernest; Clauw, Daniel J.; Goldenberg, Don L.; Harris, Richard E.; Helfenstein, Milton; Jensen, Troels Staehelin; Noguchi, Koichi; Silverman, Stuart L.; Ushida, Takahiro; Wang, Guochun

    2016-01-01

    This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients’ lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general. PMID:27022674

  3. Intravenous infusions in chronic pain management.

    Science.gov (United States)

    Kosharskyy, Boleslav; Almonte, Wilson; Shaparin, Naum; Pappagallo, Marco; Smith, Howard

    2013-01-01

    In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. PMID:23703410

  4. Cupping for Treating Pain: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Jong-In Kim

    2011-01-01

    Full Text Available The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01 and analgesia (P < .001. Another two RCTs also showed positive effects of cupping in cancer pain (P < .05 and trigeminal neuralgia (P < .01 compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03 or heat pad (P < .001. The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065. Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.

  5. 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 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 but...... also exhibiting elements that seem unique to cancer pain. In addition, the pain state is often unpredictable, and the intensity of the pain is highly variable, making it difficult to manage. The establishment of translational animal models has started to reveal some of the molecular components involved...

  6. Measuring postoperative pain

    NARCIS (Netherlands)

    Dijk, J.F.M. van

    2015-01-01

    Many patients experience pain after surgery. Adequate pain treatment begins with a reliable pain assessment. The Numeric Rating Scale (NRS) is often used for this purpose; patients are asked to score their pain on a scale from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable

  7. [Non pharmacologic treatment of neuropathic pain].

    Science.gov (United States)

    Guastella, Virginie; Mick, Gérard; Laurent, Bernard

    2008-02-01

    Nondrug treatments of neuropathic pain should always begin at the same time as pharmacologic treatment. There are three types of nondrug treatment for neuropathic pain: physical, surgical, and "psychocorporal" and psychotherapeutic treatment. Transcutaneous electrical nerve stimulation (TENS) is a simple physical treatment that strengthens local inhibitory controls and is indicated in focal neuropathic pain when upstream stimulation is possible for a superficial sensitive nerve trunk. Destructive surgery is represented today by "DREZotomy", destruction of nociceptive fibers and their dorsal root entry zones. It is indicated essentially in intractable pain due to plexus avulsion. Functional surgery is implanted electric stimulation--either spinal or central (encephalic)--of structures that exert inhibitory control on the pain pathways. Spinal stimulation is performed at the level of the posterior spinal cord and is indicated essentially in segmental mononeuropathies refractory to drug treatment. Central stimulation is performed at the motor cortex and is indicated for refractory central pain. "Psychocorporal" techniques (relaxation, sophrology, hypnosis) are useful to reduce anxiety and neurovegetative hypertonicity, both factors that aggravate neuropathic pain. PMID:18191370

  8. The Neurobiology of Orofacial Pain and Sleep and Their Interactions.

    Science.gov (United States)

    Lavigne, G J; Sessle, B J

    2016-09-01

    This article provides an overview of the neurobiology of orofacial pain as well as the neural processes underlying sleep, with a particular focus on the mechanisms that underlie pain and sleep interactions including sleep disorders. Acute pain is part of a hypervigilance system that alerts the individual to injury or potential injury of tissues. It can also disturb sleep. Disrupted sleep is often associated with chronic pain states, including those that occur in the orofacial region. The article presents many insights that have been gained in the last few decades into the peripheral and central mechanisms involved in orofacial pain and its modulation, as well as the circuits and processes in the central nervous system that underlie sleep. Although it has become clear that sleep is essential to preserve and maintain health, it has also been found that pain, particularly chronic pain, is commonly associated with disturbed sleep. In the presence of chronic pain, a circular relationship may prevail, with mutual deleterious influences causing an increase in pain and a disruption of sleep. This article also reviews findings that indicate that reducing orofacial pain and improving sleep need to be targeted together in the management of acute to chronic orofacial pain states in order to improve an orofacial pain patient's quality of life, to prevent mood alterations or exacerbation of sleep disorder (e.g., insomnia, sleep-disordered breathing) that can negatively affect their pain, and to promote healing and optimize their health. PMID:27154736

  9. Pathogenesis and clinical aspects of pain in patients with osteoporosis.

    Science.gov (United States)

    Mediati, Rocco Domenico; Vellucci, Renato; Dodaro, Lucia

    2014-09-01

    Bone pain is one of the most frequent kinds of chronic pain, mainly in elderly patients. It causes a significant worsening of functional capacity and deterioration in the quality of life in people affected. Mechanisms of pain in osteoporosis are poorly known and often extrapolated by other pathologies or other experimental model. One of principal causes would be a "hyper-remodeling" of bone, that involves osteoclasts activity and pathological modifications of bone innervation. Several studies show that osteoclasts play a significant role in bone pain etiology. Pain in osteoporosis is mainly nociceptive, if it become persistent a sensitization of peripheral and central nervous system can occur, so underlining the transition to a chronic pain syndrome. Central sensitization mechanisms are complex and involve several neuromediators and receptors (Substance P, NMDA, etc.). Most common manifestations of osteoporosis are vertebral compression fractures that cause persistent pain, though to differentiate from pain originating in structures as joint or muscle. First manifestation can be an acute pain due to pathological fracture, those of hip often causes disability. Pain in osteoporosis is an important clinical challenge. Often its complications and consequences on patient quality of life are underestimated with not negligible social implications. A balanced and early multimodal pain therapy including opioids as necessary, even in cases of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations that seems to contribute in significant way in causing irreversible pain chronic syndromes. PMID:25568647

  10. Non-inflammatory Causes of Pain in Patients with Rheumatoid Arthritis.

    Science.gov (United States)

    Boyden, Sean D; Hossain, Imtiyaz N; Wohlfahrt, Alyssa; Lee, Yvonne C

    2016-06-01

    Although pain in rheumatoid arthritis (RA) is frequently thought to be inflammatory in nature, the association between measures of inflammation and pain intensity is low. This observation is likely due to the multifactorial nature of pain. In addition to pain from joint inflammation, RA patients may also have pain due to structural damage or central etiologies, such as aberrancies in the central nervous system (CNS) pain regulatory pathways. These CNS pathways include mechanisms that facilitate pain, as well as mechanisms that inhibit pain. Other factors, such as sleep disturbances, depression, anxiety, and catastrophizing, may also impact the perception of pain in RA patients. Since pain is frequently used as a proxy for inflammation in the assessment of RA disease activity, it is important that patients and physicians recognize that not all pain is inflammatory, and alternative management strategies, other than escalating disease-modifying antirheumatic drug treatment, may need to be considered. PMID:27097817

  11. Use of Methadone for Neuropathic Pain

    Directory of Open Access Journals (Sweden)

    Dwight Moulin

    2003-01-01

    Full Text Available Chronic neuropathic pain is often considered to be a common complication of injury to the central or peripheral nervous system and the pain itself is usually assumed to be intractable. Both of these assumptions are inaccurate. For example, numbness and tingling in glove and stocking distribution are common accompaniments of longstanding diabetes mellitus, but only about 10% of patients with diabetic neuropathy consider these sensory changes to be painful (1. Anticonvulsant and antidepressant treatments provide effective analgesia in up to 50% of patients with chronic neuropathic pain (2 and there is a growing body of high-quality evidence that controlled-release opioid analgesics provide substantial pain relief in a further subset of patients (3-6. Even with polypharmacy, this still leaves perhaps 20% to 30% of chronic neuropathic pain sufferers lacking adequate analgesia, and side effects can be problematic. In addition, central pain appears to be more refractory to opioid treatment than pain due to peripheral nerve injury (7.

  12. Pain and pain management in dermatology.

    Science.gov (United States)

    Beiteke, Ulrike; Bigge, Stefan; Reichenberger, Christina; Gralow, Ingrid

    2015-10-01

    It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. -Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic -scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary -communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current -therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri- and postoperative pain management is briefly outlined. This article addresses: ▸ The fundamentals of the classification and neurophysiology of pain; ▸ Standards for pain documentation in children and adults; ▸ General standards for pharmaceutical pain management; ▸ Current specific treatment options for postherpetic neuralgia, leg ulcers, and -pyoderma gangrenosum in conjunction with the expanded WHO

  13. Dysmenorrhea: Painful Periods

    Science.gov (United States)

    ... Management Education & Events Advocacy For Patients About ACOG Dysmenorrhea: Painful Periods Home For Patients Search FAQs Dysmenorrhea: ... Dysmenorrhea: Painful Periods FAQ046, January 2015 PDF Format Dysmenorrhea: Painful Periods Gynecologic Problems What is dysmenorrhea? How ...

  14. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... acute pain and both naturally expect that some cause will be found, and when it’s found, it ... pain even in the absence of an apparent cause. But chronic pain has a physiological or neurological ...

  15. Back Pain During Pregnancy

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back ... During Pregnancy FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during ...

  16. Pain medications - narcotics

    Science.gov (United States)

    Painkillers; Drugs for pain; Analgesics; Opioids ... Narcotics are also called opioid pain relievers. They are used only for pain that is severe and is not helped by other types of painkillers. When used ...

  17. Palliative care - managing pain

    Science.gov (United States)

    End of life - pain management; Hospice - pain management ... or if you have side effects from your pain treatments. ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Medicine . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap ...

  18. Pain Information Brochure

    Science.gov (United States)

    ... of Arthritis and Musculoskeletal and Skin Diseases Top Back Pain Back Pain Information Page National Institute of Neurological Disorders and Stroke Low Back Pain Fact Sheet National Institute of Neurological Disorders and ...

  19. Pain experience and satisfaction with postoperative pain control among surgical patients.

    Science.gov (United States)

    Subramanian, Pathmawathi; Ramasamy, Suguna; Ng, Kwan Hoong; Chinna, Karuthan; Rosli, Roshaslina

    2016-06-01

    Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires (APS-POQ-R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race (P = 0.038), education level (P ≤ 0.001), previous operation status (P = 0.032) and operation status (P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery. PMID:25355297

  20. 'Hip' pain.

    Science.gov (United States)

    Zacher, Josef; Gursche, Angelika

    2003-02-01

    'Hip' pain is usually located in the groin, upper thigh or buttock and is a common complaint. Slipped capital femoral epiphysis, avascular femoral head necrosis and apophyseal avulsion are the most common diagnoses in childhood and adolescents. Strains and fractures are common in sport-active adults. Osteoarthritis occurs in middle-aged and older adults. Trauma may result in femoral head fracture or typical muscle and tendon sprains and bursitis. Septic or inflammatory arthritis can occur at every age. Septic arthritis, fractures and acute epiphyseal slipping are real emergency cases. Congenital dysplasia of the hip joint may lead to labral tears and early osteoarthritis. The most important hip problems in children, adolescents, adult and older people are discussed; these problems originate from intra-articular disorders and the surrounding extra-articular soft tissues. Medical history, clinical examination and additional tests, including imaging, will be demonstrated. Principles of treatment are given for specific disorders. PMID:12659822

  1. Dental (Odontogenic) Pain

    Science.gov (United States)

    Renton, Tara

    2011-01-01

    This article provides a simple overview of acute trigeminal pain for the non dentist. This article does not cover oral mucosal diseases (vesiculobullous disorders) that may cause acute pain. Dental pain is the most common in this group and it can present in several different ways. Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders. It is crucial to exclude these disorders whilst managing patients with chronic trigeminal pain. PMID:26527224

  2. [Review of current pharmacologic treatment of pain].

    Science.gov (United States)

    Brasseur, L

    1997-01-01

    Pain is the main reason prompting patients to consult their physicians. In acute conditions, pain has a very particular significance as a warning sign, enabling the physician to attempt a diagnosis. Nevertheless, its detrimental effect upon the individual (even in the case of acute pain) and its cost to society are now widely acknowledged. There can be no doubt about the physical component of pain, but the psychological and social aspects should not be ignored, particularly in the case of chronic pain. There is no single therapeutic approach to pain and, more often than not, successful treatment comprises a combination of several. Pharmacological treatments are undeniably the most common approach. In clinical practice, recent advances have been based upon an improved understanding of 'old' substances such as morphine and, at the same time, research continues in the hope of finding the 'ideal' analgesic-effective in most situations but without adverse effects: this appears to be a somewhat utopian arm at present, considering the number of different causes of pain. An improved understanding of the physiological mechanisms of pain has led, within the field of clinical practice, to several methods of differentiating pain. These depend on whether or not pain responds to morphine, or on the type of pain: pain due to an excess of nociception, pain resulting from deafferentation (caused by damage to nerve pathways) in the central or peripheral nervous system and psychogenic (idiopathic) pain. Likewise, there are several different ways of classifying analgesic treatments: according to the intensity of pain, as with use of the WHO ladder (which is based on the notion of steps) for the treatment of cancer pain; according to the presumed physiopathological mechanism and, in particular, the response to morphine, and according to the presumed central or peripheral mechanism of the drugs. In reality, peripherally acting drugs can also have a central mechanism of action, just as

  3. Orofacial pain: a primer.

    Science.gov (United States)

    De Rossi, Scott S

    2013-07-01

    Orofacial pain refers to pain associated with the soft and hard tissues of the head, face, and neck. It is a common experience in the population that has profound sociologic effects and impact on quality of life. New scientific evidence is constantly providing insight into the cause and pathophysiology of orofacial pain including temporomandibular disorders, cranial neuralgias, persistent idiopathic facial pains, headache, and dental pain. An evidence-based approach to the management of orofacial pain is imperative for the general clinician. This article reviews the basics of pain epidemiology and neurophysiology and sets the stage for in-depth discussions of various painful conditions of the head and neck. PMID:23809298

  4. Phantom limb pain: mechanisms and treatment approaches.

    Science.gov (United States)

    Subedi, Bishnu; Grossberg, George T

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. PMID:22110933

  5. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Science.gov (United States)

    Subedi, Bishnu; Grossberg, George T.

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. PMID:22110933

  6. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Bishnu Subedi

    2011-01-01

    Full Text Available The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

  7. Pain inhibits pain; human brainstem mechanisms.

    Science.gov (United States)

    Youssef, A M; Macefield, V G; Henderson, L A

    2016-01-01

    Conditioned pain modulation is a powerful analgesic mechanism, occurring when a painful stimulus is inhibited by a second painful stimulus delivered at a different body location. Reduced conditioned pain modulation capacity is associated with the development of some chronic pain conditions and the effectiveness of some analgesic medications. Human lesion studies show that the circuitry responsible for conditioned pain modulation lies within the caudal brainstem, although the precise nuclei in humans remain unknown. We employed brain imaging to determine brainstem sites responsible for conditioned pain modulation in 54 healthy individuals. In all subjects, 8 noxious heat stimuli (test stimuli) were applied to the right side of the mouth and brain activity measured using functional magnetic resonance imaging. This paradigm was then repeated. However, following the fourth noxious stimulus, a separate noxious stimulus, consisting of an intramuscular injection of hypertonic saline into the leg, was delivered (conditioning stimulus). During this test and conditioning stimulus period, 23 subjects displayed conditioned pain modulation analgesia whereas 31 subjects did not. An individual's analgesic ability was not influenced by gender, pain intensity levels of the test or conditioning stimuli or by psychological variables such as pain catastrophizing or fear of pain. Brain images were processed using SPM8 and the brainstem isolated using the SUIT toolbox. Significant increases in signal intensity were determined during each test stimulus and compared between subjects that did and did not display CPM analgesia (pmechanisms responsible for the maintenance of persistent pain conditions thought to involve altered analgesic circuitry. PMID:26343321

  8. Chronic pain and invasive therapy

    OpenAIRE

    Alessandro Rocco; Pierangelo Di Marco; Marta Luzi; Alessandra Canneti; Carlo Reale

    2009-01-01

    The chronic pain “three-step” OMS ladder is likely to be revised, in order to introduce a “fourth step” including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development. Most of invasive approaches include central (spinal neuromodulation) and peripheral (gangliar neurolysis, percutaneous vertebral reduction) techniques, as well as pharmacological (opioi...

  9. Managing chronic pain with nonopioid analgesics: a multidisciplinary consult.

    Science.gov (United States)

    Clauw, Daniel; McCarberg, Bill H

    2012-05-01

    As detailed in this online CME activity (www.cmeaccess.com/AJM/ChronicPain04), determining pain mechanism is an important aspect guiding treatment selection for chronic musculoskeletal pain states. Although broad classifications provide a framework, any combination of mechanisms may be present in a chronic pain patient, and there is growing evidence that pain states generally considered nociceptive may also involve elements of augmented central nervous system pain processing. Nonopioid analgesics, including serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and alpha-2-delta ligand anticonvulsants, are the treatments of choice for fibromyalgia and other central neuropathic pain states. Additionally, studies have now shown that certain SNRIs can be effective in treating "classic" nociceptive pain states, such as osteoarthritis, and also are effective for low back pain. In addition to considering biological mechanisms, chronic pain management also involves recognizing and evaluating the contribution of psychological and sociocultural factors that can influence pain chronicity and patient prognosis. A multimodal/multidisciplinary approach incorporating pharmacologic and nonpharmacologic therapy into a program that includes more than 1 discipline is important to improve outcomes in patients with chronic pain. PMID:22482859

  10. Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain

    Institute of Scientific and Technical Information of China (English)

    Asbj(φ)rn Mohr Drewes; Lars Arendt-Nielsen; Peter Funch-Jensen; Hans Gregersen

    2006-01-01

    Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy.

  11. Pain in rheumatoid arthritis: a critical review

    Directory of Open Access Journals (Sweden)

    P. Sarzi-Puttini

    2014-06-01

    Full Text Available Patients with rheumatoid arthritis (RA are frequently afflicted by pain, which may be caused by joint inflammation (leading to structural joint damage or secondary osteoarthritis, and may be increased by central sensitisation. Non-inflammatory pain may also confuse the assessment of disease activity, and so the aim of treatment is not only to combat inflammatory disease, but also relieve painful symptoms. In order to ensure effective treatment stratification, it is necessary to record a patients medical history in detail, perform a physical examination, and objectively assess synovitis and joint damage. The management of pain requires various approaches that include pharmacological analgesia and biological and non-biological treatments. Although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease.

  12. Ketamine for chronic pain: risks and benefits

    OpenAIRE

    Niesters, Marieke; Martini, Christian; Dahan, Albert

    2014-01-01

    The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during ...

  13. Chronic pain: Model of psychosomatic disorder (review

    Directory of Open Access Journals (Sweden)

    Chernus N.P.

    2011-12-01

    Full Text Available The article presents a detailed review on epidemiology, pathogenesis and interrelation of serotonin neuromedia-tor metabolism in the central nervous system in state of chronic pain and depression. It has been demonstrated that neurophysiological conditions serve as psychological defense of an individual. That mechanism has been proved to «transform» serious emotions onto the inner level (body and it assists in the development of psychosomatic disorders — chronic pain syndrome

  14. Facts and Figures on Pain

    Science.gov (United States)

    ... Room Position Statements AAPM Facts and Figures on Pain Overview What is Chronic Pain? Incidence of Pain, ... of them. Back to Top What is Chronic Pain? While acute pain is a normal sensation triggered ...

  15. TMD and chronic pain: A current view

    Directory of Open Access Journals (Sweden)

    Bruno D'Aurea Furquim

    2015-02-01

    Full Text Available This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs. While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-α and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation.

  16. Dental restoration induced orofacial pain and its management

    Directory of Open Access Journals (Sweden)

    Xiuxin Liu

    2015-01-01

    Full Text Available Dental procedure induced pain may develop into a chronic condition that accompanied with functional or neuropathy changes in the nerve system. In this case, severe persistent pain gradually developed after repeatedly placing a subgingival amalgam restoration in the right second molar. Hyperalgesia and allodynia were present at the affected region. A provisional diagnosis of chronic orofacial pain with peripheral and central sensitization was considered. After re-contouring, local debridement and occlusal adjustment the pain disappeared. The underlying mechanism in this case is neuronal sensitization and peripheral Aβ-fiber mechanoreceptor activation. Its diagnosis and management depend on identification and treatment of the cause for pain generation and sensitization.

  17. Guided Internet-Based Cognitive Behaviour Therapy for Chronic Pain

    OpenAIRE

    Buhrman, Monica

    2012-01-01

    Chronic pain is a one of the most common causes of disability and sick leave. Psychological factors play a central role in the experience of pain and are important in the management of pain. However, for many people with chronic pain CBT is not available. There is a need to develop alternative ways to deliver treatments that reach more individuals with chronic pain. Internet-based treatments have been shown to be effective for several disorders and recent research suggests that internet-based...

  18. Brain activations during pain: a neuroimaging meta-analysis of patients with pain and healthy controls.

    Science.gov (United States)

    Jensen, Karin B; Regenbogen, Christina; Ohse, Margarete C; Frasnelli, Johannes; Freiherr, Jessica; Lundström, Johan N

    2016-06-01

    In response to recent publications from pain neuroimaging experiments, there has been a debate about the existence of a primary pain region in the brain. Yet, there are few meta-analyses providing assessments of the minimum cerebral denominators of pain. Here, we used a statistical meta-analysis method, called activation likelihood estimation, to define (1) core brain regions activated by pain per se, irrelevant of pain modality, paradigm, or participants and (2) activation likelihood estimation commonalities and differences between patients with chronic pain and healthy individuals. A subtraction analysis of 138 independent data sets revealed that the minimum denominator for activation across pain modalities and paradigms included the right insula, secondary sensory cortex, and right anterior cingulate cortex (ACC). Common activations for healthy subjects and patients with pain alike included the thalamus, ACC, insula, and cerebellum. A comparative analysis revealed that healthy individuals were more likely to activate the cingulum, thalamus, and insula. Our results point toward the central role of the insular cortex and ACC in pain processing, irrelevant of modality, body part, or clinical experience; thus, furthering the importance of ACC and insular activation as key regions for the human experience of pain. PMID:26871535

  19. 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...... precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined to...... the mouse femur. This model prompted related approaches and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer induced bone pain results in progressive bone destruction, elevated osteoclast activity and...

  20. Structural Brain Changes in Chronic Pain Reflect Probably Neither Damage Nor Atrophy

    OpenAIRE

    Rodriguez-Raecke, Rea; Niemeier, Andreas; Ihle, Kristin; Ruether, Wolfgang; May, Arne

    2013-01-01

    Chronic pain appears to be associated with brain gray matter reduction in areas ascribable to the transmission of pain. The morphological processes underlying these structural changes, probably following functional reorganisation and central plasticity in the brain, remain unclear. The pain in hip osteoarthritis is one of the few chronic pain syndromes which are principally curable. We investigated 20 patients with chronic pain due to unilateral coxarthrosis (mean age 63.25±9.46 (SD) years, 1...

  1. Modulation of Pain with Transcranial Direct Current Stimulation and Diffuse Noxious Inhibitory Controls

    OpenAIRE

    Reidler, Jay S.

    2014-01-01

    Background: While pain is essential for physiological functioning, chronic or pathologic pain is responsible for a major burden of disease in society. Novel approaches to treating acute and chronic pain have employed neuromodulatory tools to target the central and peripheral neural structures that mediate pain. Transcranial direct current stimulation (tDCS), for example, is a safe, non-invasive brain stimulation technique that has been shown in preliminary studies to reduce chronic pain when ...

  2. Painful peripheral neuropathy

    OpenAIRE

    Sun, Bo; Xu-sheng HUANG

    2013-01-01

    Painful peripheral neuropathy (PPN) is characterized by neuropathic pain (NP), which is accompanied by dysfunction of motor, sensory and autonomic nervous system. It always involves small nerve fibers, including A δ and C fibers. PPN can be classified into two types according to etiology: hereditary and acquired. Pain of PPN can manifest as spontaneous pain and stimulus-evoked pain (allodynia, hyperalgesia and hyperpathia). The manifestation of typical cases is length-dependent, which firstly...

  3. Dental (Odontogenic) Pain

    OpenAIRE

    Renton, Tara

    2011-01-01

    This article provides a simple overview of acute trigeminal pain for the non dentist.This article does not cover oral mucosal diseases (vesiculobullous disorders) that may cause acute pain.Dental pain is the most common in this group and it can present in several different ways.Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders.It is crucial to exclude these disorders whilst managing patients with chronic trigeminal p...

  4. Painful Hip Prosthesis: Definition

    OpenAIRE

    Ferrata, P.; Carta, S.; Fortina, M.; Scipio, D.; Riva, A.; Di Giacinto, S.

    2010-01-01

    Pain is the main reason inducing patients to undergo surgery and persistence of pain after the operation is a major concern, both for the patient and the surgeon. Up to 10% of patients report pain five years after hip arthroplasty. An analysis of the literature reveals numerous causes of pain localised to the replacement hip. In assessing a painful hip it is fundamental to arrive at a definite diagnosis before starting any treatment. Intrinsic causes can be identified, such as unrecognised as...

  5. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  6. Untying chronic pain

    OpenAIRE

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-01-01

    Background: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods: A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic ...

  7. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke%缺血性卒中急性期血浆谷氨酸水平与卒中后抑郁相关性的初步研究

    Institute of Scientific and Technical Information of China (English)

    钱方媛; 张志珺; 钱俊枫

    2013-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke and post-stroke depression (PSD) initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory (BDI,21-item) and DSM-Ⅳ criteria was used to diagnose post-stroke depression (PSD) at 2 weeks after stroke.The Hamilton Depression Rating Scale (HDRS,17-item) was used to assess the severity of major depressive symptoms.Plasma level of glutamate between PSD and non-PSD patients was measured by high performance liquid chromatography (HPLC) on day 2 and 2 weeks after stroke.Results (1) The glutamate levels on day 2 after stroke were significantly lower in PSD patients(Twenty-six patients) than non-PSD patients [(4.995 ±2.514) g/L vs.(6.558 ±2.835) g/L;t =2.140,P =0.036].(2) In post-stroke patients,a strong negative correlation was observed between glutamate levels on day 2 after stroke and severity of depression(r =-0.311,P =0.013).(3) In patients with PSD,the levels of glutamate at 2 weeks after stroke (6.312 ± 2.604) g/L significantly increased compared to the levels of glutamate on day 2 after stroke (t =-2.361,P =0.026).(4) Using a multivariate logistic regression,plasma glutamate on day 2 was associated with incident PSD at 2 weeks after stroke (OR =0.651,95% CI:0.459-0.922,P =0.016).Conclusion Plasma glutamate during the acute phase of stroke may be associated with PSD.%目的 初步探讨急性缺血性卒中患者血浆谷氨酸水平与卒中后抑郁(post-strokedepression,PSD)的关系.方法 于卒中后2周,采用Beck抑郁问卷(21项)及《美国精神障碍诊断与统计手册(第4版)》躯体疾病所致心境障碍诊断标准,对连续入组的74例急性缺血性卒中患者进行PSD诊断,以17项汉密尔顿抑郁量表(the 17-item Hamilton Depression Rating Scale,HDRS)评估抑郁症状严重程度,并采用高效液相

  8. Changes of post-stroke mental symptom group and interventional effect ofChinese medicinal in rat model%脑卒中后大鼠模型精神症状组群的改变及中药的干预作用

    Institute of Scientific and Technical Information of China (English)

    李冬梅; 唐启盛; 李小黎; 王戈; 冯光达

    2011-01-01

    目的 从脑卒中后大鼠精神症状组群的改变探讨脑卒中后精神症状的演变趋势及益肾调气方药——颐脑解郁方对其早期干预作用.方法 选择雄性 Wistar大鼠,经Open-Field行为学评分后,随机分为正常组、假手术组、多发脑梗(MCI)组、中药组、西药组、卒中后抑郁(PSD)组及血管性痴呆(VD)组.正常组常规饲养.假手术组经颈外动脉推注0.3mL生理盐水,并灌胃蒸馏水.其余各组均采用同种系微栓子体外注入法,由颈外动脉推注同等剂量的同种异体血栓栓子;中药组及西药组在模型制备后,予颐脑解郁方、尼莫地平干预给药4周;PSD组术后7d予21 d慢性不可预知的温和应激(CUMS)加孤养复制PSD模型;VD组术后28 d 经水迷宫筛选后进入实验.模型复制成功后,于第4周进行表征观察包括动态观察大鼠毛发、眼部变化,平均进食量及大鼠体重;同时进行行为学测试:蔗糖水消耗实验、Open-Field行为测定、穿梭箱主动回避反应实验.结果 表征观察发现3个模型组大鼠平均进食量下降,尤以PSD组及VD组下降显著,与体重变化趋势相一致.行为学测定发现3个模型组大鼠存在兴趣及记忆能力明显下降;蔗糖水消耗量、Open-Field实验提示PSD组以兴趣下降为主;穿梭箱主动回避反应实验结果提示VD组记忆及学习能力下降更为明显.而中药能减缓表征、学习和兴趣能力的下降趋势.结论 脑血管病后大鼠存在精神症状组群的改变,并有向PSD及VD演变趋势.颐脑解郁方能减慢此过程的进展.%Objective To probe into the development trends of post-stroke mental symptoms based on the changes of post-stroke mental symptom group in rats and the interventional effect of Yi Nao Jie Yu Fang with the actions of replenishing kidney and regulating qi. Methods Male Wistar rats, after open-field ethology scoring, were randomly divided into the normal group, sham

  9. Effect of neuromuscular electrical stimulation on hyolaryngeal structural movement in post-stroke dysphagia%神经肌肉电刺激对脑卒中后吞咽障碍患者舌骨喉复合体动度的影响

    Institute of Scientific and Technical Information of China (English)

    高婧慧; 王强; 李明; 孟萍萍; 张子青

    2015-01-01

    目的 观察神经肌肉电刺激(NMES)治疗脑卒中后吞咽障碍的临床疗效,对比分析不同部位电刺激对患者舌骨喉复合体动度的影响.方法 采用随机数字表法将30例脑卒中后吞咽障碍患者分为治疗A组、治疗B组及对照组.3组患者均给予常规吞咽训练、药物治疗及一般康复治疗,治疗A组在此基础上辅以舌骨上、下区神经肌肉电刺激,治疗B组则辅以单纯舌骨上区神经肌肉电刺激.分别于治疗前、治疗2周后对各组患者进行电视X线透视吞咽功能检查,并测量吞咽半流质食物时其舌骨及甲状软骨向上、向前移动距离;同时采用洼田饮水试验、才藤分级、吞咽障碍结局与严重度量表(DOSS)对各组患者疗效进行评定.结果 3组患者治疗后其洼田饮水试验分级、才藤分级、DOSS量表评分均较治疗前明显改善(P<0.05);治疗A组及治疗B组洼田分级[分别为(2.40±1.26)级和(2.10±0.99)级]、才藤分级[分别为(5.30±1.89)级和(5.20±1.69)级]、DOSS量表评分[分别为(5.20±1.40)分和(5.10±1.45)分]均显著优于对照组(P<0.05),两电刺激组患者治疗后上述疗效指标组间差异均无统计学意义(P>0.05).治疗B组患者治疗后在吞咽半流质食物时其舌骨前移距离[(12.15±7.59)mm]较治疗前及治疗A组、对照组均明显增大(P<0.05).结论 在常规吞咽训练基础上辅以神经肌肉电刺激可显著改善脑卒中后吞咽障碍患者吞咽功能;将电极片放置在舌骨上区或舌骨上、下区刺激时其疗效间无显著差异,但单纯舌骨上区电刺激可进一步改善脑卒中患者吞咽时舌骨前移距离.%Objective To explore the effect of neuromuscular electrical stimulation(NMES) on hyolaryngeal structural movement in post-stroke dysphagia.Methods Thirty patients with post-stroke dysphagia were randomly divided into 3 groups (n =10) namely group A,group B and group C.On the basis of routine swallowing training

  10. Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study.

    Directory of Open Access Journals (Sweden)

    Thomas Torstensson

    Full Text Available To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP persisting after childbirth with the purpose to improve diagnostics and give implications for treatment.In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas.Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm² (19.2 to 53.7 in women with CPP as compared to 3.2 mm² (1.0 to 5.1 in women without CPP, p< 0.0001.Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis.

  11. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization. A randomized controlled trial

    DEFF Research Database (Denmark)

    Petersen, Tom; Larsen, Kristian; Nordsteen, Jan; Olsen, Steen; Fournier, Gilles; Jacobsen, Soren

    2011-01-01

    as a reduction of at least 5 points or an absolute score below 5 points on the Roland Morris Questionnaire. Secondary outcomes were reduction in disability and pain, global perceived effect, general health, mental health, lost work time, and medical care utilization.Results. Both treatment groups...... structured exercise programme tailored to the individual patient as well as manual therapy for the treatment of persistent low back pain. There is presently insufficient evidence to recommend the use of specific decision methods tailoring specific therapies to clinical subgroups of patients in primary care...

  12. Relation of the factor to menstrual pain and musculoskeletal pain

    OpenAIRE

    Lee, Jang-Won; Park, Hye-Sang

    2015-01-01

    The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measu...

  13. Pain and the ethics of pain management.

    Science.gov (United States)

    Edwards, R B

    1984-01-01

    In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern. PMID:6710192

  14. Prevalence of Neuropathic Pain and the Need for Treatment

    OpenAIRE

    2006-01-01

    Recent publications have suggested that more than two million adults in the United States suffer from neuropathic pain, but this number seems to be a significant underestimate. The prevalence of neuropathic pain from diabetes and postherpetic neuralgia alone, using the most conservative estimates of incidence, would equal two million Americans. Lesions of the nervous system responsible for pain genesis can occur either in the central or the peripheral nervous system. The most common causes of...

  15. Thalamic pain: anatomical and physiological indices of prediction.

    Science.gov (United States)

    Vartiainen, Nuutti; Perchet, Caroline; Magnin, Michel; Creac'h, Christelle; Convers, Philippe; Nighoghossian, Norbert; Mauguière, François; Peyron, Roland; Garcia-Larrea, Luis

    2016-03-01

    Thalamic pain is a severe and treatment-resistant type of central pain that may develop after thalamic stroke. Lesions within the ventrocaudal regions of the thalamus carry the highest risk to develop pain, but its emergence in individual patients remains impossible to predict. Because damage to the spino-thalamo-cortical system is a crucial factor in the development of central pain, in this study we combined detailed anatomical atlas-based mapping of thalamic lesions and assessment of spinothalamic integrity using quantitative sensory analysis and laser-evoked potentials in 42 thalamic stroke patients, of whom 31 had developed thalamic pain. More than 97% of lesions involved an area between 2 and 7 mm above the anterior-posterior commissural plane. Although most thalamic lesions affected several nuclei, patients with central pain showed maximal lesion convergence on the anterior pulvinar nucleus (a major spinothalamic target) while the convergence area lay within the ventral posterior lateral nucleus in pain-free patients. Both involvement of the anterior pulvinar nucleus and spinothalamic dysfunction (nociceptive thresholds, laser-evoked potentials) were significantly associated with the development of thalamic pain, whereas involvement of ventral posterior lateral nucleus and lemniscal dysfunction (position sense, graphaesthesia, pallaesthesia, stereognosis, standard somatosensory potentials) were similarly distributed in patients with or without pain. A logistic regression model combining spinothalamic dysfunction and anterior pulvinar nucleus involvement as regressors had 93% sensitivity and 87% positive predictive value for thalamic pain. Lesion of spinothalamic afferents to the posterior thalamus appears therefore determinant to the development of central pain after thalamic stroke. Sorting out of patients at different risks of developing thalamic pain may be achievable at the individual level by combining lesion localization and functional investigation of

  16. Tissue Injury and Related Mediators of Pain Exacerbation

    OpenAIRE

    Amaya, Fumimasa; Izumi, Yuta; Matsuda, Megumi; Sasaki, Mika

    2013-01-01

    Tissue injury and inflammation result in release of various mediators that promote ongoing pain or pain hypersensitivity against mechanical, thermal and chemical stimuli. Pro-nociceptive mediators activate primary afferent neurons directly or indirectly to enhance nociceptive signal transmission to the central nervous system. Excitation of primary afferents by peripherally originating mediators, so-called “peripheral sensitization”, is a hallmark of tissue injury-related pain. Many kinds of p...

  17. Rehabilitation of the athlete with low back pain.

    Science.gov (United States)

    Standaert, Christopher J; Herring, Stanley A; Pratt, Todd W

    2004-02-01

    The rehabilitation of athletes with low back pain should be considered an essential component of their care. Comprehensive rehabilitation begins at the time of acute injury and encompasses the period of acute care through sport-specific training and return to competition. Rehabilitation of athletes with spinal pain should include a thorough psychosocial evaluation to identify potential barriers to clinical improvement. For athletes with low back pain, establishing effective core stability is central to optimizing the functional performance of the athlete. PMID:14728912

  18. Pediatric pain management.

    Science.gov (United States)

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

  19. [Muscle-skeletal pain].

    Science.gov (United States)

    Vygonskaya, M V; Filatova, E G

    2016-01-01

    The paper is devoted to the most complicated aspects of low back pain. The differences between specific and nonspecific low back pain using the "red flags" system is highlighted. The authors consider the causes of pain chronification (the "yellow flags" system) and the necessity of using a biopsychosocial model. Main pathogenetic mechanisms of chronic muscle/skeletal pain are considered and the possible involvement of several mechanism in the pathogenesis of chronic pain as well as the use of complex therapy is discussed. The high efficacy and safety of ketorolac in treatment of nonspecific muscle/skeletal pain is demonstrated. PMID:27042717

  20. Growing pains

    International Nuclear Information System (INIS)

    While most people would do anything to protect their children from environmental hazards, many parents would be shocked to learn that children's exposure to toxicants can be much higher than their own. Far from being ''little adults,'' children are very different both behaviourally and physiologically. For instance, children's habit of putting things in their mouths can increase their relative exposure to environmental toxicants such as lead. Moreover, children are particularly vulnerable to toxicants and other environmental hazards because many organ systems, including the gastrointestinal, central nervous, immune, and reproductive systems, are still developing after birth. In general, the younger the child, the greater any potential health effects. Despite differences in behavior and physiology between children and adults, few studies have focused on the effects of these differences on risks to children's health of environmental exposures. ''Children are not routinely included in risk assessment processes, and most environmental regulations are based on exposure data of adult males,'' write Joy Carlson and Katie Sokoloff of the Children's Environmental Health Network in the 1995 Environmental Health Perspectives Supplement on child health

  1. Is the Experience of Thermal Pain Genetics Dependent?

    Directory of Open Access Journals (Sweden)

    Emilia Horjales-Araujo

    2015-01-01

    Full Text Available It is suggested that genetic variations explain a significant portion of the variability in pain perception; therefore, increased understanding of pain-related genetic influences may identify new targets for therapies and treatments. The relative contribution of the different genes to the variance in clinical and experimental pain responses remains unknown. It is suggested that the genetic contributions to pain perception vary across pain modalities. For example, it has been suggested that more than 60% of the variance in cold pressor responses can be explained by genetic factors; in comparison, only 26% of the variance in heat pain responses is explained by these variations. Thus, the selection of pain model might markedly influence the magnitude of the association between the pain phenotype and genetic variability. Thermal pain sensation is complex with multiple molecular and cellular mechanisms operating alone and in combination within the peripheral and central nervous system. It is thus highly probable that the thermal pain experience is affected by genetic variants in one or more of the pathways involved in the thermal pain signaling. This review aims to present and discuss some of the genetic variations that have previously been associated with different experimental thermal pain models.

  2. Pain perception and hypnosis: findings from recent functional neuroimaging studies.

    Science.gov (United States)

    Del Casale, Antonio; Ferracuti, Stefano; Rapinesi, Chiara; Serata, Daniele; Caltagirone, Saverio Simone; Savoja, Valeria; Piacentino, Daria; Callovini, Gemma; Manfredi, Giovanni; Sani, Gabriele; Kotzalidis, Georgios D; Girardi, Paolo

    2015-01-01

    Hypnosis modulates pain perception and tolerance by affecting cortical and subcortical activity in brain regions involved in these processes. By reviewing functional neuroimaging studies focusing on pain perception under hypnosis, the authors aimed to identify brain activation-deactivation patterns occurring in hypnosis-modulated pain conditions. Different changes in brain functionality occurred throughout all components of the pain network and other brain areas. The anterior cingulate cortex appears to be central in modulating pain circuitry activity under hypnosis. Most studies also showed that the neural functions of the prefrontal, insular, and somatosensory cortices are consistently modified during hypnosis-modulated pain conditions. Functional neuroimaging studies support the clinical use of hypnosis in the management of pain conditions. PMID:25719519

  3. Anodic or cathodic motor cortex stimulation for pain?

    NARCIS (Netherlands)

    Holsheimer, J.; Manola, L.

    2006-01-01

    Objective. In motor cortex stimulation (MCS) for central and trigeminal pain Resume leads are placed epidurally over the motor and sensory cortex. Several bipolar combinations are used to identify the cortical target corresponding to the painful body segment. The cathode giving the largest motor r

  4. Muscle function and origin of pain in fibromyalgia

    DEFF Research Database (Denmark)

    Bennett, R M; Jacobsen, Søren

    1994-01-01

    It may be concluded that both peripheral and central mechanisms may operate in the pathophysiology of both impaired muscle function and pain in FM. These mechanisms may in part be attributable to physical deconditioning and disuse of muscle secondary to the characteristic pain and fatigue so ofte...

  5. Anterior herniation of lumbar disc induces persistent visceral pain:discogenic visceral pain

    Institute of Scientific and Technical Information of China (English)

    TANG Yuan-zhang; Moore-Langston Shannon; LAI Guang-hui; LI Xuan-ying; LI Na; NI Jia-xiang

    2013-01-01

    Background Visceral pain is a common cause for seeking medical attention.Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves.The lumbar sympathetic nerve trunk lies in front of the lumbar spine.Thus,it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc.This study aimed to evaluate lumbar discogenic visceral pain and its treatment.Methods Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012.These patients suffered from long-term abdominal pain unresponsive to current treatment options.Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging,no significant pathology was noted on gastroscopy,vascular ultrasound,or abdominal computed tomography (CT).To prove that their visceral pain originated from the anteriorly protruding disc,we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc.If the block was effective,CT-guided continuous lumbar sympathetic nerve block was finally performed.Results All patients were positive for pain relief by sympathetic block.Furthermore,the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P <0.05).Up to 11/12 patients had satisfactory pain relief at 1 week after discharge,8/12 at 4 weeks,7/12 at 8 weeks,6/12 at 12 weeks,and 5/12 at 24 weeks.Conclusions It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain.Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

  6. Chronic pain and invasive therapy

    Directory of Open Access Journals (Sweden)

    Alessandro Rocco

    2009-05-01

    Full Text Available The chronic pain “three-step” OMS ladder is likely to be revised, in order to introduce a “fourth step” including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development. Most of invasive approaches include central (spinal neuromodulation and peripheral (gangliar neurolysis, percutaneous vertebral reduction techniques, as well as pharmacological (opioids and adiuvants, chemical (alcohol and physical (electrical stimulation, thermic neurolysis means. Rarely effective as unique therapies, invasive procedures have to be accurately patient-selected and considered supplementary to conservative approaches, in order to minimize the adverse events deriving from a long term opioid therapy. In the near future, the development of both pain science and biomedical technology will probably be accompanied by the improvement of the knowledge regarding the recourse to invasive analgesic procedures.

  7. Review of post-stroke Aphasia Screening Tests

    OpenAIRE

    Navideh Shkeri; Hamideh Faal Fard; Seyed Amin Piran; Hamid Tahmasian; Mojtaba Tajaddod; Shohreh Jalaei

    2014-01-01

    Background and Aim: The aim of this study was to collect and review Aphasia screening test s for speech- language pathologists .   Materials and Methods : Searching was done in databases of MEDLIN, SID, Magiran, IRAN MEDEX and 5 site of ASHA, Pub Med, Google Scholar, Science Direct , and Web of Science from 1949 to 2012 , and Screening tests were collected and reviewed on the basis of time of composition, subtests ,validity, and reliability.   Results: In this study, 14 screening tests were i...

  8. Monitoring mobility assistive device use in post-stroke patients

    DEFF Research Database (Denmark)

    Boissy, Patrice; Hester, Todd; Sherrill, Delsey; Corriveau, Hélène; Bonato, Paolo

    2007-01-01

    Mobility assistive devices (MAD) such as canes can improve mobility and allow independence in the performance of mobility-related tasks. The use of MAD is often prescribed for stroke survivors. Despite their acknowledged qualities, MAD in real life conditions are typically underutilized, misused...... and abandoned. Ecologically sound, evidence based outcome measures need to be developed so as to capture the inherent complexities behind real life use of MAD and identify markers and mitigators of a successful integration of MAD into the daily activities of stroke survivors. In this study, we used...

  9. Clinical Observation on Acupuncture for Post-stroke Ataxia

    Institute of Scientific and Technical Information of China (English)

    白慧梅; 何剑炜; 崔学军

    2010-01-01

    目的: 观察头针、体针结合治疗中风后共济失调的临床疗效.方法: 选择符合诊断标准的中风后共济失调患者124例,采用头针、体针结合治疗,观察治疗前后脑血管血液流速变化及总体治疗效果.结果: 根据Berg平衡量表评定结果,总有效率93.5%.治疗前后日常生活活动能力(Activities of Daily Living,ADL)指数比较,总有效率91.1%.治疗前后椎基底动脉血液流速比较差异具有统计学意义(P<0.05).结论: 针刺治疗中风共济失调疗效明显.

  10. Epidemiology and treatment of post-stroke depression

    OpenAIRE

    Stefano Paolucci

    2008-01-01

    Stefano PaolucciFondazione Santa Lucia – I.R.C.C.S, Rome, ItalyAbstract: Mood depression is a common and serious complication after stroke. According to epidemiological studies, nearly 30% of stroke patients develop depression, either in the early or in the late stages after stroke. Although depression may affect functional recovery and quality of life after stroke, such condition is often ignored. In fact, only a minority of patients is diagnosed and even fewer are treated in the c...

  11. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to ... pain is real. Site Map Terms & Conditions Privacy Policy Advertising Policy Language Disclaimer Endorsement Policy Development of ...

  12. Treatments for Managing Pain

    Science.gov (United States)

    ... Expect Patient Stories FAQs Anesthesia Topics Treatments for Managing Pain Share PRINT Print Home > Anesthesia Topics > Detail Page Treatments for Managing Pain Medication alone may not be enough to ...

  13. Acupuncture for Pediatric Pain

    Directory of Open Access Journals (Sweden)

    Brenda Golianu

    2014-08-01

    Full Text Available Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed.

  14. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs ... pain is different. And because it is different, we need to think about it in very different ...

  15. Perspectives in Pancreatic Pain

    Directory of Open Access Journals (Sweden)

    A. S. Salim

    1997-01-01

    Full Text Available This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.

  16. What Is Back Pain?

    Science.gov (United States)

    ... component. Other diseases. Some types of arthritis and cancer can cause back pain. Your job. If you ... pain. Spinal stenosis. This condition causes the spinal canal to become ... or a nerve root problem called cauda equina syndrome, surgery is needed ...

  17. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... chronic pain there may be no apparent physical injury or illness to explain it. The physician and ... expected period of healing for an illness or injury. You can experience pain even if you are ...

  18. Prevent Back Pain

    Science.gov (United States)

    ... Prevent Back Pain Print This Topic En español Prevent Back Pain Browse Sections The Basics Overview Am ... at Risk? 3 of 5 sections Take Action: Prevent Injuries Focus on good posture. Good posture can ...

  19. Endometriosis and pain

    Directory of Open Access Journals (Sweden)

    Guido Orlandini

    2011-03-01

    Full Text Available In some patients endometriosis causes persistent or chronic pain and is a specialistic algologic problem. Considering various possible pathogenic pain mechanisms, when pain therapy of endometriosis cannot be etiologic, far from be only symptomatic, it is based on a pathogenetic criterion. We must consider that in endometriosis can be a pain due to activation of nociceptors sensibilized by endometriosic tissues (tissutal nociceptive pain unresponding to NSAIDs and opioids or a pain due to the nerve damage by nerve compression from endometriosic cistis or by involvement of nerve structures in scar tissue (neuropathic pain unresponding to antinociceptive therapy but responding, at least partially, to some neuropathic specific pain drugs and to electrostimulation of the nerve system.

  20. Phytotherapy for pain relief.

    Science.gov (United States)

    Zareba, Grazyna

    2009-06-01

    Pain is considered the third most common healthcare problem disabling more individuals than heart disease and cancer together. Although pharmacological pain management offers a significant relief in several pain-related diseases, many patients turn to its supplementation with complementary and alternative medicine. Botanicals used in pain therapy can contribute to restoring the quality of life to a patient and may effect and enhance conventional pain management. Herbal analgesic use in several pain-related diseases such as rheumatologic diseases, back pain, cancer, diabetic peripheral neuropathy and migraine will be discussed. In addition, this review describes botanicals with known analgesic activity for which randomized, placebo-controlled, double-blind trials assessing their efficacy in different pain-related diseases have been published and which have been recently evaluated in many systematic reviews with well-described methodology. PMID:19649334