Sample records for virus vzv-associated pain

  1. Role for the Ventral Posterior Medial/Posterior Lateral Thalamus and Anterior Cingulate Cortex in Affective/Motivation Pain Induced by Varicella Zoster Virus

    Directory of Open Access Journals (Sweden)

    Phillip R. Kramer


    Full Text Available Varicella zoster virus (VZV infects the face and can result in chronic, debilitating pain. The mechanism for this pain is unknown and current treatment is often not effective, thus investigations into the pain pathway become vital. Pain itself is multidimensional, consisting of sensory and affective experiences. One of the primary brain substrates for transmitting sensory signals in the face is the ventral posterior medial/posterior lateral thalamus (VPM/VPL. In addition, the anterior cingulate cortex (ACC has been shown to be vital in the affective experience of pain, so investigating both of these areas in freely behaving animals was completed to address the role of the brain in VZV-induced pain. Our lab has developed a place escape avoidance paradigm (PEAP to measure VZV-induced affective pain in the orofacial region of the rat. Using this assay as a measure of the affective pain experience a significant response was observed after VZV injection into the whisker pad and after VZV infusion into the trigeminal ganglion. Local field potentials (LFPs are the summed electrical current from a group of neurons. LFP in both the VPM/VPL and ACC was attenuated in VZV injected rats after inhibition of neuronal activity. This inhibition of VPM/VPL neurons was accomplished using a designer receptor exclusively activated by a designer drug (DREADD. Immunostaining showed that cells within the VPM/VPL expressed thalamic glutamatergic vesicle transporter-2, NeuN and DREADD suggesting inhibition occurred primarily in excitable neurons. From these results we conclude: (1 that VZV associated pain does not involve a mechanism exclusive to the peripheral nerve terminals, and (2 can be controlled, in part, by excitatory neurons within the VPM/VPL that potentially modulate the affective experience by altering activity in the ACC.

  2. Biopsychosocial Factors Associated with Pain in Veterans with the Hepatitis C Virus (United States)

    Morasco, Benjamin J.; Lovejoy, Travis I.; Turk, Dennis C.; Crain, Aysha; Hauser, Peter; Dobscha, Steven K.


    Background Little research has examined etiological factors associated with pain in patients with the hepatitis C virus (HCV). The purpose of this study was to evaluate the relationship between biopsychosocial factors and pain among patients with HCV. Methods Patients with HCV and pain (n=119) completed self-report measures of pain, mental health functioning, pain-specific psychosocial variables (pain catastrophizing, self-efficacy for managing pain, social support), prescription opioid use, and demographic characteristics. Results In multivariate models, biopsychosocial factors accounted for 37% of the variance in pain severity and 56% of the variance in pain interference. In adjusted models, factors associated with pain severity include pain catastrophizing and social support, whereas variables associated with pain interference were age, pain intensity, prescription opioid use, and chronic pain self-efficacy (all p-valuesbiopsychosocial model in evaluating and treating chronic pain in patients with HCV. PMID:24338521

  3. Chronic Pain Treatment and Health Service Utilization of Veterans with Hepatitis C Virus Infection (United States)

    Lovejoy, Travis I.; Dobscha, Steven K.; Cavanagh, Renee; Turk, Dennis C.; Morasco, Benjamin J.


    Objectives Hepatitis C virus (HCV) infection is estimated to affect 2% of the general U.S. population and chronic pain is a common comorbidity among persons with HCV. The primary purpose of this study was to compare health service utilization of U.S. military veterans with HCV with and without the presence of comorbid chronic pain. Design Cross-sectional study with retrospective review of patient medical records. Patients One hundred seventy-one U.S. military veterans with confirmed HCV, recruited through a single U.S. Veterans Administration hospital. Outcome Measures Medical service utilization data from the past five years were extracted from participants’ electronic medical records. Results Sixty-four percent of veterans with HCV (n = 110) had chronic pain. Veterans with HCV and chronic pain utilized more health services including total inpatient stays (OR = 2.58 [1.46, 4.56]) and days hospitalized for psychiatric services (OR = 5.50 [3.37, 8.99]), compared to participants with HCV and no chronic pain, after statistically adjusting for demographic, psychiatric, substance use, medical comorbidity, and disability covariates. In addition, those with HCV and chronic pain had more total outpatient visits with primary care providers (OR = 1.73 [1.15, 2.59]), physical therapists (OR = 9.57 [4.79, 19.11]), and occupational therapists (OR = 2.72 [1.00, 7.48]). Conclusions Patients with HCV and chronic pain utilize medical services to a greater extent than patients with HCV but no chronic pain. Future studies that examine the efficacy of both pharmacological and nonpharmacological pain treatment for patients with comorbid HCV and chronic pain appear warranted. PMID:22958315

  4. Pain (United States)

    ... Grant Funding for Pain Initiatives Current Funding Opportunities Research on the Impact of Creative Arts in Military Populations More Health Professional Information Earn CME More Related Topics Chronic Pain ( NINDS ) NIH Pain Seminar Series Pain: You Can Get Help ( NIA ) NIH ...

  5. The role of pain in quitting among human immunodeficiency virus (HIV)-positive smokers enrolled in a smoking cessation trial. (United States)

    Aigner, Carrie J; Gritz, Ellen R; Tamí-Maury, Irene; Baum, George P; Arduino, Roberto C; Vidrine, Damon J


    Smoking rates among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) are at least twice as high as rates in the general population. Consistent with the reciprocal model of pain and smoking, PLWHA with pain who smoke may use smoking as a means of coping with pain, thus presenting a potential barrier to quitting. The aim of this study is to better understand how pain relates to smoking cessation among 474 HIV-positive adults enrolled in a cell phone-delivered smoking cessation trial. Participants were randomly assigned to usual care (cessation advice and self-help materials) or 11 sessions of cell phone-delivered smoking cessation treatment. Pain, as assessed by the Medical Outcomes Study-HIV Health Survey (MOS-HIV), and point prevalence abstinence were collected at the 3-month treatment end and at 6- and 12-month follow-ups. Self-reported abstinence was biochemically verified by expired carbon monoxide (CO) level of <7 ppm. Using multilevel modeling for binary outcome data, the authors examined the relationship between pain and abstinence, from treatment end through the 12-month follow-up. Consistent with the authors' hypothesis, less pain was associated with greater likelihood of 24-hour (β = .01, t(651) = 2.53, P = .01) and 7-day (β = .01, t(651) = 2.35, P = .02) point prevalence abstinence, controlling for age, gender, baseline pain, nicotine dependence, and treatment group. No pain × treatment group interaction was observed. These results can help us to better identify PLWHA at greater risk for relapse in smoking cessation treatment. Future research may examine the effectiveness of more comprehensive smoking cessation treatment that incorporates aspects of pain management for PLWHA who smoke and have high pain and symptom burden.


    Indian Academy of Sciences (India)

    and-mouth disease in livestock was an infectious particle smaller than any bacteria. This was the first clue to the nature of viruses, genetic entities that lie somewhere in the gray area between living and non-living states.

  7. 2017 HIV Medicine Association of Infectious Diseases Society of America Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With Human Immunodeficiency Virus. (United States)

    Bruce, R Douglas; Merlin, Jessica; Lum, Paula J; Ahmed, Ebtesam; Alexander, Carla; Corbett, Amanda H; Foley, Kathleen; Leonard, Kate; Treisman, Glenn Jordan; Selwyn, Peter


    Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

  8. Utility of ultra-deep sequencing for detection of varicella-zoster virus antiviral resistance mutations. (United States)

    Mercier-Darty, Mélanie; Boutolleau, David; Lepeule, Raphaël; Rodriguez, Christophe; Burrel, Sonia


    We report the first application of ultra-deep sequencing (UDS) to varicella-zoster virus (VZV) genotypic antiviral testing in a case of acyclovir-resistant VZV infection initially detected by Sanger sequencing within a deeply immunocompromised heart transplant recipient. As added-value compared to Sanger analysis, UDS revealed complex dynamics of viral population under antiviral pressure. Varicella-zoster virus (VZV) is a ubiquitous human herpesvirus affecting populations worldwide. VZV is commonly acquired in youth whose primary infection usually manifests as benign varicella (chickenpox). After the initial infection, the virus establishes lifelong latency in sensory ganglia leading to a risk of subsequent reactivation. Reactivation usually results in the development of localized herpes zoster (HZ) lesions, a painful skin rash commonly known as shingles (Cohen, 2013). The incidence and severity of HZ increase with impaired specific cell-mediated immunity mainly as a result of increasing age, malignancy, immunodeficiency, organ transplantation, or immunosuppressive drug therapy (Cohen, 2013; Koo et al., 2014; Pavlopoulou et al., 2015). In particular, HZ remains a significant cause of morbidity among solid organ transplant (SOT) recipients, especially in patients undergoing heart transplantation (HT) compared with liver, kidney, or lung transplant recipients (Carby et al., 2007; Koo et al., 2014; Pavlopoulou et al., 2015). These particular individuals are at increased risk of primary infection, reactivation followed by dissemination with visceral involvement and associated with bacterial superinfection, and chronic recurrences (Cohen, 2013). VZV infections may also engender debilitating neuralgia among highly immunocompromised patients (Sampathkumar et al., 2009). HT is also associated with the risk of reactivation of other latent viruses belonging to the Herpesviridae family as herpes simplex virus (HSV). Currently licensed drugs to prevent or to cure HSV- or VZV-associated

  9. Controlling neuropathic pain by adeno-associated virus driven production of the anti-inflammatory cytokine, interleukin-10

    Directory of Open Access Journals (Sweden)

    Flotte Terence R


    Full Text Available Abstract Despite many decades of drug development, effective therapies for neuropathic pain remain elusive. The recent recognition of spinal cord glia and glial pro-inflammatory cytokines as important contributors to neuropathic pain suggests an alternative therapeutic strategy; that is, targeting glial activation or its downstream consequences. While several glial-selective drugs have been successful in controlling neuropathic pain in animal models, none are optimal for human use. Thus the aim of the present studies was to explore a novel approach for controlling neuropathic pain. Here, an adeno-associated viral (serotype II; AAV2 vector was created that encodes the anti-inflammatory cytokine, interleukin-10 (IL-10. This anti-inflammatory cytokine is known to suppress the production of pro-inflammatory cytokines. Upon intrathecal administration, this novel AAV2-IL-10 vector was successful in transiently preventing and reversing neuropathic pain. Intrathecal administration of an AAV2 vector encoding beta-galactosidase revealed that AAV2 preferentially infects meningeal cells surrounding the CSF space. Taken together, these data provide initial support that intrathecal gene therapy to drive the production of IL-10 may prove to be an efficacious treatment for neuropathic pain.

  10. Chronic Pain (United States)

    ... over. There are two types: acute pain and chronic pain. Acute pain lets you know that you may ... have problem you need to take care of. Chronic pain is different. The pain may last for weeks, ...

  11. Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study. (United States)

    Towns, Janet M; Leslie, David E; Denham, Ian; Azzato, Francesca; Fairley, Christopher K; Chen, Marcus


    Chancres, the hallmark of primary syphilis, are classically described as single, painless ulcers at the site of Treponema pallidum inoculation. We aimed to determine the frequency of painful or multiple anogenital lesions of primary syphilis among men, whether there was concurrent herpes simplex virus (HSV) infection and whether HIV status altered clinical presentations. This study was conducted among men with T. pallidum PCR-positive lesions, attending a clinic in Melbourne, Australia, between 2009 and 2014. Lesions were also tested with HSV PCR, and syphilis serology undertaken. 183 men with T. pallidum PCR-positive primary anogenital lesions were included. 89% were men who have sex with men, and 10.9% were heterosexual. 38 men (20.8%) were HIV positive. Anal lesions were more common in HIV-positive men (34.2%) than in HIV-negative men (11.6%). Primary lesions were frequently painful (49.2%) or multiple (37.7%), and infrequently associated with HSV (2.7%). Of 37 men with both painful and multiple primary lesions, only 8% had concurrent HSV. Presentation was not significantly altered by HIV status. Primary syphilis lesions are often painful and/or multiple in the absence of herpes coinfection, and may be clinically misdiagnosed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  12. Neck Pain (United States)

    ... Conditions Living Well with Rheumatic Disease Neck Pain Neck Pain Fast Facts Whiplash from motor vehicle accidents is ... more frequently in women than men. What causes neck pain? Most episodes of neck pain are caused by ...

  13. Genetic analysis of varicella-zoster virus in the aqueous humor in uveitis with severe hyphema. (United States)

    Hosogai, Mayumi; Nakatani, Yoko; Mimura, Kensuke; Kishi, Shoji; Akiyama, Hideo


    Genetic variations have been identified in the genome of varicella-zoster virus (VZV) strains using vesicle fluid, varicella scabs and throat swab samples. We report a rare case of VZV-associated uveitis with severe hyphema, which was immediately diagnosed by polymerase chain reaction (PCR) using the aqueous humor, in which we were able to analyze the VZV genotype for the first time. A 16-year-old Japanese boy was referred to our hospital with a 20-day history of unilateral anterior uveitis and 11-day history of hyphema. At presentation, details of the iris, the iridocorneal angle, and the fundus were not visible due to the severe hyphema. Serum anti-VZV IgG and anti-VZV IgM were elevated, and 1.61 × 10 9 copies/mL of VZV-DNA were detected by real-time PCR using the aqueous humor. As there were no eruptions on his face or body, we diagnosed zoster sine herpete and started intravenous administration of prednisolone and acyclovir. The hyphema completely disappeared 2 weeks after presentation, while sectorial iris atrophy and mild periphlebitis of the fundus became gradually apparent. Anterior inflammation and periphlebitis gradually improved and VZV-DNA in the aqueous humor was reduced to 1.02 × 10 6 copies/mL at 4 weeks after presentation. Examination by slit lamp microscope revealed no inflammation after 5 months, and VZV-DNA could no longer be detected in the aqueous humor. Serum anti-VZV IgG and anti-VZV IgM also showed a gradual decrease along with improvement in ocular inflammation. The genetic analysis of multiple open reading frames and the R5 variable repeat region in the VZV genes, using DNA extracted from the aqueous humor at presentation, showed that the isolate was a wild-type clade 2 VZV strain (prevalent in Japan and surrounding countries) with R5A allele and one SNP unique to clade 1 (both are major types in Europe and North America). VZV-associated uveitis may develop hyphema that obscures ocular inflammation, thus PCR analysis using the

  14. Cytokines Produced in Response to Varicella-Zoster Virus Infection of ARPE-19 Cells Stimulate Lymphocyte Chemotaxis. (United States)

    Graybill, Chiharu; Claypool, David J; Brinton, John T; Levin, Myron J; Lee, Katherine S


    Posterior uveitis is an ocular complication that can occur with reactivation of varicella-zoster virus (VZV). It may lead to loss of vision due to retinal detachment and chronic inflammation, which often causes more severe disease than the virus infection itself. To increase our understanding of the immune response, we infected the retinal pigment epithelial (RPE) cell line, ARPE-19, with cell-associated VZV and compared its response to that of the MeWo cell line using multiplex assays. We observed (1) a difference in the magnitude and kinetics of cytokine responses between the 2 cell types and (2) differential migration of CD4+ and CD8+ T cells towards these cytokines. Thus, our data provide information about the cytokine and lymphocytic responses to VZV infection of RPE cells, thereby providing a useful platform for future studies to address mechanisms underlying the immunopathology of VZV-associated posterior uveitis. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

  15. Pain assessment. (United States)

    Haefeli, Mathias; Elfering, Achim


    Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.

  16. Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: a randomized crossover clinical trial. (United States)

    Borges, Jaqueline; Baptista, Abrahão Fontes; Santana, Nayara; Souza, Israel; Kruschewsky, Ramon A; Galvão-Castro, Bernardo; Sá, Katia Nunes


    Low back pain is highly prevalent in patients with HTLV-1. The effects of physical activity on this condition are not known, but postural misalignment and motor deficits are frequently present. To assess the effect of Pilates exercises on chronic low back pain in these patients, and its impact on quality of life. A randomized crossover clinical trial was conducted, involving 22 patients from a reference center in Salvador, Bahia, Brazil. The VAS was used to evaluate the effect of Pilates on pain intensity and the SF-36 to assess its impact on quality of life. Our results provide evidence of positive effects on pain intensity and almost all domains of quality of life when patients followed the Pilates exercise program described. The Pilates method may be a useful tool in alleviating the symptoms of low back pain, and had a significant impact on quality of life in this sample of patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Back Pain (United States)

    ... Accessed May 29, 2015. Adult acute and subacute low back pain. Bloomington, Minn.: Institute for Clinical Systems Improvement. Accessed June ...

  18. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B


    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...

  19. Hashimoto's Thyroiditis Presenting as Acute Painful Thyroiditis and as a Manifestation of an Immune Reconstitution Inflammatory Syndrome in a Human Immunodeficiency Virus-Seropositive Patient.

    NARCIS (Netherlands)

    Visser, R.; Mast, Q. de; Netea-Maier, R.T.; Ven, A.J.A.M. van der


    Background: An immune reconstitution inflammatory syndrome (IRIS) may complicate immune restoration following start of antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected patients. The occurrence of Graves' disease in the setting of an IRIS is well recognized. We hereby

  20. Neuropathic Pain

    African Journals Online (AJOL)


    pain is not at all clear and this can be attributed to the fact that terminology defining the disease is very uncertain. ... This is also classified as chronic pain. In these ... CRPS Type II (Complete regional pain syndrome). * Phantom limb pain. * Spinal cord injury. * Post surgery. - laminectorny. - spinal fusion. - general surgery.

  1. Ebola Virus and Marburg Virus (United States)

    Ebola virus and Marburg virus Overview Ebola virus and Marburg virus are related viruses that cause hemorrhagic fevers — illnesses marked by severe bleeding (hemorrhage), organ failure and, in many ...

  2. Exploration of pain in children on antiretroviral treatment in a ...

    African Journals Online (AJOL)

    Background: Patients with human immunodeficiency virus (HIV) disease on antiretroviral therapy (ART) may experience pain for a variety of reasons, including the effects of the virus itself, associated opportunistic infections and the ART. Studies indicate that pain in adults on ART is frequent, can be severe, and is often ...

  3. Sexual pain. (United States)

    Boardman, Lori A; Stockdale, Colleen K


    Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain.

  4. Testicle Pain (United States)

    ... Scrotal pain. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016. Jan. 11, 2018 Original article: . Mayo Clinic Footer Legal Conditions and ...

  5. Neck Pain (United States)

    ... triggers muscle strains. Even minor things, such as reading in bed or gritting your teeth, can strain ... determine the cause of your pain. Other tests Electromyography (EMG). If your doctor suspects your neck pain ...

  6. Chest Pain (United States)

    ... or tightness in your chest Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms Pain that lasts ... com. Accessed Sept. 6, 2017. Yelland MJ. Outpatient evaluation of the adult with chest pain. Accessed Sept. ...

  7. Neck Pain (United States)

    ... arms or hands or if you have shooting pain into your shoulder or down your arm. Symptoms Signs and symptoms ... org/search/Pages/results.aspx?k=Chronic neck pain. Accessed June 11, 2015. Isaac Z. Evaluation of the patient with neck pain and cervical ...

  8. Breast pain (United States)

    ... the level of of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before your period is normal. Some women who have pain in one or both breasts may fear breast cancer . However, breast pain is not a common symptom ...

  9. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)


    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. Spontaneous pain attacks: neuralgic pain

    NARCIS (Netherlands)

    de Bont, L.G.


    Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either

  11. 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.

  12. Bone pain

    DEFF Research Database (Denmark)

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


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

  13. Ejaculatory pain

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Møhl, Bo; Kehlet, Henrik


    BACKGROUND: Sexual dysfunction due to ejaculatory and genital pain after groin hernia surgery may occur in approximately 2.5% of patients. However, the specific psychosexological and neurophysiologic characteristics have not been described, thereby precluding assessment of pathogenic mechanisms...... and treatment strategies. METHODS: Ten patients with severe pain-related sexual dysfunction and ejaculatory pain were assessed in detail by quantitative sensory testing and interviewed by a psychologist specialized in evaluating sexual functional disorders and were compared with a control group of 20 patients...... with chronic pain after groin hernia repair but without sexual dysfunction, to identify sensory changes associated with ejaculatory pain. RESULTS: Quantitative sensory testing showed significantly higher thermal and mechanical detection thresholds and lowered mechanical pain detection thresholds in both groups...

  14. [Chest pain]. (United States)

    Horn, Benedikt


    Chest pain in ambulatory setting is predominantly not heart-associated. Most patients suffer from muskuloskeletal or functional (psychogenic) chest pain. Differential diagnosis covers aortic dissection, rib-fracture, shingles, GERD, Tietze-Syndrome, pulmonary embolism, pleuritis, pneumothorax, pleurodynia and metastatic disease. In most cases history, symptoms and signs allow a clinical diagnosis of high pretest-probability.

  15. Breast Pain (United States)

    ... result in the development of breast cysts. Breast trauma, prior breast surgery or other factors localized to the breast can lead to breast pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and ...

  16. Muscle pain

    African Journals Online (AJOL)

    of muscle or tendons.4,14. Management of muscle pain. Non-Pharmacological Management. The non-pharmacological treatments for muscle pain are illustrated in Figure 1. Treatment modalities include the following. Transcutaneous electrical stimulation (TENS). TENS is a non-invasive procedure used in rehabilitation to.

  17. Abdominal Pain (United States)

    ... weight loss slowed growth rate lots of vomiting chronic severe diarrhea gastrointestinal blood loss persistent pain on the right ... or Spanish)—from The North American Society for Pediatric Gastroenterology, Hepatology and ... Chronic Abdominal Pain in Children , a clinical report from ...

  18. Painful shoulder

    Directory of Open Access Journals (Sweden)

    Benno Ejnismann


    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. Shoulder pain (United States)

    ... and ligaments inside the shoulder become stiff, making movement difficult and painful Overuse or injury of nearby tendons, such as the bicep muscles of the arms Tears of the rotator cuff tendons Watch this video about: Shoulder joint dislocation Sometimes, shoulder pain may ...

  20. Painful shoulder


    Benno Ejnismann; Gustavo Cará Monteiro; Luis Fernando Uyeda


    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.

  1. Neuropathic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Re


    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.

  2. Chest pain (United States)

    ... pain. The pain may spread to the arm, shoulder, jaw, or back. A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body ( aortic dissection ) causes sudden, severe ...

  3. A new looming of Zika virus

    Directory of Open Access Journals (Sweden)

    Nirav R. Soni


    Full Text Available Zika virus (ZIKV is a member of the virus family Flaviviridae and the genus Flavivirus, transmitted by daytime-active Aedes mosquitoes, such as A. aegypti. ZIKV will continue to spread and it will be difficult to determine how the virus will spread over time. Sign and symptoms of ZIKAVD (Zika virus disease were conjunctivitis (red eyes, back pain, birth defect-abnormal brain development known as microcephaly and it is diagnosed through PCR (polymerase chain reaction and virus isolation from blood samples.

  4. ECHO virus (United States)

    ... page: // ECHO virus To use the sharing features on this page, please enable JavaScript. Enteric cytopathic human orphan (ECHO) viruses are a group of viruses that can lead ...

  5. [Painful ejaculation]. (United States)

    Delavierre, D; Sibert, L; Rigaud, J; Labat, J-J


    To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE). Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior. PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies. The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  6. [Hindfoot pain]. (United States)

    Damiano, Joël; Bouysset, Maurice


    The hindfoot is the part of the foot which is proximal to the midtarsal joint. The obvious causes of pain are not considered (post-traumatic etiologies, sprains and fractures but also cutaneous lesions). The main etiologies on the subject are successively exposed by following the localization of the pain. Diffuse pains (ankle arthritis tarsal osteoarthritis, algodystrophy, calcaneo-navicular synostosis but also bone diseases like stress fractures, Paget disease or tumors). Plantar talalgia (Sever's disease, plantar fasciitis and entrapment neuropathies such as (esions of the medial calcaneal nerve, of the first branch of the plantar lateral nerve, medial plantar nerve and lateral plantar nerve). Posterior pains: calcaneal tendinopathy including peritendinitis, tendinosis, retro-calcaneal bursitis and pathology of the postero-lateral talar tuberosity. Medial pains: tendinopathies of the posterior tibial tendon and tendinopathy of the flexor hallucis longus tendon and tarsal tunnel syndrome. Lateral pains: fibularis tendinopathies including split lesions of the fibularis brevis tendon, displacement of the fibularis iongus tendon, sinus tarsi syndrome and finally thickenings of capsules and ligaments and ossifications localized under the tibial malleoli. Anterior pains: antero-inferior tibio-fibular ligament, anterior tibial tendinopathy and anterior impingment syndrome.

  7. Pain Disorder

    Directory of Open Access Journals (Sweden)

    Carlos Capela


    Full Text Available Pain disorder is a psychiatric disorder diagnosed when the pain becomes the predominant focus of the clinical presentation and causes significant distress or impairment. Besides the high economic impact, there is a reciprocal relationship with the affective state. Pain is a subjective sensation and its severity and quality of experience in an individual is dependent on a complex mix of factors. In the treatment of acute pain, the primary purpose is pain relief, while chronic pain typically requires a combination of psychotropic drugs. In this context, it is also important to recognize and treat depression. Psychological treatments aimed at providing mechanisms to allow patients to "control and live with the pain" rather than aspire to eliminate it completely. A growing group of researchers proposes the elimination of the chapter of Somatoform Disorders and the modification of the category "psychological factors affecting a medical condition" to "psychological factors affecting an identified or feared medical condition" with clinical entities as ubchapters, largely based upon Diagnostics for Psychosomatic Research criteria.

  8. Glia and pain: is chronic pain a gliopathy? (United States)

    Ji, Ru-Rong; Berta, Temugin; Nedergaard, Maiken


    Activation of glial cells and neuro-glial interactions are emerging as key mechanisms underlying chronic pain. Accumulating evidence has implicated 3 types of glial cells in the development and maintenance of chronic pain: microglia and astrocytes of the central nervous system (CNS), and satellite glial cells of the dorsal root and trigeminal ganglia. Painful syndromes are associated with different glial activation states: (1) glial reaction (ie, upregulation of glial markers such as IBA1 and glial fibrillary acidic protein (GFAP) and/or morphological changes, including hypertrophy, proliferation, and modifications of glial networks); (2) phosphorylation of mitogen-activated protein kinase signaling pathways; (3) upregulation of adenosine triphosphate and chemokine receptors and hemichannels and downregulation of glutamate transporters; and (4) synthesis and release of glial mediators (eg, cytokines, chemokines, growth factors, and proteases) to the extracellular space. Although widely detected in chronic pain resulting from nerve trauma, inflammation, cancer, and chemotherapy in rodents, and more recently, human immunodeficiency virus-associated neuropathy in human beings, glial reaction (activation state 1) is not thought to mediate pain sensitivity directly. Instead, activation states 2 to 4 have been demonstrated to enhance pain sensitivity via a number of synergistic neuro-glial interactions. Glial mediators have been shown to powerfully modulate excitatory and inhibitory synaptic transmission at presynaptic, postsynaptic, and extrasynaptic sites. Glial activation also occurs in acute pain conditions, and acute opioid treatment activates peripheral glia to mask opioid analgesia. Thus, chronic pain could be a result of "gliopathy," that is, dysregulation of glial functions in the central and peripheral nervous system. In this review, we provide an update on recent advances and discuss remaining questions. Copyright © 2013 International Association for the

  9. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Learned Going to the ER Communication Tools Pain Management Programs Videos Resources FAQs Glossary Surveys Resource Guide to Chronic Pain Treatments The Art of Pain Management Partners for Understanding Pain Pain Awareness Toolkits September ...

  10. Chronic Pelvic Pain (United States)

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

  11. Phantom Pain (United States)

    ... 16, 2014. Phantom pain Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  12. Chronic Pain (United States)

    ... have shown that there are higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling ...

  13. Penis pain (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 ) ...

  14. Joint pain (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 ...

  15. Elbow pain (United States)

    ... chap 62. Kane SF, Lynch JH, Taylor JC. Evaluation of elbow pain in adults. Am Fam Physician . ... Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  16. Habituating pain

    DEFF Research Database (Denmark)

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


    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...... the industry reproduce physical strain and the habituation of pain as unquestioned conditions in construction work. The understanding of this mutual reinforcement of the necessity of physically straining, painful, high-paced construction work provides fruitful perspectives on the overrepresentation...

  17. Heel Pain (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 ...

  18. Back Pain (United States)

    ... emotional stress. Sometimes the cause is unknown. Common risk factors for back pain include being overweight, poor physical conditioning, smoking, whole body vibration, and improper lifting technique and body mechanics, including poor posture. Repeated activities (lifting, carrying, bending, ...

  19. Neuropathic Pain (United States)

    ... feels, and how much it hurts. This graphic representation provides a lot of important information in an ... can learn about the different parts of the body where nerve pain can manifest. Online Tool Back ...

  20. Period Pain (United States)

    ... your uterus or other reproductive organs, such as endometriosis and uterine fibroids. This kind of pain often ... Taking a hot bath Doing relaxation techniques, including yoga and meditation You might also try taking over- ...

  1. Pain relief can be painful

    Directory of Open Access Journals (Sweden)

    Ashish Bindra


    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.

  2. Pain and pain management in haemophilia


    Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cédric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić


    Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients? experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement redu...

  3. Low back pain - acute (United States)

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  4. Deep Pain

    DEFF Research Database (Denmark)

    Rodriguez, Pau; Cucurull, Guillem; Gonzàlez, Jordi


    appearance versus taking into account the whole image: As a result, we outperform current state- of-the-art AUC performance in the UNBC-McMaster Shoulder Pain Expression Archive Database. In addition, to evaluate the generalization properties of our proposed methodology on facial motion recognition, we also......Pain is an unpleasant feeling that has been shown to be an important factor for the recovery of patients. Since this is costly in human resources and difficult to do objectively, there is the need for automatic systems to measure it. In this paper, con- trary to current state-of-the-art techniques...... in pain assessment, which are based on facial features only, we suggest that the performance can be enhanced by feeding the raw frames to deep learning models, outperforming the latest state-of-the-art results while also directly facing the problem of imbalanced data. As a baseline, our approach first...

  5. Glial activation: a driving force for pathological pain. (United States)

    Watkins, L R; Milligan, E D; Maier, S F


    Pain is classically viewed as being mediated solely by neurons, as are other sensory phenomena. The discovery that spinal cord glia (microglia and astrocytes) amplify pain requires a change in this view. These glia express characteristics in common with immune cells in that they respond to viruses and bacteria, releasing proinflammatory cytokines, which create pathological pain. These spinal cord glia also become activated by certain sensory signals arriving from the periphery. Similar to spinal infection, these signals cause release of proinflammatory cytokines, thus creating pathological pain. Taken together, these findings suggest a new, dramatically different approach to pain control, as all clinical therapies are focused exclusively on altering neuronal, rather than glial, function.

  6. Painful menstrual periods (United States)

    Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps ... a few days during each menstrual cycle. Painful menstruation is the leading cause of lost time from ...

  7. Shoulder pain. (United States)

    Ramponi, Denise R


    Shoulder pain is a frequent complaint encountered in the emergency setting. A brief review of shoulder anatomy and physical examination sets the foundation for evaluation of shoulder pain. Considerations of patient's age are helpful to predict injuries. Fractured clavicles are often seen in traumatic injuries in children and young adults, whereas fractures of the humeral head are more often seen in the elderly from traumatic injuries. Shoulder dislocations are more common in teens to fourth decade. This article reviews specific acute injuries, chronic conditions, and radiologic considerations of patients with shoulder complaints encountered in emergency settings.

  8. Gastric pain

    African Journals Online (AJOL)

    diabetes, viral illness or drugs. Nausea, bloating and fullness. Oesophageal spasm. Substernal chest pain, with or without dysphagia for liquids and solids. Gastro-oesophageal reflux disease. • Heartburn. • Occasional reflux of acid or the stomach contents into the mouth. • Symptoms occasionally triggered by lying down.

  9. Achilles Pain. (United States)

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  10. Pain (PDQ) (United States)

    ... With Your Health Insurance Plan Federal Government Programs Patient Safety Informed Consent Children's Assent Scientific Review Ending Trials ... losing support once their care moves from their oncology team back to their primary ... Each patient needs a personal plan to control cancer pain. ...

  11. Orofacial pain

    Directory of Open Access Journals (Sweden)

    Marjolijn Oomens


    Full Text Available In the primary care sector, diagnosis and initial management of orofacial pain are often performed by familydoctors and dentists. Knowledge of the different types of orofacial pain and headache disorders is therefor of great importance. The International Classification of Headache Disorders (ICHD-3 provides an overview of the different types of orofacial pain and will be discussed in this lecture. The main focus will be on trigeminal neuralgia and cluster headache and the current research in this field. Trigeminal Neuralgia (TN is defined as a disorder characterized by recurrent, unilateral, brief, electricshock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of thetrigeminal nerve and triggered by innocuous stimuli. Unfortunately, most TN is idiopathic, and the aetiology isnot clear. The guidelines on pharmaceutical TN management published by the American Academy of Neurology (AAN and the European Federation of Neurological Societies (EFNS recommend carbamazepine (CBZ; 200–1200 mg/day or oxcarbazepine (OXC; 600–1800 mg/day as first-line therapy. Both are antiepileptics with well known interactions with other drugs and safety problems. An overview of the currently available literature on the pharmaceutical management of TN patients is discussed. Cluster headache (CH is one of the most painful primary headache disorders. It is characterized by daily or almost daily attacks of unilateral excruciating periorbital pain associated with ipsilateral cranial autonomic symptoms, typically lasting between 15 and 180 minutes if untreated. Cluster headache is caused by the relaesement of neurotransmitters and vasodilators from the sphenopalatine ganglion (SPH. The SPG is a large extracranial parasympathetic ganglion located in the pterygopalatine fossa (PPF. The current treatments for CH attacks are injectable sumatriptan and oxygen inhalation. Both treatments have well known side effects and

  12. When Sex Is Painful (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 ...

  13. 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 ... Pain Awareness Toolkits September is Pain Awareness Month Home Pain Management Tools Videos What Is Chronic Pain? ...

  14. Persistent facial pain conditions

    DEFF Research Database (Denmark)

    Forssell, Heli; Alstergren, Per; Bakke, Merete


    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...

  15. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Covington, MD, director of the Cleveland Clinic Pain Management Program, explains some of the physiology of pain. Narrator: Most pain is temporary and manageable, but chronic pain is different. And because it is different, we need to ...

  16. [Pain characteristics in HIV/AIDS patients]. (United States)

    Pérez-Carranco, María Luisa; Guevara-López, Uriah; Covarrubias-Gómez, Alfredo; Alvarez, Julio Delgado; Villafaña-Tello, José de Jesús S; Espin-Paredes, Elena


    Human immunodeficiency virus infection (HIV), affects 0.6 % of world population and 0.3 % of the adult population in Mexico. Pain, in this group, is frequently not identified by the health care team, is poorly defined, and undertreated. Our objective was to evaluate the prevalence of pain and its characteristics in Mexican HIV patients. HIV diagnosed patients were included. Social and demographic information about pain characteristics, response to analgesic treatment and the presence of comorbidities were analyzed. The illness status was identified and CD4 cell count was documented. Pain was identified in 11 of 55 cases. Mean time of pain onset was 26 months (SD 28.6). Mean pain intensity by visual analogue scale was 7 (SD 2.3), and by verbal analogue scale proportions were reported as follows: 18 % mild, 36.5 % moderate, and 45 % severe pain. We observed that pain appeared in 20 % of subjects. CD4 count was observed to be related to pain decrease. Type of study and sample size does not permit a definite interpretation of the results; therefore a generation of prospective studies with larger samples is needed.

  17. Mast cell-derived histamine mediates cystitis pain.

    Directory of Open Access Journals (Sweden)

    Charles N Rudick


    Full Text Available Mast cells trigger inflammation that is associated with local pain, but the mechanisms mediating pain are unclear. Interstitial cystitis (IC is a bladder disease that causes debilitating pelvic pain of unknown origin and without consistent inflammation, but IC symptoms correlate with elevated bladder lamina propria mast cell counts. We hypothesized that mast cells mediate pelvic pain directly and examined pain behavior using a murine model that recapitulates key aspects of IC.Infection of mice with pseudorabies virus (PRV induces a neurogenic cystitis associated with lamina propria mast cell accumulation dependent upon tumor necrosis factor alpha (TNF, TNF-mediated bladder barrier dysfunction, and pelvic pain behavior, but the molecular basis for pelvic pain is unknown. In this study, both PRV-induced pelvic pain and bladder pathophysiology were abrogated in mast cell-deficient mice but were restored by reconstitution with wild type bone marrow. Pelvic pain developed normally in TNF- and TNF receptor-deficient mice, while bladder pathophysiology was abrogated. Conversely, genetic or pharmacologic disruption of histamine receptor H1R or H2R attenuated pelvic pain without altering pathophysiology.These data demonstrate that mast cells promote cystitis pain and bladder pathophysiology through the separable actions of histamine and TNF, respectively. Therefore, pain is independent of pathology and inflammation, and histamine receptors represent direct therapeutic targets for pain in IC and other chronic pain conditions.

  18. Chikungunya virus (United States)

    Chikungunya virus infection; Chikungunya ... Where Chikungunya is Found Before 2013, the virus was found in Africa, Asia, Europe, and the Indian and Pacific oceans. In late 2013, outbreaks occurred for the first time in the ...

  19. Zika Virus (United States)

    ... through blood transfusions. There have been outbreaks of Zika virus in the United States, Africa, Southeast Asia, the ... not travel to areas where there is a Zika virus outbreak. If you do decide to travel, first ...

  20. Chikungunya Virus (United States)

    ... Gaines, PhD, MPH, MA, CHES Differentiating Chikungunya From Dengue: A Clinical Challenge For Travelers CDC Travelers' Health Chikungunya Virus Home Prevention Transmission Symptoms & Treatment Geographic Distribution Chikungunya virus in the United States ...

  1. Zika Virus (United States)

    ... Funding CDC Activities For Healthcare Providers Clinical Evaluation & Disease Sexual Transmission HIV Infection & Zika Virus Testing for Zika Test Specimens – At Time of Birth Diagnostic Tests Understanding Zika Virus Test Results ...

  2. Data mining and analysis of bacillus virus

    Directory of Open Access Journals (Sweden)

    An Jiwoo


    Full Text Available Anthrax- can be found naturally in soil and commonly affects domestic and wild animals around the world. Bacillus anthracis is mostly common viruses of Anthrax. There are some more occurred in similar DNA sequences: 3 Bacillus Viruses: Bacillus anthracis, Bacillus cereus, and Bacillus thuringiensis. This is a report about analyzing the similarities between the Bacillus viruses by investigating the frequency of amino acid and finding the difference between those three viruses based on the gene. Those diseases are infected by parasite and host animals, and cause muscle pain. Therefore, we can conclude that Leucine is a protein that plays a significant role in causing muscle pain. Secondly, In Analysis of decision tree, there are only little differences between each classes. The classes represent positions that include representative protein. The very position that windows mention is their difference.

  3. Pain and Nociception

    DEFF Research Database (Denmark)

    Falk, Sarah; Dickenson, Anthony H


    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......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...

  4. Optimising pain management- An update

    African Journals Online (AJOL)

    Types of pain. There are three types of pain, namely acute pain, chronic non- cancer (non-malignant) pain and cancer pain (chronic malignant pain). These types are explained in more detail below. Acute pain. This is defined as pain of recent onset and of short or limited duration. The pain is related to an identifiable cause.

  5. Melanocortins and Neuropathic Pain

    NARCIS (Netherlands)

    Vrinten, Dorien Henriëtte


    Neuropathic pain (pain initiated by a lesion or dysfunction of the nervous system) is characterised by symptoms such as allodynia (pain due to a stimulus that does not normally provoke pain) and hyperalgesia (an increased response to a stimulus that is normally painful). It constitutes a major

  6. Measuring postoperative pain

    NARCIS (Netherlands)

    Dijk, J.F.M. van


    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. CHLORELLA VIRUSES (United States)

    Yamada, Takashi; Onimatsu, Hideki; Van Etten, James L.


    Chlorella viruses or chloroviruses are large, icosahedral, plaque‐forming, double‐stranded‐DNA—containing viruses that replicate in certain strains of the unicellular green alga Chlorella. DNA sequence analysis of the 330‐kbp genome of Paramecium bursaria chlorella virus 1 (PBCV‐1), the prototype of this virus family (Phycodnaviridae), predict ∼366 protein‐encoding genes and 11 tRNA genes. The predicted gene products of ∼50% of these genes resemble proteins of known function, including many that are completely unexpected for a virus. In addition, the chlorella viruses have several features and encode many gene products that distinguish them from most viruses. These products include: (1) multiple DNA methyltransferases and DNA site‐specific endonucleases, (2) the enzymes required to glycosylate their proteins and synthesize polysaccharides such as hyaluronan and chitin, (3) a virus‐encoded K+ channel (called Kcv) located in the internal membrane of the virions, (4) a SET domain containing protein (referred to as vSET) that dimethylates Lys27 in histone 3, and (5) PBCV‐1 has three types of introns; a self‐splicing intron, a spliceosomal processed intron, and a small tRNA intron. Accumulating evidence indicates that the chlorella viruses have a very long evolutionary history. This review mainly deals with research on the virion structure, genome rearrangements, gene expression, cell wall degradation, polysaccharide synthesis, and evolution of PBCV‐1 as well as other related viruses. PMID:16877063

  8. Virus Crystallography (United States)

    Fry, Elizabeth; Logan, Derek; Stuart, David

    Crystallography provides a means of visualizing intact virus particles as well as their isolated constituent proteins and enzymes (1-3) at near-atomic resolution, and is thus an extraordinarily powerful tool in the pursuit of a fuller understanding of the functioning of these simple biological systems. We have already expanded our knowledge of virus evolution, assembly, antigenic variation, and host-cell interactions; further studies will no doubt reveal much more. Although the rewards are enormous, an intact virus structure determination is not a trivial undertaking and entails a significant scaling up in terms of time and resources through all stages of data collection and processing compared to a traditional protein crystallographic structure determination. It is the methodology required for such studies that will be the focus of this chapter. The computational requirements were satisfied in the late 1970s, and when combined with the introduction of phase improvement techniques utilizing the virus symmetry (4,5), the application of crystallography to these massive macromolecular assemblies became feasible. This led to the determination of the first virus structure (the small RNA plant virus, tomato bushy stunt virus), by Harrison and coworkers in 1978 (6). The structures of two other plant viruses followed rapidly (7,8). In the 1980s, a major focus of attention was a family of animal RNA viruses; the Picornaviridae.

  9. Recurrent herpes simplex virus keratitis in a young Nigerian male ...

    African Journals Online (AJOL)

    Herpes Simplex Virus Keratitis is the infection of cornea by double stranded DNA Viruses.This condition has a tendency to reoccur after a certain period of time. A 25 year old male presented to the clinic with reduced visual acuity, itching, redness, pain and photophobia in the left eye. Onset of symptoms was 10 days prior to ...

  10. Fighting Chronic Pain (United States)

    ... Disease-Related Pain: Various cancers, ALS (Lou Gehrig's Disease), tuberculosis, HIV-AIDs, and others Head/Neck: Migraine, headaches, jaw pain (TMJ), earache, toothache, sore throat, sinus pain, facial numbness ...

  11. Side Effects: Pain (United States)

    Controlling pain is an important part of your cancer treatment plan. Learn how to track levels of pain. Find out how pain, a side effect of cancer treatment, is treated using acupuncture, biofeedback, and physical therapy.

  12. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Going to the ER Communication Tools Pain Management Programs Videos Resources FAQs Glossary Surveys Resource Guide to ... MD, director of the Cleveland Clinic Pain Management Program, explains some of the physiology of pain. Narrator: ...

  13. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... the pain will go away. Part of the problem with chronic pain is that when we start ... is that the presence of a severe pain problem which exists for some period of time can ...

  14. Low back pain - chronic (United States)

    ... this page: // Low back pain - chronic To use the sharing features on this page, please enable JavaScript. Low back pain refers to pain that you feel in your ...

  15. Buprenorphine Buccal (chronic pain) (United States)

    Buprenorphine (Belbuca) is used to relieve severe pain in people who are expected to need pain medication ... and who cannot be treated with other medications. Buprenorphine (Belbuca) should not be used to treat pain ...

  16. Pain dilates time perception

    National Research Council Canada - National Science Library

    Amandine E Rey; George A Michael; Corina Dondas; Marvin Thar; Luis Garcia-Larrea; Stéphanie Mazza


    .... We show that being in pain leads to an expansion of subjective time whereby a stronger increase in pain perception relative to non-painful stimulation leads to a stronger time-estimate distortion...

  17. Managing your chronic pain (United States)

    ... Managing your chronic back pain To use the sharing features on this page, please enable JavaScript. Managing chronic pain means finding ways to make your back pain ...

  18. Soul Pain

    Directory of Open Access Journals (Sweden)

    Sarah L. Jirek


    Full Text Available This study extends prior research on vicarious traumatization and emotion management by exploring a deeper, more life-altering effect of working with traumatized clients—namely, “soul pain.” Analyses of in-depth interviews with 29 advocates working with survivors of physical and sexual violence reveal that, as a direct consequence of hearing countless stories of human brutality, some staff members experience a profound wounding of their spirit. This finding expands our understanding of the occupational hazards of the helping professions by revealing another dimension of advocates’ lives—that of the soul or spirit—that may be affected by their work with trauma survivors.

  19. [Benign chronic pain]. (United States)

    Serrie, A; Thurel, C


    Recent data indicate that 25 to 30% of the population in industrialized countries suffers from benign chronic pain. Among these patients, 50 to 75% are professionally incapable for varied lengths of time, from a few days to some weeks or months, or even definitively. The aetiology and clinical presentation of chronic benign pain are enormously varied because this definition includes such different pathologies as headache, pain of rheumatologic, postsurgical, organic, and post-zoster origin, lombalgia, radiculalgia, post-amputation pain, neuropathologic pain, causalgia, algoneurodystrophic pain, psychosomatic and idiopathic pain. Since these syndromes and causes of pain could not be discussed individually, they have been grouped according to their neurophysiology and pathophysiology.

  20. Pain characteristics of adolescent spinal pain


    Wirth, Brigitte; Humphreys, B Kim


    Background Although adolescent spinal pain increases the risk for chronic back pain in adulthood, most adolescents can be regarded as healthy. The aim of the present study was to provide data on localization, intensity and frequency of adolescent spinal pain and to investigate which physical and psycho-social parameters predict these pain characteristics. Method On the occasion of Spine Day, an annual event where children and adolescents are examined by chiropractors on a voluntary basis for ...

  1. Pain characteristics of adolescent spinal pain. (United States)

    Wirth, Brigitte; Humphreys, B Kim


    Although adolescent spinal pain increases the risk for chronic back pain in adulthood, most adolescents can be regarded as healthy. The aim of the present study was to provide data on localization, intensity and frequency of adolescent spinal pain and to investigate which physical and psycho-social parameters predict these pain characteristics. On the occasion of Spine Day, an annual event where children and adolescents are examined by chiropractors on a voluntary basis for back problems, 412 adolescents (10 to 16 years) were tested (by questionnaire and physical examination). Pain characteristics (localization, intensity, and frequency) were identified and evaluated using descriptive statistics. Regression analyses were performed to investigate possible influencing psycho-social and physical influence factors. Adolescents who suffered from pain in more than one spinal area reported higher pain intensity and frequency than those with pain in only one spinal area. Sleep disorders were a significant predictor for pain in more than one spinal area (p report data on pain frequency, intensity and localization. Adolescents who present with pain in more than one spinal area or report frequent pain should be followed carefully. Reduced balance with visual deprivation might be a physical indicator of a serious back problem.

  2. Pain and musculoskeletal pain syndromes in adolescents. (United States)

    Zapata, Aura Ligia; Moraes, Ana Julia Pantoja; Leone, Claudio; Doria-Filho, Ulysses; Silva, Clovis Artur Almeida


    The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain.


    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. CHANDIPURA VIRUS. First isolated from a village called Chandipura near Nagpur in 1965 in India. Belongs to rhabdoviridae family. Used as a Model System to study RNA virus multiplication in the infected cell at molecular level. Notes:

  4. Low Back Pain (United States)

    ... are good exercises to improve your overall fitness. Low back pain treatment Most people who have low back pain can ... sitting, standing, sleeping, or lifting.Severe cases of low back pain may require medical treatment. This could include prescription pain relievers or injections. ...

  5. Hemiplegic Shoulder Pain. (United States)

    Wilson, Richard D; Chae, John


    Hemiplegic shoulder pain is a common complaint for stroke survivors. Many pathologies are included in the diagnosis of hemiplegic shoulder pain, and many with shoulder pain have a multifactorial cause. This article provides rehabilitation specialists with an approach to evaluation and management of those with hemiplegic shoulder pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Paediatric pain management

    African Journals Online (AJOL)

    cultural attitudes about pain, and the cognitive component of pain control.3 All of these ... applied to any patient, regardless of his/her age; however, paediatric pain expression is dependent on the child's level of cognitive development and .... pain.5 This approach involves the participation of the parent and the child during ...

  7. Computer viruses (United States)

    Denning, Peter J.


    The worm, Trojan horse, bacterium, and virus are destructive programs that attack information stored in a computer's memory. Virus programs, which propagate by incorporating copies of themselves into other programs, are a growing menace in the late-1980s world of unprotected, networked workstations and personal computers. Limited immunity is offered by memory protection hardware, digitally authenticated object programs,and antibody programs that kill specific viruses. Additional immunity can be gained from the practice of digital hygiene, primarily the refusal to use software from untrusted sources. Full immunity requires attention in a social dimension, the accountability of programmers.

  8. Cancer Pain Physiology

    DEFF Research Database (Denmark)

    Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony


    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...

  9. [Assessing a patient's pain]. (United States)

    Mathieu, Laurent


    Pain assessment has taken a predominant role in nursing practice. In day-to-day care, the way a patient in pain is approached and the assessment of their pain are sometimes subject to extensive questioning. The subjective part of pain is still often emphasised when the quantified assessment and the nurse's clinical observation are contradictory. The exhaustive gathering of information is key to an effective assessment of a patient's pain. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.


    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: 2008/3...

  11. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik


    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...

  12. [Chest pain units or chest pain algorithm?]. (United States)

    Christ, M; Dormann, H; Enk, R; Popp, S; Singler, K; Müller, C; Mang, H


    A large number of patients present to the emergency department (ED) for evaluation of acute chest pain. About 10-15% are caused by acute myocardial infarction (MI), and over 50% of cases are due to noncardiac reasons. Further improvement for chest pain evaluation appears necessary. What are current options to improve chest pain evaluation in Germany? A selective literature search was performed using the following terms: "chest pain", "emergency department", "acute coronary syndrome" and "chest pain evaluation". A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.

  13. Pain perception and modulation in acute and chronic pain states

    NARCIS (Netherlands)

    Oudejans, L.C.J.


    This thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain phenotypes are determined in patients with chronic pain. The ability of patients with acute pain after

  14. Extraterrestrial Viruses?


    Jurado Hernández, Daniel José


    Fundamentals of Life - Origin and Fundamentals of Living Things. Evaluation rubric to evaluate the debate and presentation about the point of view regarding the possibility of viruses from the outer space.

  15. Zika Virus


    Musso, Didier; Gubler, Duane J.


    Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) in the genus Flavivirus and the family Flaviviridae. ZIKV was first isolated from a nonhuman primate in 1947 and from mosquitoes in 1948 in Africa, and ZIKV infections in humans were sporadic for half a century before emerging in the Pacific and the Americas. ZIKV is usually transmitted by the bite of infected mosquitoes. The clinical presentation of Zika fever is nonspecific and can be misdiagnosed as other infectious diseases, especi...


    African Journals Online (AJOL)

    Rash (including Stevens-Johnson syndrome), insomnia, somnolence, dizziness, trouble concentrating, nightmares. Nausea, diarrhoea, anorexia, abdominal pain, fatigue, headache, insomnia, hypersensitivity reactions. tAvailable as a combined formulation Combivir®, the recommended dose is one tablet twice daily.

  17. Psychological aspects of pain. (United States)

    Gorczyca, Rafał; Filip, Rafał; Walczak, Ewa


    Pain is defined "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Pain is a sensation of the body, and is always an unpleasant emotional experience. The role of psychology is auxiliary and supplemental to medicine. This is an aid addressed to the patient, physician and patient's caregivers: professional caregivers, family members and significant others. At each stage of the diagnostic and therapeutic process, psychology offers help, both from the cognitive and practical aspects. The objective of the article is to present important psychological aspects of studies concerning pain, and the psychological methods and techniques of pain treatment. Pain is the leading reason for patients seeking medical care and is one of the most disabling, burdensome, and costly conditions. Pain accompanies many diseases, each one of which generates unique/separate diagnostic, therapeutic and research problems. DEPRESSION AND RELATED PSYCHICAL DISORDERS: There is a significant relationship between depression and pain symptoms, as well as between pain and suicidal thoughts. Patients with a long history of pain disorders also have increased depression and anxiety symptoms, as well as suicidal thoughts. Patients with more severe depression and anxiety symptoms also have an increase in pain problems. The intensity of pain correlates with the intensity of psychopathological symptoms - both with mood lowering and with anxiety symptoms and worry. Active pain coping strategies strive to function in spite of pain, or to distract oneself from pain, are associated with adaptive functioning. Passive strategies involve withdrawal or relinquishing control to an external force or agent and are related to greater pain and depression. Pain catastrophizing is a negatively distorted perception of pain as awful, horrible and unbearable. Catastrophizing is strongly associated with depression and pain. Studies in which

  18. [The pain from burns]. (United States)

    Latarjet, J


    The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres.

  19. Pain, objectivity and history: understanding pain stigma. (United States)

    Goldberg, Daniel S


    The primary claim of this paper is that understanding the stigma so commonly endured by chronic pain sufferers today in the USA and the UK is unlikely without proper appreciation of the history of pain. Ameliorating such stigma is an ethical imperative, and yet most approaches eschew even an attempt to trace connections between historical attitudes, practices and beliefs towards pain and the stigmatisation so many pain sufferers currently endure. The manuscript aims to help fill this gap by framing pain in the modern era in context of two crucial intellectual schemes that waxed in the 19th and 20th centuries: mechanical objectivity and somaticism. The analysis explains these frameworks and applies them to exploration of primary sources connected to contested pain conditions such as railway spine. By properly situating the historical roots of what it means to cite the 'subjectivity' of pain as a problem, the modern roots of stigmatising attitudes and practices towards chronic pain sufferers become much clearer. The manuscript concludes by suggesting that interventions expressly intended to target the root causes of such stigma are much more likely to be successful than approaches that proceed in ignorance of the historical forces shaping and driving pain stigma in the present. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. Newcastle Disease Virus (PDQ) (United States)

    ... to Ask about Your Treatment Research Newcastle Disease Virus (PDQ®)–Patient Version Overview Go to Health Professional ... Question 8 ). Questions and Answers About Newcastle Disease Virus What is Newcastle disease virus? Newcastle disease virus ( ...

  1. Powassan (POW) Virus Basics (United States)

    ... Professionals Related Topics For International Travelers Powassan (POW) Virus Basics Download this fact sheet formatted for print: ... POW) Virus Fact Sheet (PDF) What is Powassan virus? Powassan (POW) virus is a flavivirus that is ...

  2. Pediatric pain management. (United States)

    Lederhaas, G


    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated.

  3. Facilitated pronociceptive pain mechanisms in radiating back pain compared with localized back pain

    DEFF Research Database (Denmark)

    Vaegter, Henrik Bjarke; Palsson, Thorvaldur Skuli; Graven-Nielsen, Thomas


    Facilitated pain mechanisms and impaired pain inhibition are often found in chronic pain patients. This study compared clinical pain profiles, pain sensitivity, as well as pro-nociceptive and anti-nociceptive mechanisms in patients with localized low back pain (n=18), localized neck pain (n=17......), low back and radiating leg pain (n=18), or neck and radiating arm pain (n=17). It was hypothesized that patients with radiating pain had facilitated pain mechanisms and impaired pain inhibition compared with localized pain patients. Cuff algometry was performed on the non-painful lower leg to assess...... threshold (HPT) at the non-painful hand were also assessed. Clinical pain intensity, psychological distress, and disability were assessed with questionnaires. TSP was increased in patients with radiating back pain compared with localized back pain (Ppain or localized low...

  4. Computer Viruses. Technology Update. (United States)

    Ponder, Tim, Comp.; Ropog, Marty, Comp.; Keating, Joseph, Comp.

    This document provides general information on computer viruses, how to help protect a computer network from them, measures to take if a computer becomes infected. Highlights include the origins of computer viruses; virus contraction; a description of some common virus types (File Virus, Boot Sector/Partition Table Viruses, Trojan Horses, and…

  5. Viruses Avian influenza, bovine herpes, bovine viral diarrhea virus ...

    Indian Academy of Sciences (India)

    ... human cytomegalovirus, herpes simplex virus, human immunodeficiency virus I, influenza, lymphocytic choriomeningitis virus, measles, papilloma, rabies, respiratory syncitial virus, simian immunodeficiency virus, simian virus 40. Bacteria Borrelia burgdorferi (Lyme disease), Moraxella bovis, Mycobacterium tuberculosis, ...

  6. Computer viruses

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, F.B.


    This thesis investigates a recently discovered vulnerability in computer systems which opens the possibility that a single individual with an average user's knowledge could cause widespread damage to information residing in computer networks. This vulnerability is due to a transitive integrity corrupting mechanism called a computer virus which causes corrupted information to spread from program to program. Experiments have shown that a virus can spread at an alarmingly rapid rate from user to user, from system to system, and from network to network, even when the best-availability security techniques are properly used. Formal definitions of self-replication, evolution, viruses, and protection mechanisms are used to prove that any system that allows sharing, general functionality, and transitivity of information flow cannot completely prevent viral attack. Computational aspects of viruses are examined, and several undecidable problems are shown. It is demonstrated that a virus may evolve so as to generate any computable sequence. Protection mechanisms are explored, and the design of computer networks that prevent both illicit modification and dissemination of information are given. Administration and protection of information networks based on partial orderings are examined, and probably correct automated administrative assistance is introduced.

  7. What a Pain! Kids and Growing Pains (United States)

    ... Steven Dowshen, MD Date reviewed: June 2015 For Teens For Kids For Parents MORE ON THIS TOPIC Why Do I Have Pain? How Do Pain Relievers Work? Growth Disorders I'm Growing Up - But Am I Normal? What Medicines Are and What They Do Feeling Too Tall or Too Short Contact Us Print Resources Send ...

  8. Pain Control After Surgery: Pain Medicines (United States)

    ... if I still have pain after finishing my medicine? Resources National Institutes of Health: MedlinePlus, Post Surgical Pain Treatment – Adults U.S. Food and Drug Administration, Opioid Medications Last Updated: July 2017 This article was contributed by: editorial staff Categories: ...

  9. Abdominal Pain (Stomach Pain), Long-Term (United States)

    ... Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath in Infants and Children Shoulder Problems Skin Rashes & Other Skin Problems Throat Problems Tooth Problems Urination Problems Back to Symptoms Step 2 Answering Questions Does your pain get ...

  10. TMJ pain and cryoanalgesia


    Sidebottom, Andrew J


    Temporomandibular (TMJ) joint pain is a complex issue involving several factors in a spectrum including myofascial pain, internal derangement and degenerative disease, all of which are reciprocally affected by psychological factors.

  11. Science of pain

    National Research Council Canada - National Science Library

    Basbaum, A. I; Bushnell, M. Catherine


    "The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage...

  12. Chronic pelvic pain

    National Research Council Canada - National Science Library

    Slawomir Wozniak


    [b][/b][b]Introduction. [/b]Chronic pelvic pain (CPP) affects about 10–40% of women presenting to a physician, and is characterised by pain within the minor pelvis persisting for over 6 months. [b...

  13. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Support the ACPA Contact Us Shop What We Have Learned Going to the ER Communication Tools Pain ... are no longer ill or if your injuries have healed. In fact, many persons experience pain even ...

  14. Chest Pain: First Aid (United States)

    ... angina with any of the following signs and symptoms, it may indicate a more serious condition, such as a heart attack: Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness ...

  15. American Pain Society (United States)

    ... Psychological Flexibility Might Be the Key to Better Cognitive-Behavioral Interventions APS Presents 2016 Achievement Awards APS Honors ... with Pain Persistence After Pediatric Surgery Study Shows Cognitive Behavioral Therapy Improves Functioning for People with Chronic Pain ...

  16. Acupuncture for Pediatric Pain

    Directory of Open Access Journals (Sweden)

    Brenda Golianu


    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.

  17. Diclofenac Topical (osteoarthritis pain) (United States)

    ... gel (Voltaren) is used to relieve pain from osteoarthritis (arthritis caused by a breakdown of the lining ... Diclofenac topical liquid (Pennsaid) is used to relieve osteoarthritis pain in the knees. Diclofenac is in a ...

  18. 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 ...

  19. Perspectives in Pancreatic Pain

    Directory of Open Access Journals (Sweden)

    A. S. Salim


    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.

  20. Eldercare at Home: Pain (United States)

    ... or "heaviness" or “misery.” Look for behavior or body language that looks like a response to pain. An ... to communicate about pain in words. Behaviors or body language to look for include facial expressions such as ...

  1. Pain in cancer survivors. (United States)

    Brown, Matthew Rd; Ramirez, Juan D; Farquhar-Smith, Paul


    Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients' quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available.

  2. Breast pain (image) (United States)

    ... breast pain is from hormonal fluctuations from menstruation, pregnancy, puberty, menopause, and breastfeeding. Breast pain can also be associated with fibrocystic breast disease, but it is a very unusual symptom of breast cancer.

  3. Prevent Back Pain (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 ...

  4. Painful Intercourse (Dyspareunia) (United States)

    ... 3, 2017. Related Vagina Endometriosis: Reduce pain during sex Painful intercourse (dyspareunia) Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Advertising & ...

  5. Hendra virus. (United States)

    Middleton, Deborah


    Hendra virus infection of horses occurred sporadically between 1994 and 2010 as a result of spill-over from the viral reservoir in Australian mainland flying-foxes, and occasional onward transmission to people also followed from exposure to affected horses. An unprecedented number of outbreaks were recorded in 2011 leading to heightened community concern. Release of an inactivated subunit vaccine for horses against Hendra virus represents the first commercially available product that is focused on mitigating the impact of a Biosafety Level 4 pathogen. Through preventing the development of acute Hendra virus disease in horses, vaccine use is also expected to reduce the risk of transmission of infection to people. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  6. Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain (United States)

    Alappattu, Meryl J; George, Steven Z; Robinson, Michael E; Fillingim, Roger B; Moawad, Nashat; LeBrun, Emily Weber; Bishop, Mark D


    Introduction Evidence suggests that painful intercourse, pain-related psychosocial factors, and altered pain processing magnify the pain experience, but it is not clear how these factors are related to each other. Aim The aims were to (i) characterize differences between women with pelvic pain and pain-free women using a battery of pain-related psychosocial measures, clinical pain ratings, and evoked local and remote pain sensitivity; and (ii) examine the relationship between intercourse pain, clinical pain, and local and remote evoked pain sensitivity. Methods Women with pelvic pain lasting at least 3 months and pain-free women completed questionnaires and underwent pain sensitivity testing. Self-report measures included clinical pain intensity, pain catastrophizing, pain-related fear, pain anxiety, depression, sexual function, and self-efficacy. Pain sensitivity measures included threshold and tolerance and temporal summation of pain. Separate analyses of variance (anova) were used to test group differences in self-report and pain sensitivity measures. Correlations were calculated among dyspareunia, psychosocial factors, and evoked pain. Main Outcome Measures Self-reported pain and pain sensitivity measures. Results Twenty-eight pain-free women and 14 women with pelvic pain participated in this study. Women with pelvic pain reported greater pain intensity and greater psychosocial involvement compared with pain-free women. No differences existed between groups for thermal or pressure measures, but women with pelvic pain rated their pain with pain testing significantly higher than pain-free women. Intercourse pain was significantly associated with affective and sensory pain and pressure pain ratings at the puborectalis, vulvar vestibule, adductor longus tendons, and tibialis anterior muscle. Conclusions Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of

  7. Neonatal pain management. (United States)

    Carter, Brian S; Brunkhorst, Jessica


    Pain management in the neonatal ICU remains challenging for many clinicians and in many complex care circumstances. The authors review general pain management principles and address the use of pain scales, non-pharmacologic management, and various agents that may be useful in general neonatal practice, procedurally, or at the end of life. Chronic pain and neonatal abstinence are also noted. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Neurological diseases and pain


    Borsook, David


    Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequentl...

  9. Ketogenic Diets and Pain (United States)

    Masino, Susan A.; Ruskin, David N.


    Ketogenic diets are well-established as a successful anticonvulsant therapy. Based on overlap between mechanisms postulated to underlie pain and inflammation, and mechanisms postulated to underlie therapeutic effects of ketogenic diets, recent studies have explored the ability for ketogenic diets to reduce pain. Here we review clinical and basic research thus far exploring the impact of a ketogenic diet on thermal pain, inflammation, and neuropathic pain. PMID:23680946

  10. Ketogenic Diets and Pain


    Masino, Susan A.; Ruskin, David N.


    Ketogenic diets are well-established as a successful anticonvulsant therapy. Based on overlap between mechanisms postulated to underlie pain and inflammation, and mechanisms postulated to underlie therapeutic effects of ketogenic diets, recent studies have explored the ability for ketogenic diets to reduce pain. Here we review clinical and basic research thus far exploring the impact of a ketogenic diet on thermal pain, inflammation, and neuropathic pain.

  11. Painful Traumatic Trigeminal Neuropathy. (United States)

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav


    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Pain in Down's Syndrome

    Directory of Open Access Journals (Sweden)

    Federica Mafrica


    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

  13. Marburg virus. (United States)

    Dowdle, W R


    Marburg virus disease, which produced 20 per cent mortality when it first occured during 1967 in Germany and Yugoslavia, recently appeared again in South Africa. The source of the first outbreak was monkeys shipped from Africa; the origin of the second episode is unclear. Because distribution of the virus in nature is unknown, its threat to man cannot be readily determined. Differential laboratory diagnoses of hemorrhagic fevers should be encouraged in order to learn more about the epidemiology of these diseases and to better assess the risks which their etiologic agents may pose for attending medical personnel.

  14. Back pain - returning to work (United States)

    Nonspecific back pain - work; Backache - work; Lumbar pain - work; Pain - back - chronic; Low back pain - work; Lumbago - work ... strong. If walking is too hard for you, work with a physical therapist to develop an exercise ...

  15. Non-Cardiac Chest Pain (United States)

    ... it: “atypical chest pain, chest pain of undetermined origin, unexplained chest pain, functional chest pain, soldier’s heart, ... Return to Top GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity ...

  16. Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study

    Directory of Open Access Journals (Sweden)

    Schaefer C


    Full Text Available Caroline Schaefer,1 Alesia Sadosky,2 Rachael Mann,3 Shoshana Daniel,4 Bruce Parsons,2 Michael Tuchman,5 Alan Anschel,6 Brett R Stacey,7 Srinivas Nalamachu,8 Edward Nieshoff9 1Covance Market Access Services Inc., Gaithersburg, MD, 2Pfizer, Inc., New York, NY, 3Covance Market Access Services Inc., San Diego, CA, 4Covance Market Access Services Inc., Conshohocken, PA, 5Palm Beach Neurological Center, Palm Beach Gardens, FL, 6Rehabilitation Institute of Chicago, Chicago, IL, 7Oregon Health and Science University, Portland, OR, 8International Clinical Research Institute, Overland Park, KS, 9Rehabilitation Institute of Michigan/Wayne State University, Detroit, MI, USABackground: As with many chronic conditions, patients with neuropathic pain (NeP are high consumers of health care resources. However, limited literature exists on the economic burden of NeP, including its impact on productivity. The aim of this study was to characterize health care resource utilization, productivity, and costs associated with NeP by pain severity level in US adults.Methods: Subjects (n=624 with painful diabetic peripheral neuropathy, human immunodeficiency virus-related peripheral NeP, post-trauma/post-surgical NeP, spinal cord injury with NeP, chronic low back pain with NeP, and small fiber neuropathy were recruited during routine office visits to US community-based general practitioners and specialists. Clinicians captured clinical characteristics, NeP-related medications, and health care resource utilization based on 6-month retrospective medical chart review. Subjects completed questionnaires on demographics, pain/symptoms, costs, and productivity. Brief Pain Inventory pain severity scores were used to classify subjects by mild, moderate, or severe pain. Annualized NeP-related costs (adjusted for covariates were estimated, and differences across pain severity groups were evaluated.Results: In total, 624 subjects were recruited (mean age 55.5±13.7 years; 55.4% male

  17. Complex Regional Pain Syndrome (United States)

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. It may happen ... move the affected body part The cause of CRPS is unknown. There is no specific diagnostic test. ...

  18. Surgical management of pain

    African Journals Online (AJOL)

    music therapy, physiotherapy, and cognitive behavioural therapy, the pain team should consider surgery. The techniques available in the surgical management of pain are summarised in Table 1.[5-12]. Surgery can help in the management of pain in the following ways: • by modulating neural function:[5-8] TENS, spinal cord ...

  19. Pain sensitisation in osteoarthritis

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars


    Treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the peripheral and central pain mechanisms are not fully discovered, and safe and as efficient analgesic drugs are not available. In general, the preclinical models of OA are limited...

  20. 21. Phantom pain.

    NARCIS (Netherlands)

    Wolff, A.P.; Vanduynhoven, E.; Kleef, M. van; Huygen, F.; Pope, J.E.; Mekhail, N.


    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

  1. Physiotherapists' knowledge of pain

    African Journals Online (AJOL)

    subsequently, to poor pain management. Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA). Methods. Data were collected online by means of a demographic questionnaire and Unruh's Revised Pain Knowledge and Attitudes. Questionnaire (RPKAQ).

  2. Analgesia for acute pain

    African Journals Online (AJOL)

    human right, and therefore the aim of acute pain management is adequate pain control to achieve ... the intervention causes unacceptable side-effects, it can lead to suboptimal pain relief and potentially dire outcomes. Knowledge .... it was found in a systematic review that music therapy reduces anxiety and analgesia ...

  3. Pain and patienthood

    NARCIS (Netherlands)

    Meijler, WJ

    Objective: The objective of this study was to identify possible differences between chronic pain patients (consumers) and persons with chronic pain lasting >1 year who had not consulted a doctor because of the pain during the last year (nonconsumers). Group differences were studied from the

  4. 13. Sacroiliac joint pain

    NARCIS (Netherlands)

    Vanelderen, P.; Szadek, K.M.; Cohen, S.P.; Witte, J.; Lataster, A.; Patijn, J.; Mekhail, N.; van Kleef, M.; van Zundert, J.


    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower

  5. [Pain in edentulous patients

    NARCIS (Netherlands)

    Baat, C. de


    In daily social life, orofacial pain is strongly associated with teeth. However, edentulousness is no lifetime guarantee of being pain-free in the orofacial region. Common oral pains in edentulous people are caused by denture misfits or occlusal errors, by alveolar ridge atrophy, by (sharp)

  6. Acute pain guidelines

    African Journals Online (AJOL)

    Pain is a complex interaction of sensory, emotional and behavioral factors. There are no pain pathways, ... of Pain as an “unpleasant sensory and emotional experience, associated with actual or potential tissue ..... to interact and sleep deprivation all contribute to psychological disturbances, which can increase the risk of ...

  7. Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Meryl J. Alappattu, DPT, PhD


    Conclusions: Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23.

  8. Children's pain perspectives. (United States)

    Esteve, R; Marquina-Aponte, V


    Previous studies on children's pain perspectives remain limited to English-speaking populations. An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectives Inventory was applied to 180 healthy Spanish children. A coding system was developed following the content analysis method. Three age groups were compared: 4-6 years, corresponding to the Piagetian pre-operational stage of cognitive development; 7-11 years, corresponding to stage of concrete operations; and 12-14 years, corresponding to the period of early formal operations. In children between 4 and 6, the predominant narratives related to physical injuries, the notion of causality and the definition of pain. In children between 7 and 11, the predominant narratives were those in which pain was described as a sensation in one part of the body. The view of pain as having an emotional basis significantly increased with age and was more frequent in adolescents. In contrast, children between 4-6 and 7-11 indicated that pain occurs spontaneously. The denial of any positive aspects of pain significantly decreased with age; some children between 7 and 11 referred to the 'possibility of relief', while the view that pain is a 'learning experience' was significantly more frequent among adolescents aged between 12 and 14 years. The use of cognitive strategies to control pain significantly increased with age. Between 12 and 14 years of age, adolescents communicate pain by non-verbal behaviour and reported that they do not express demands for relief. There was a progression from concrete to more complex notions of pain as age increased. These results may be of use to health professionals and parents to understand how children at various developmental stages express and cope with pain and to develop tools that effectively assess and

  9. Dual Infection with Hepatitis B and Epstein-Barr Virus Presenting with Severe Jaundice, Coagulopathy, and Hepatitis B Virus Chronicity Outcome. (United States)

    Rao, Sirish C; Ashraf, Imran; Mir, Fazia; Samiullah, Sami; Ibdah, Jamal A; Tahan, Veysel


    BACKGROUND Hepatitis B virus (HBV) has been reported as a coinfection with hepatitis C virus (HCV), hepatitis D virus (HDV), cytomegalovirus (CMV), and human immunodeficiency virus (HIV). CASE REPORT A 34-year-old female presented to our clinic with epigastric pain and severe acute hepatitis manifested as jaundice associated with hyperbilirubinemia, elevated transaminases, and coagulopathy. The patient was diagnosed with acute HBV with Epstein-Barr virus (EBV) coinfection leading to subsequent chronic hepatitis B. CONCLUSIONS To our knowledge, this patient case is the first reported case of HBV and EBV coinfection reported in the literature. HBV and EBV coinfection may cause severe acute hepatitis with HBV chronicity.

  10. Pain-related worry in patients with chronic orofacial pain. (United States)

    Davis, C Ervin; Stockstill, John W; Stanley, William D; Wu, Qiang


    Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

  11. Myofascial low back pain. (United States)

    Ramsook, Ryan R; Malanga, Gerard A


    Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain.

  12. Is neuropathic pain underdiagnosed in musculoskeletal pain conditions? The Danish PainDETECTive study

    DEFF Research Database (Denmark)

    Jespersen, A; Amris, K; Bliddal, H


    In all, 19-22% of the adult Danish population suffer from chronic pain - most frequently in the musculoskeletal system. Different pain management strategies depending on pain mechanism (neuropathic/nociceptive) make diagnosing the pain condition especially important.......In all, 19-22% of the adult Danish population suffer from chronic pain - most frequently in the musculoskeletal system. Different pain management strategies depending on pain mechanism (neuropathic/nociceptive) make diagnosing the pain condition especially important....


    Directory of Open Access Journals (Sweden)

    A.N. Mayansky


    Full Text Available The lecture is devoted to oncogenic viruses, particularly human papilloma virus. Papilloma viral infection is found in all parts of the globe and highly contagious. In addition to exhaustive current data on classification, specifics of papilloma viruses composition and epidemiology, the author describes in great detail the malignization mechanisms of papilloma viruses pockets. Also, issues of diagnostics and specific prevention and treatment of diseases caused by this virus are illustrated. Key words: oncogenic viruses, papilloma viruses, prevention, vaccination. (Pediatric Pharmacology. – 2010; 7(4:48-55

  14. Fantom pain: Case report

    Directory of Open Access Journals (Sweden)

    Marić Sanja S.


    Full Text Available Background Phantom limb pain is a common problem after limb amputation (41-85%. It is described as an extremely painful sensation in the missing part of the body that can last for hours, days or even years. It is considered to arise from cortical reorganization, although many factors can increase the risk of phantom limb pain: pain before surgery, age and sex of the patients, the time elapsed since surgery, stump pain, inadequate prosthesis. Phantom limb pain therapy is very complicated. Case report We reported a case of 80-year-old patient suffering from phantom limb pain and phantom sensation 25 years after the amputation of his left leg due to the injury. The patient has pain at the site of amputation, sensation that he has the leg and that it occupies an unusual position and almost daily exhausting phantom limb pain (6-9 visual analogue scale - VAS with disturbed sleep and mood. We managed to reduce the pain under 4 VAS and decrease the patient suffering by combining drugs from the group of coanalgetics (antidepressants, antiepileptics, non-pharmacological methods (transcutaneous electroneurostimulation - TENS, mirror therapy and femoral nerve block in the place of disarticulation of the left thigh. Conclusion Phantom limb pain therapy is multimodal, exhausting for both the patient and the physician and it is often unsuccessful. The combination of different pharmacological and non-pharmacological modalities can give satisfactory therapeutic response.

  15. Pain in burn patients. (United States)

    Latarjet, J; Choinère, M


    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  16. The Pain of Labour (United States)

    Labor, Simona


    Labour is an emotional experience and involves both physiological and psychological mechanisms. The pain of labour is severe but despite this its memory diminishes with time. Labour pain has two components: visceral pain which occurs during the early first stage and the second stage of childbirth, and somatic pain which occurs during the late first stage and the second stage. The pain of labour in the first stage is mediated by T10 to L1 spinal segments, whereas that in the second stage is carried by T12 to L1, and S2 to S4 spinal segments. Pain relief in labour is complex and often challenging without regional analgesia. Effective management of labour pain plays a relatively minor role in a woman's satisfaction with childbirth. PMID:26526404

  17. Back Pain in Children

    Directory of Open Access Journals (Sweden)

    Sadi Kayiran ; Sinan Mahir Kayiran;


    Full Text Available Contrary to popular knowledge, back pain is quite frequently seen in children. While very rare in the pre-school age group, frequency reaches 30% in the adolescent period. In many cases, the causes of back pain in childhood cannot be exactly determined and the pain disappears by itself in a short time. It should be remembered that back pain that persists for more than two weeks may be associated with organic causes. Whether or not there have been disruptions in neurological functions should be definitely probed in the medical history. Keeping in mind that back pain could be a part of a systemic disease, a systemic examination should be carried out in cases where there has been long-term back pain. The complaint of childhood back pain should be assessed with a thorough history, a careful physical examination and advanced testing tools. [TAF Prev Med Bull 2011; 10(1.000: 115-118

  18. Acute chest pain. (United States)

    Jindal, Atul; Singhi, Sunit


    Chest pain is a worrisome symptom that often causes parents to bring their child to emergency department(ED) for evaluation. In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. The clinician's primary goal in ED evaluation of chest pain is to identify serious causes and rule out organic pathology. The diagnostic evaluation includes a thorough history and physical examination. Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas an adolescent is more likely to have a psychogenic cause. Children having an organic cause of chest pain are more likely to have acute pain, sleep disturbance due to pain and associated fever or abnormal examination findings, whereas those with non-organic chest pain are more likely to have pain for a longer duration. Chest radiograph is required in some, especially in patients with history of trauma . In children, myocardial ischemia is rare, thus routine ECG is not required on every patient. However, both pericarditis and myocarditis can present with chest pain and fever. Musculoskeletal chest pain, such as caused by costochondritis and trauma, is generally reproducible on palpation and is exaggerated by physical activity or breathing. Pneumonia with or without pleural effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. In asthmatic children bronchospasm and persistent coughing can lead to excess use of chest wall muscles and chest pain. Patients' who report acute pain and subsequent respiratory distress should raise suspicion of a spontaneous pneumothorax or pneumomediastinum. ED management includes analgesics, specific treatment directed at underlying etiology and appropriate referral.

  19. The role of helplessness, fear of pain, and passive pain-coping in chronic pain patients.

    NARCIS (Netherlands)

    Samwel, J.J.A.; Evers, A.W.M.; Crul, B.J.P.; Kraaimaat, F.W.


    OBJECTIVES: The goal of this study was to examine the relative contribution of helplessness, fear of pain, and passive pain-coping to pain level, disability, and depression in chronic pain patients attending an interdisciplinary pain center. METHODS: One hundred sixty-nine chronic pain patients who

  20. Oropuche virus: A virus present but ignored

    Directory of Open Access Journals (Sweden)

    Salim Mattar V.


    Full Text Available Bunyaviruses are RNA viruses that affect animals and plants; they have five genera and four of them affect humans: Orthobunyavirus, Nairovirus, Phlebovirus and Hantavirus. All of them are Arbovirus, except Hantavirus. The Orthobunyaviruses comprise Oropouche, Tahyna, La Crosse virus, California encephalitis virus and Heartland virus recently discovered (1. Except for Heartland virus which is transmitted by ticks of the genus Amblyoma, these Phleboviruses have as vectors mosquitoes, which bite small mammals which are able to be as reservoirs amplifiers.

  1. Pain Management: Post-Amputation Pain (United States)

    ... common use group of terms to describe and define the different kinds of pain. Immediate Post-op ... caused by poor circulation and nerve damage from diabetes. Since there are numerous problems that can result ...

  2. Pain management in the elderly. (United States)

    Malec, Monica; Shega, Joseph W


    Persistent pain in older adults is common, and associated with substantial morbidity. Optimal management starts with assessment, including pain presence, intensity, characteristics, and interference; painful conditions; pain behaviors; pain-related morbidity; pain treatments; and coping style. Treatment incorporates analgesics demonstrated to decrease pain and improve a patient's sense of well-being. The World Health Organization's 3-step pain ladder is widely accepted and adopted for selecting analgesics among patients with non-cancer pain. Shared decision making is essential to balance the benefits and burdens of analgesics. This article reviews pain assessment/management for older adults, focusing on commonly used analgesics. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Mengenal Hanta Virus


    Wijayanti, Tri


    Virus Hanta kurang infeksius, kecuali di dalam lingkungan tertentu. Lamanya waktu virus ini dapat bertahan di lingkungan, setelah keluar dari tubuh tikus tidaklah diketahui secara pasti. Tetapi percobaan laboratorium menunjukkan bahwa, daya infektifitasnya tidak dijumpai setelah dua hari pengeringan. Genus hanta virus terdiri dari 22 spesies virus, dapat menyebabkan hemorrhagic fever with renal syndrome (HFRS) dan hanta virus pulmonary syndrome (HPS).

  4. Viruses of hyperthermophilic Crenarchaea

    DEFF Research Database (Denmark)

    Prangishvili, D.; Garrett, R. A.


    , when one examines the archaeal viruses, the picture appears complex. Most viruses that are known to infect members of the kingdom Euryarchaeota resemble bacterial viruses, whereas those associated with the kingdom Crenarchaeota show little resemblance to either bacterial or eukaryal viruses....... This review summarizes our current knowledge of this group of exceptional and highly diverse archaeal viruses....

  5. Pain Management in Newborns (United States)

    Hall, Richard W.; Anand, Kanwaljeet J. S.


    Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress. PMID:25459780

  6. Central pain control. (United States)

    Calvino, Bernard; Grilo, Rose Marie


    We describe the anatomic and physiological components involved in pain physiology, with the goal of providing readers with the background information needed to understand central pain control mechanisms. These include spinal segmental controls, supraspinal excitatory and inhibitory controls, and diffuse noxious inhibitory controls (DNICs). Pain is a subjective sensation produced by an emotionally unpleasant experience considered to originate in adaptive processes taking place within neuron networks located at various levels of the central nervous system. The intensity of the components of pain is influenced by the stimulus characteristics, patient-related factors, and the setting in which the stimulus occurs. The various components of pain and the psychological and neurophysiological mechanisms that underlie the affective dimension of pain are reviewed. As a conclusion, phantom pain is used to illustrate the role for physiological systems independent from those involved in the physiology of nociception and pain, such as the motor cortex. This example highlights the extreme complexity of pain and pain control systems in humans.

  7. Zika Virus. (United States)

    Musso, Didier; Gubler, Duane J


    Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) in the genus Flavivirus and the family Flaviviridae. ZIKV was first isolated from a nonhuman primate in 1947 and from mosquitoes in 1948 in Africa, and ZIKV infections in humans were sporadic for half a century before emerging in the Pacific and the Americas. ZIKV is usually transmitted by the bite of infected mosquitoes. The clinical presentation of Zika fever is nonspecific and can be misdiagnosed as other infectious diseases, especially those due to arboviruses such as dengue and chikungunya. ZIKV infection was associated with only mild illness prior to the large French Polynesian outbreak in 2013 and 2014, when severe neurological complications were reported, and the emergence in Brazil of a dramatic increase in severe congenital malformations (microcephaly) suspected to be associated with ZIKV. Laboratory diagnosis of Zika fever relies on virus isolation or detection of ZIKV-specific RNA. Serological diagnosis is complicated by cross-reactivity among members of the Flavivirus genus. The adaptation of ZIKV to an urban cycle involving humans and domestic mosquito vectors in tropical areas where dengue is endemic suggests that the incidence of ZIKV infections may be underestimated. There is a high potential for ZIKV emergence in urban centers in the tropics that are infested with competent mosquito vectors such as Aedes aegypti and Aedes albopictus. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  8. Neonatal pain management

    Directory of Open Access Journals (Sweden)

    Tarun Bhalla


    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.

  9. Treatment of myofascial pain. (United States)

    Desai, Mehul J; Bean, Matthew C; Heckman, Thomas W; Jayaseelan, Dhinu; Moats, Nick; Nava, Andrew


    SUMMARY The objective of this article was to perform a narrative review regarding the treatment of myofascial pain syndrome and to provide clinicians with treatment recommendations. This paper reviews the efficacy of various myofascial pain syndrome treatment modalities, including pharmacological therapy, injection-based therapies and physical therapy interventions. Outcomes evaluated included pain (visual analog scale), pain pressure threshold and range of motion. The evidence found significant benefit with multiple treatments, including diclofenac patch, thiocolchicoside and lidocaine patches. Trigger point injections, ischemic compression therapy, transcutaneous electrical nerve stimulation, spray and stretch, and myofascial release were also efficacious. The authors recommend focusing on treating underlying pathologies, including spinal conditions, postural abnormalities and underlying behavioral issues. To achieve maximum pain reduction and improve function, we recommend physicians approach myofascial pain syndrome with a multimodal plan, which includes a combination of pharmacologic therapies, various physical therapeutic modalities and injection therapies.


    Directory of Open Access Journals (Sweden)

    Aleš Vesnaver


    Full Text Available Background. Chronic unexplained orofacial pain is frequently the cause of prolonged suffering for the patient and an unsolvable problem for the therapist. Pathophysiology of the onset of this type of pain is virtually unknown. Still, it is possible to divide chronic orofacial pain into several separate categories, according to its onset, symptoms and therapy. All forms of this type of pain have a strong psychological component.Methods. A retrograde review was conducted, in which patients’ records, treated in 1994 for chronic unexplained orofacial pain, were followed through a 5 year period. The modalities of treatment then and at present were compared.Conclusions. Except for trigeminal neuralgia, where carbamazepine remains the first choice drug, treatment of chronic facial pain has changed considerably.

  11. Thoracic spine pain

    Directory of Open Access Journals (Sweden)

    Aleksey Ivanovich Isaikin


    Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

  12. Low back pain and the post-laminectomy pain syndrome

    African Journals Online (AJOL)

    Back pain is one of the most common disorders seen in general practice. Patients with chronic low back pain form a large proportion of the work of any pain relief unit. The aetiology of low back pain and the post-laminectomy pain syndrome are briefly presented and treatment of the 'failed back surgery patient' and the ...

  13. Early Events in Chikungunya Virus Infection—From Virus CellBinding to Membrane Fusion

    Directory of Open Access Journals (Sweden)

    Mareike K. S. van Duijl-Richter


    Full Text Available Chikungunya virus (CHIKV is a rapidly emerging mosquito-borne alphavirus causing millions of infections in the tropical and subtropical regions of the world. CHIKV infection often leads to an acute self-limited febrile illness with debilitating myalgia and arthralgia. A potential long-term complication of CHIKV infection is severe joint pain, which can last for months to years. There are no vaccines or specific therapeutics available to prevent or treat infection. This review describes the critical steps in CHIKV cell entry. We summarize the latest studies on the virus-cell tropism, virus-receptor binding, internalization, membrane fusion and review the molecules and compounds that have been described to interfere with virus cell entry. The aim of the review is to give the reader a state-of-the-art overview on CHIKV cell entry and to provide an outlook on potential new avenues in CHIKV research.

  14. Mechanisms of Myofascial Pain


    Jafri, M. Saleet


    Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of t...

  15. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and ... Education Pamphlets - Spanish Share: PEV002, September 2016 Zika Virus and Pregnancy There are risks to your fetus ...

  16. Zika Virus and Pregnancy (United States)

    ... Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and ... Patient Education Pamphlets - Spanish Share: PEV002, September 2016 Zika Virus and Pregnancy There are risks to your fetus ...

  17. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and ... Patient Education Pamphlets - Spanish Share: PEV002, September 2016 Zika Virus and Pregnancy There are risks to your fetus ...

  18. Computer Viruses: An Overview. (United States)

    Marmion, Dan


    Discusses the early history and current proliferation of computer viruses that occur on Macintosh and DOS personal computers, mentions virus detection programs, and offers suggestions for how libraries can protect themselves and their users from damage by computer viruses. (LRW)

  19. Virus Ebola Asia


    Wuryadi, Suharyono


    Virus Marburg dan Ebola diklasifikasikan sebagai virus yang sangat menular dan dimasukkan dalam klasifikasi sebagai virus/pathogen dengan derajat biosafety 4, sehingga untuk menanganinya diperlukan laboratorium khusus tingkat 4.

  20. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and Pregnancy Page ... Spanish Share: PEV002, September 2016 Zika Virus and Pregnancy There are risks to your fetus if you ...

  1. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus ... Patient Education Pamphlets - Spanish Share: PEV002, September 2016 Zika Virus and Pregnancy There are risks to your ...

  2. Viruses in pulp and periapical inflammation: a review. (United States)

    Hernández Vigueras, Scarlette; Donoso Zúñiga, Manuel; Jané-Salas, Enric; Salazar Navarrete, Luis; Segura-Egea, Juan José; Velasco-Ortega, Eugenio; López-López, José


    The presence of viruses in endodontic disease has been studied in the last decade. Their presence is associated with periapical radiolucency and with clinical findings, such as pain. The aim of this review is to analyze the scientific evidence currently published about viruses in pulp and periapical inflammation, and its possible clinical implications. A literature review was carried out using the Medline/Pubmed database. The search was performed, in English and Spanish, using the following keyword combinations: virus AND endodontic; virus AND periapical; virus AND pulpitis; herpesvirus AND periapical; papillomavirus AND periapical. We subsequently selected the most relevant studies, which complied with the search criterion. A total of 21 articles were included, of which 18 detected the present of viruses in the samples. In 3 of the studies, viral presence was not found in the samples studied. The Epstein-Barr virus was found in about 41 % of cases compared to controls, in which it was present in about 2 %. The main association between viruses and endodontic pathosis is between Cytomegalovirus and Epstein-Barr virus; these are found in 114 of the 406 samples of different endodontic pathosis. Some evidence supports that the Epstein-Barr virus is present in a significant number of endodontic diseases, without exact knowledge of their action in these diseases.

  3. Low back pain, radiculopathy. (United States)

    Selkirk, Stephen M; Ruff, Robert


    Low back pain is a pervasive problem in the adult population. Most patients with low back pain will not require imaging as spontaneous recovery within 12 weeks is the rule. However, a small percentage of patients with low back pain will have serious underlying pathology requiring more intensive investigation. This chapter delineates the signs and symptoms related to potential serious underlying causes and discusses appropriate imaging modalities that should be utilized in patients with low back pain. © 2016 Elsevier B.V. All rights reserved.

  4. Pain management in ferrets. (United States)

    van Oostrom, Hugo; Schoemaker, Nico J; Uilenreef, Joost J


    The growing popularity of ferrets as pets has created the demand for advanced veterinary care for these patients. Pain is associated with a broad range of conditions, including acute or chronic inflammatory disease, neoplasia, and trauma, as well as iatrogenic causes, such as surgery and diagnostic procedures. Effective pain management requires knowledge and skills to assess pain, good understanding of the pathophysiology of pain, and general knowledge of pharmacologic and pharmacodynamic principles. Unfortunately, scientific studies on efficacy, pharmacokinetics, pharmacodynamics, and safety of analgesic drugs in the ferret are limited. However, basic rules on the treatment of pain and mechanisms of action, safety, and efficacy of analgesic drugs in other species can be adapted and applied to pain management in ferrets. This article aims to make an inventory of what is known on the recognition of pain in ferrets, what analgesic drugs are currently used in ferrets, and how they can be adopted in a patient-orientated pain management plan to provide effective pain relief while reducing and monitoring for unwanted side effects. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Extraversion and pain. (United States)

    Barnes, G E


    According to Eysenck's (1957, 1960, 1967) theory of personality, extroverts are posited as having higher pain thresholds and greater pain tolerance than introverts. The evidence for these hypothesized relationships is reviewed. Findings appear inconclusive in both cases. Probability pooling (Mosteller & Bush, 1954) is therefore performed, grouping the comparable studies and carrying out overall tests of significance. Results support the hypothesized relationships between extraversion and pain threshold and between extraversion and pain tolerance. Possible reasons why certain studies failed to find these results are discussed.

  6. Pain and Complementary Therapies. (United States)

    Hamlin, Amy S; Robertson, T Michelle


    Treatment of both acute and chronic pain typically involves a combination of pharmacologic and provider-based interventions, which is effective for some patients but not for others. Use of pain medications, especially repeated and frequent usage, involves the risk of adverse reactions, overuse, and dependency. Complementary and alternative therapies (CAT) offer an alternative or adjunctive method to decrease the pain experience and enhance function and quality of life. Various evidence-based CAT methods have been proved to be effective in the management of both acute and chronic pain. Nurses are well placed to implement various CAT modalities. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Acute dental pain II

    DEFF Research Database (Denmark)

    Jonasson, Peter; Kirkevang, Lise-Lotte; Rosen, Annika


    Acute dental pain most often occurs in relation to inflammatory conditions in the dental pulp or in the periradicular tissues surrounding a tooth, but it is not always easy to reach a diagnose and determine what treatment to perform. The anamnesis and the clinical examination provide valuable...... dental pain, they expect that the dentist starts treatment at once and that the treatment should provide pain relief. In this situation many patients are fragile, anxious and nervous. If the dentist is able to manage emergency treatment of acute dental pain this will build confidence and trust between...

  8. The neurobiology of pain. (United States)

    Besson, J M


    Understanding the plasticity of pain and analgesia exhibited in different pain states may improve therapies for the two major types of pain, neuropathic and inflammatory pain, in which nerve and tissue damage leads to alterations at both peripheral and central levels. At the level of the peripheral nerve, drugs that act on particular sodium channels may target only pain-related activity. Agents that act on some of the peripheral mediators of pain may control peripheral nerve activity. A new generation of non-steroidal anti-inflammatory drugs, cyclo-oxygenase 2 inhibitors, that lack gastric actions are becoming available. In the spinal cord, the release of peptides and glutamate causes activation of multiple receptors, particularly, the N-methyl-D-aspartate receptor for glutamate, which, in concert with other spinal systems, generates spinal hypersensitivity. Blocking the generation of excitability is one approach, but increasing inhibitions may also provide analgesia. Opioid actions are via presynaptic and post-synaptic inhibitory effects on central and peripheral C fibre terminals, spinal neurones, and supraspinal mechanisms. Our knowledge of brain mechanisms of pain is still, however, limited. Other new targets have been revealed by molecular biology and animal models of clinical pain, but the possibility of a "magic bullet" is doubtful. Thus, another approach could be single molecules with dual drug actions, that encompass targets where additive or synergistic effects of different mechanisms may enable pain relief without major adverse effects.

  9. Pain and communication. (United States)

    van Hooft, Stan


    It is frequently said that pain is incommunicable and even that it "destroys language". This paper offers a phenomenological account of pain and then explores and critiques this view. It suggests not only that pain is communicable to an adequate degree for clinical purposes, but also that it is itself a form of communication through which the person in pain appeals to the empathy and ethical goodness of the clinician. To explain this latter idea and its ethical implications, reference is made to the writings of Emmanuel Levinas.

  10. Acute pain assessment

    LENUS (Irish Health Repository)

    Clear, Elaine


    The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (IASP, 1997). This definition of pain emphasises that it is neither a sensory nor an emotional experience, but a combination of both. It is a subjective experience influenced by physical, psychological and environmental factors that is assessed from a biopsychosocial perspective. The gold standard in assessing pain however is always what the patient says it is.

  11. Persistent idiopathic facial pain. (United States)

    Benoliel, Rafael; Gaul, Charly


    Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed 'Atypical Odontalgia', and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.

  12. Myofascial pelvic pain. (United States)

    Spitznagle, Theresa Monaco; Robinson, Caitlin McCurdy


    Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Imaging of painful scoliosis

    Energy Technology Data Exchange (ETDEWEB)

    Davies, Alun; Saifuddin, Asif [Royal National Orthopaedic Hospital Trust, Department of Radiology, London (United Kingdom)


    Scoliosis is defined as a lateral deviation of the spine from the normal plumb line. Commonly, there is a rotational component and deviation also in the sagittal plane (kyphosis or hyperlordosis). When scoliosis presents in adults, it is often painful. In contrast, back pain in a child is considered rare, and serious underlying pathology should be excluded, particularly since idiopathic scoliosis is typically painless. A painful scoliosis in a child or adolescent, especially if the patient has a left-sided curve, should be examined thoroughly. The aim of this review is to illustrate the causes of a painful scoliosis in children, adolescents and adults. (orig.)

  14. Computer Virus and Trends


    Tutut Handayani; Soenarto Usna,Drs.MMSI


    Since its appearance the first time in the mid-1980s, computer virus has invited various controversies that still lasts to this day. Along with the development of computer systems technology, viruses komputerpun find new ways to spread itself through a variety of existing communications media. This paper discusses about some things related to computer viruses, namely: the definition and history of computer viruses; the basics of computer viruses; state of computer viruses at this time; and ...

  15. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness

    Directory of Open Access Journals (Sweden)

    Dallel Radhouane


    Full Text Available Abstract Background Chikungunya virus (CHIKV is responsible for major epidemics worldwide. Autochthonous cases were recently reported in several European countries. Acute infection is thought to be monophasic. However reports on chronic pain related to CHIKV infection have been made. In particular, the fact that many of these patients do not respond well to usual analgesics suggests that the nature of chronic pain may be not only nociceptive but also neuropathic. Neuropathic pain syndromes require specific treatment and the identification of neuropathic characteristics (NC in a pain syndrome is a major step towards pain control. Methods We carried out a cross-sectional study at the end of the major two-wave outbreak lasting 17 months in Réunion Island. We assessed pain in 106 patients seeking general practitioners with confirmed infection with the CHIK virus, and evaluated its impact on quality of life (QoL. Results The mean intensity of pain on the visual-analogical scale (VAS was 5.8 ± 2.1, and its mean duration was 89 ± 2 days. Fifty-six patients fulfilled the definition of chronic pain. Pain had NC in 18.9% according to the DN4 questionnaire. Conversely, about two thirds (65% of patients with NC had chronic pain. The average pain intensity was similar between patients with or without NC (6.0 ± 1.7 vs 6.1 ± 2.0. However, the total score of the Short Form-McGill Pain Questionnaire (SF-MPQ(15.5 ± 5.2 vs 11.6 ± 5.2; p Conclusions There exists a specific chronic pain condition associated to CHIKV. Pain with NC seems to be associated with more aggressive clinical picture, more intense impact in QoL and more challenging pharmacological treatment.

  16. [Facial pain of cardiac origin]. (United States)

    Peñarrocha Diago, M; Silvestre Donat, F J; Rodriguez Gil, R


    Two cases of anginal pain limited to the mandible with secondary radiation of the pain to the neck and clavicular region are presented. Although the pain was initially diagnosed as odontogenic in origin, further historial workup suggest the suspicion of referred pain from coronary insufficiency. Appropriate medical referral confirmed diagnostic suspicions. Important aspects involved with differential diagnosis of referred anginal pain are also discussed.

  17. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. (United States)

    Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus; Licht, Peter B; Toft, Palle


    Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1 week postoperatively, and 3, 6, and 12 months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12 months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  18. Pain centers professionals' beliefs on non-cancer chronic pain

    National Research Council Canada - National Science Library

    Dayse Maioli Garcia; Cibele Andrucioli de Mattos-Pimenta


    ...%) pain centers in the city of S.Paulo. The Survey of Chronic Pain Attitudes-Professionals was employed to evaluate pain professionals' beliefs toward emotions, control, disability, solicitude, cure and harm...

  19. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

    Directory of Open Access Journals (Sweden)

    Mallick-Searle T


    Full Text Available Theresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin, tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine, or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence

  20. Cancer and orofacial pain. (United States)

    Romero-Reyes, M; Salvemini, D


    Cancer pain is a devastating condition. Pain in the orofacial region, may be present as the single symptom of cancer or as a symptom of cancer in its later stages. This manuscript revises in a comprehensive manner the content of the conference entitled "Orofacial Pain and Cancer" (Dolor Orofacial y Cancer) given at the VI Simposio International "Advances in Oral Cancer" on the 22 July, 2016 in San Sebastioan-Donostia, Spain. We have reviewed (pubmed-medline) from the most relevant literature including reviews, systematic reviews and clinical cases, the significant and evidence-based mechanisms and mediators of cancer-associated facial pain, the diverse types of cancers that can be present in the craniofacial region locally or from distant sites that can refer to the orofacial region, cancer therapy that may induce pain in the orofacial region as well as discussed some of the new advancements in cancer pain therapy. There is still a lack of understanding of cancer pain pathophysiology since depends of the intrinsic heterogeneity, type and anatomic location that the cancer may present, making more challenging the creation of better therapeutic options. Orofacial pain can arise from regional or distant tumor effects or as a consequence of cancer therapy. The clinician needs to be aware that the pain may present the characteristics of any other orofacial pain disorder so a careful differential diagnosis needs to be given. Cancer pain diagnosis is made by exclusion and only can be reached after a thorough medical history, and all the common etiologies have been carefully investigated and ruled out. The current management tools are not optimal but there is hope for new, safer and effective therapies coming in the next years.

  1. Zika Virus: Cutaneous Manifestations in 3 Patients. (United States)

    Cosano-Quero, A; Velasco-Tirado, V; Sánchez Seco, M P; Manzanedo-Bueno, L; Belhassen-García, M


    Zika virus infection should be suspected in travelers or immigrants with the signs or symptoms of a viral infection (rash, fever, joint pains, conjunctivitis, headache, etc.) and a compatible epidemiological history. Although cutaneous manifestations are among the most common clinical signs of Zika, they are not specific and very few images are available. We present 3 patients (2 travelers and 1 immigrant) in whom a rash was the presenting manifestation of Zika virus infection. Prompt diagnosis optimizes outcomes in these patients, improves the management of severe disease, and minimizes the risk of local transmission by Aedes albopictus, now a potential local vector for the virus due to its presence in areas along Spain's Mediterranean coast. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... In the overwhelming majority of cases acute pain can be linked to some specific occurrence; there’s an ... will be found, and when it’s found, it can be fixed and at that point the pain ...

  3. Pain without nociceptors?

    DEFF Research Database (Denmark)

    Minett, Michael S; Falk, Sarah; Santana-Varela, Sonia


    Nav1.7, a peripheral neuron voltage-gated sodium channel, is essential for pain and olfaction in mice and humans. We examined the role of Nav1.7 as well as Nav1.3, Nav1.8, and Nav1.9 in different mouse models of chronic pain. Constriction-injury-dependent neuropathic pain is abolished when Nav1...... and cold allodynia required distinct sets of neurons and different repertoires of sodium channels depending on the nerve injury model. Surprisingly, pain induced by the chemotherapeutic agent oxaliplatin and cancer-induced bone pain do not require the presence of Nav1.7 sodium channels or Nav1.8-positive.......7 is deleted in sensory neurons, unlike nerve-transection-related pain, which requires the deletion of Nav1.7 in sensory and sympathetic neurons for pain relief. Sympathetic sprouting that develops in parallel with nerve-transection pain depends on the presence of Nav1.7 in sympathetic neurons. Mechanical...

  4. [Pain and coma]. (United States)

    Blanchet, Véronique


    Pain is a complex notion which caregivers must be able to decipher. Its aspects vary depending on the patient's condition. In cases of verbal communication disorders, the subjectivity of the caregiver is enlisted. How should pain be assessed in situations of coma and how should it be treated?

  5. Chronic pain after childbirth. (United States)

    Landau, R; Bollag, L; Ortner, C


    With over four million deliveries annually in the United States alone and a constant increase in cesarean delivery rate, childbirth is likely to have a huge impact on the occurrence of acute and possibly chronic postpartum pain. Recent awareness that chronic pain may occur after childbirth has prompted clinicians and researchers to investigate this topic. Current evidence points towards a relatively low incidence of chronic pain after cesarean delivery, with rates ranging between 1% and 18%. To provide a potential mechanistic explanation for the relatively low occurrence of chronic pain after cesarean delivery compared with that after other types of surgery, it has been proposed that endogenous secretion of oxytocin may confer specific protection. Clinical interventions to reduce the incidence and severity of chronic post-surgical pain have not been consistently effective. Likely explanations are that the drugs that have been investigated were truly ineffective or that the effect was too modest because with a low incidence of chronic pain, studies were likely to be underpowered and failed to demonstrate an effect. In addition, since not all women require preventive therapies, preoperative testing that may identify women vulnerable to pain may be highly beneficial. Further research is needed to identify valid models that predict persistent pain to allow targeted interventions to women most likely to benefit from more tailored anti-hyperalgesic therapies. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Breakthrough cancer pain

    DEFF Research Database (Denmark)

    Davies, Andrew; Buchanan, Alison; Zeppetella, Giovambattista


    Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients.......Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients....

  7. Neuropathic pain - Current concepts

    African Journals Online (AJOL)

    extremely severe “electric shock” shooting pain lasting from seconds to two minutes, and it does not cross the .... Localised muscle tenderness and myofascial trigger points. (indicative of secondary myofascial pain .... such as physiotherapy, exercise, sleep hygiene, transcutaneous electrical nerve stimulation (TENS), etc.

  8. Paediatric pain management

    African Journals Online (AJOL)

    Middle childhood. 6–11 years. Early adolescent. 12–18 years. Late adolescent. 19–21 years. Abstract. Pain is defined by the International Association for the Study .... adverse effects.5. Paracetamol. Paracetamol is one of the drugs of choice in pain management during the postoperative period in children due to its excellent.

  9. Analgesia for acute pain

    African Journals Online (AJOL)

    modified by various factors.1. Pain in the acute setting generally manifests as three broad ... based on targeting the correct pathways, although nociceptive and neuropathic pain do often co-occur, e.g. during surgery or ..... codeine following cosmetic facial surgery. J Otolaryngol Head Neck Surg. 2009;38(5):580–586. 30.

  10. Bladder pain syndrome

    DEFF Research Database (Denmark)

    Hanno, Philip; Nordling, Jørgen; Fall, Magnus


    Bladder pain syndrome is a deceptively intricate symptom complex that is diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom. It is a diagnosis of exclusion in a patient who has...

  11. Painful and painless channelopathies. (United States)

    Bennett, David L H; Woods, C Geoffrey


    The discovery of genetic variants that substantially alter an individual's perception of pain has led to a step-change in our understanding of molecular events underlying the detection and transmission of noxious stimuli by the peripheral nervous system. For example, the voltage-gated sodium ion channel Nav1.7 is expressed selectively in sensory and autonomic neurons; inactivating mutations in SCN9A, which encodes Nav1.7, result in congenital insensitivity to pain, whereas gain-of-function mutations in this gene produce distinct pain syndromes such as inherited erythromelalgia, paroxysmal extreme pain disorder, and small-fibre neuropathy. Heterozygous mutations in TRPA1, which encodes the transient receptor potential cation channel, can cause familial episodic pain syndromes, and variants of genes coding for the voltage-gated sodium channels Nav1.8 (SCN10A) and Nav1.9 (SCN11A) lead to small-fibre neuropathy and congenital insensitivity to pain, respectively. Furthermore, other genetic polymorphisms have been identified that contribute to risk or severity of more complex pain phenotypes. Novel models of sensory disorders are in development-eg, using human sensory neurons differentiated from human induced pluripotent stem cells. Understanding rare heritable pain disorders not only improves diagnosis and treatment of patients but may also reveal new targets for analgesic drug development. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. No pain, more gain. (United States)

    Cox, James J; Wood, John N


    A new study shows that a specific mutation in SCN11A, which encodes the Nav1.9 voltage-gated sodium channel, underlies a human disorder characterized by insensitivity to pain. This finding provides fresh insights into human pain perception and suggests a new avenue for the development of analgesic drugs.

  13. Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain (United States)

    Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana


    Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

  14. Neurofibromatosis and the Painful Neuroma

    National Research Council Canada - National Science Library

    Belzberg, Allan J


    .... The pain is often due to the formation of a neuroma. To understand better how neuromas cause pain and what treatments may be provided, we have attempted to develop an animal model of a painful neuroma...

  15. Radiological Approach to Forefoot Pain

    Directory of Open Access Journals (Sweden)

    Sai Chung Ho


    Full Text Available Forefoot pain is a common clinical complaint in orthopaedic practice. In this article, we discuss the anatomy of the forefoot, clinical and radiological approaches to forefoot pain, and common painful forefoot disorders and their associated radiological features.

  16. Chronic Pelvic Pain in Women (United States)

    ... exercise. When to see a doctor With any chronic pain problem, it can be difficult to know when ... Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often ...

  17. Working with Musculoskeletal Pain (United States)

    Wynne-Jones, Gwenllian; Varnava, Alice; Main, Chris J; Phillips, Ceri J


    Pain has a significant impact on work in terms of presenteeism, sickness absence, and long-term incapacity for work A bio-psychosocial approach is required in understanding pain-related disability and incapacity for work Long-term absence from work is associated with a number of negative outcomes including; poverty, social exclusion and poorer physical and psychosocial well-being Return to work can improve recovery for people with musculoskeletal complaints and pain Interventions to reduce the impact of pain on work can operate at clinical, worker, workplace, and wider systems levels A broader whole systems approach to pain management needs to be adopted, with a greater focus on work retention as well as rehabilitation PMID:26527353

  18. Victimization and pain

    Directory of Open Access Journals (Sweden)

    Małgorzata K. Szerla


    Full Text Available Pain has several causes. It can be caused not only by operative trauma or cancer. Some patients suffer from pain as a result of being victims of violence. The aim of the study was to introduce diagnosis and treatment of pain problems in patients who are victims of violence, from a physician’s and a psychologist’s common perspective. Physical pain-related primary effects experienced by the victims of domestic violence go far beyond the results which are noticeable directly and confirmed visually in a forensic examination. In the present paper we introduce an ‘invisible’ group of secondary effects of violence. They appear in time, often after several years, in the form of a variety of psychosomatic disorders. The body is devastated insidiously and the secondary effects are visible as vegetative symptoms, a variety of psychosomatic disorders and pain, difficult to diagnose and treat.

  19. Orofacial pain conditions

    DEFF Research Database (Denmark)

    Pedersen, Anne Marie Lynge; Forssell, Heli; Grinde, Bjørn


    Pain of the oral mucosa is a common accompanying symptom of various oral mucosal lesions caused by local and systemic diseases. Pain of the oral mucosa is usually associated with a known cause of tissue damage, e.g. mucosal ulcer or erosion, and it generally responds to adequate treatment...... of any obvious noxious stimuli, and in the oral mucosal, the pain is often described as tingling and burning. In the oral cavity, burning mouth syndrome (BMS) is presently considered to have neuropathic background. It is important for dental practitioners to have a clear understanding of the various...... diseases that can cause oral mucosal pain to provide appropriate care to patients. This paper focuses on the most common local and systemic diseases that can cause oral mucosal pain with respect to their clinical features and management....

  20. Pain and neuroplasticity

    Directory of Open Access Journals (Sweden)

    Sabine Sator-Katzenschlager, MD.


    However, the cerebral processing of hyperalgesia and allodynia is still controversially discussed. In recent years, neuroimaging methods (functional magnetic resonance imaging, fMRI; magnetoencephalography, MEG; positron emission tomography, PET have provided new insightsinto the aberrant cerebral processing of neuropathic pain. Thepresent paper reviews different cerebral mechanisms contributing to chronicity processes in neuropathic pain syndromes. These mechanisms include reorganisation of cortical somatotopic maps in sensory or motor areas (highly relevant for phantom limb pain and CRPS, increased activity in primary nociceptive areas, recruitment of new cortical areas usually not activated by nociceptive stimuli and aberrant activity in brain areas normally involved in descending inhibitory pain networks. Moreover, there is evidence from PET studies for changes of excitatory and inhibitory transmitter systems. Finally, advanced methods of structural brain imaging (voxel-based morphometry, VBM show significant structural changes suggesting that chronic pain syndromes may be associated with neurodegeneration.

  1. Mental Pain and Suicide

    DEFF Research Database (Denmark)

    Verrocchio, Maria Cristina; Carrozzino, Danilo; Marchetti, Daniela


    ideation than depression. Conclusion: Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard...... a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. Methods: We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain......" "OR" "psychological pain" OR "psychache" combined with the Boolean "AND" operator with "suicid*." In addition, a manual search of the literature, only including the term "psychache," was performed on Google Scholar for further studies not yet identified. Results: Initial search identified 1450...

  2. Heritability of neck pain

    DEFF Research Database (Denmark)

    Fejer, R; Hartvigsen, J; Kyvik, K O


    OBJECTIVES: To determine the heritability of neck pain in a large population-based study of twins. METHODS: Data on lifetime prevalence of neck pain from a population-based cross-sectional survey of Danish twins were used. To assess twin similarity, the probandwise concordance rates, zygosity......-specific odds ratios and tetrachoric correlations were calculated and compared for monozygotic and dizygotic twins. Using biometric modelling (structural equation modelling), the genetic and environmental contributions of the liability to neck pain were estimated. RESULTS: A total of 33,794 twins (response rate...... 73%) answered the questions regarding neck pain. Probandwise concordance rates, zygosity-specific odds ratios and tetrachoric correlations showed a significant genetic effect on neck pain. An overall additive genetic component of 44% was found. The genetic effect decreased with age, accounting...

  3. Chronicity of orofacial pain. (United States)

    Gerschman, J A


    Acute and chronic orofacial pain continues to be poorly understood and managed. The National Health and Medical Research Council of Australia (NHMRC) 1999 report on acute pain management promotes the development of evidence based clinical practice guidelines aimed at improving both the quality of health care and health outcomes in medical and dental practice in Australia. Nerve signals arising from sites of tissue or nerve injury lead to long term changes in the central nervous system and the amplification and persistence of pain. These nociceptor activity-induced neuronal changes known as central sensitization, have important clinical implications in the development of new approaches to the management of persistent pain. These findings and implications are discussed in relationship to poorly managed and understood conditions such as oral dysaesthesia, burning mouth syndrome, atypical facial pain/atypical odontalgia, peripheral nerve injury, deafferentation and phantom tooth syndrome.

  4. Contribution of amygdala CRF neurons to chronic pain. (United States)

    Andreoli, Matthew; Marketkar, Tanvi; Dimitrov, Eugene


    We investigated the role of amygdala corticotropin-releasing factor (CRF) neurons in the perturbations of descending pain inhibition caused by neuropathic pain. Forced swim increased the tail-flick response latency in uninjured mice, a phenomenon known as stress-induced analgesia (SIA) but did not change the tail-flick response latency in mice with neuropathic pain caused by sciatic nerve constriction. Neuropathic pain also increased the expression of CRF in the central amygdala (CeAmy) and ΔFosB in the dorsal horn of the spinal cord. Next, we injected the CeAmy of CRF-cre mice with cre activated AAV-DREADD (Designer Receptors Exclusively Activated by Designer Drugs) vectors. Activation of CRF neurons by DREADD/Gq did not affect the impaired SIA but inhibition of CRF neurons by DREADD/Gi restored SIA and decreased allodynia in mice with neuropathic pain. The possible downstream circuitry involved in the regulation of SIA was investigated by combined injections of retrograde cre-virus (CAV2-cre) into the locus ceruleus (LC) and cre activated AAV-diphtheria toxin (AAV-FLEX-DTX) virus into the CeAmy. The viral injections were followed by a sciatic nerve constriction ipsilateral or contralateral to the injections. Ablation of amygdala projections to the LC on the side of injury but not on the opposite side, completely restored SIA, decreased allodynia and decreased ΔFosB expression in the spinal cord in mice with neuropathic pain. The possible lateralization of SIA impairment to the side of injury was confirmed by an experiment in which unilateral inhibition of the LC decreased SIA even in uninjured mice. The current view in the field of pain research attributes the process of pain chronification to abnormal functioning of descending pain inhibition. Our results demonstrate that the continuous activity of CRF neurons brought about by persistent pain leads to impaired SIA, which is a symptom of dysregulation of descending pain inhibition. Therefore, an over



    Thomas Eko P


    The incidence of pain increases with age. Neuropathic pain are common in elderly patients and pose challenges in both their diagnosis and treatment. The most common neuropathic pain in elderly are radiculopathy due to foraminal or spinal stenosis, diabetic neuropathy, and postherpetic neuralgia. Pain in the elderly is often unrecognized and undertreated. The main problem with pain in older adults relates to impaired quality of life secondary to pain which may be expressed by depression (in...

  6. Judgments about pain intensity and pain genuineness: the role of pain behavior and judgmental heuristics. (United States)

    Martel, Marc O; Thibault, Pascal; Sullivan, Michael J L


    The primary objective of the present study was to examine the relative importance of pain behaviors and judgmental heuristics (eg, gender stereotypes) in observers' inferences about pain intensity and pain genuineness. Participants (n = 90) observed video depictions of chronic pain patients performing a physically challenging task and were asked to make inferences of pain intensity and pain genuineness. Analyses indicated that observers relied on judgmental heuristics and pain behaviors both when making inferences about pain intensity and when making inferences about pain genuineness. Follow-up analyses, however, revealed that judgmental heuristics (eg, gender stereotypes) were significantly less utilized when observers made inferences about pain genuineness than when observers made inferences about pain intensity. When observers made inferences about pain genuineness, analyses indicated that patients' facial pain behaviors became the most important source of information. Taken together, these findings suggest that observers who are asked to make inferences about the genuineness of others' pain are likely to reduce their reliance on judgmental heuristics in favor of more controlled and thoughtful inferential processes characterized by detailed processing of behavioral information, particularly others' facial pain behaviors. The current study provides new insights into the processes that are involved in observers' inferences about pain intensity and pain genuineness. These inferences play an important role in treatment decisions and advances in this domain could ultimately contribute to more effective management of the challenges facing patients with pain-related disorders. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  7. American Academy of Pain Medicine (United States)

    ... 7. GET STARTED AAPM... the Voice of Pain Medicine Become part of the distinguished multimodal, interdisciplinary community of pain medicine clinicians. Join Today! Welcome The American Academy of ...

  8. Neurophysiological characterization of postherniotomy pain

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Brandsborg, Birgitte; Christensen, Bente


    postoperatively. A quantitative sensory testing protocol was used, assessing sensory dysfunction type, location and severity. We assessed the protocol test-retest variability using data from healthy control subjects. All patients (pain and pain-free) had signs of nerve damage, seen as sensory dysfunction...... pain on the painful side than on the unaffected side in pain patients, and was not observed in controls. Our findings showed large and small fiber dysfunction in both pain and pain-free patients but more profound in pain patients and with signs of central sensitization (abnormal temporal summation...

  9. What's West Nile Virus? (United States)

    ... OK for Kids? Your Teeth Heart Murmurs What's West Nile Virus? KidsHealth > For Kids > What's West Nile Virus? Print A A A en español ¿Qué es ... Virus del Nilo Occidental? What exactly is the West Nile virus? And why is everyone talking about mosquitoes ? Even ...

  10. Viruses infecting maize


    Krstić, Branka; Stanković, Ivana; Bulajić, Aleksandra


    Over 40 plant viruses has been known to cause diseases of maize, but economically the most important yield looses, which in certain years can be total, are caused by viruses from Potyvirus genera, known to be aphid-transmitted in a non-persistant maner. The most important viruses, pathogens of maize, sugar cane and sorghum are considered to be Maize dwarf mosaic virus (MDMV), Sorghum mosaic virus (SrMV), Sugarcane mosaic virus (SCMV), and Johnsongrass mosaic virus (JGMV). In Serbia, the prese...

  11. Viruses in cancer treatment. (United States)

    Alemany, R


    Soon after the discovery that viruses cause human disease, started the idea of using viruses to treat cancer. After the initial indiscriminate use, crude preparations of each novel virus in the early twentieth century, a second wave of virotherapy blossomed in the 60s with purified and selected viruses. Responses were rare and short-lived. Immune rejection of the oncolytic viruses was identified as the major problem and virotherapy was abandoned. During the past two decades virotherapy has re-emerged with engineered viruses, with a trend towards using them as tumor-debulking immunostimulatory agents combined with radio or chemotherapy. Currently, oncolytic Reovirus, Herpes, and Vaccinia virus are in late phase clinical trials. Despite the renewed hope, efficacy will require improving systemic tumor targeting, overcoming stroma barriers for virus spread, and selectively stimulating immune responses against tumor antigens but not against the virus. Virotherapy history, viruses, considerations for clinical trials, and hurdles are briefly overviewed.

  12. Sodium channelopathies and pain. (United States)

    Lampert, Angelika; O'Reilly, Andrias O; Reeh, Peter; Leffler, Andreas


    Chronic pain often represents a severe, debilitating condition. Up to 10% of the worldwide population are affected, and many patients are poorly responsive to current treatment strategies. Nociceptors detect noxious conditions to produce the sensation of pain, and this signal is conveyed to the CNS by means of action potentials. The fast upstroke of action potentials is mediated by voltage-gated sodium channels, of which nine pore-forming alpha-subunits (Nav1.1-1.9) have been identified. Heterogeneous functional properties and distinct expression patterns denote specialized functions of each subunit. The Nav1.7 and Nav1.8 subunits have emerged as key molecules involved in peripheral pain processing and in the development of an increased pain sensitivity associated with inflammation and tissue injury. Several mutations in the SCN9A gene encoding for Nav1.7 have been identified as important cellular substrates for different heritable pain syndromes. This review aims to cover recent progress on our understanding of how biophysical properties of mutant Nav1.7 translate into an aberrant electrogenesis of nociceptors. We also recapitulate the role of Nav1.8 for peripheral pain processing and of additional sodium channelopathies which have been linked to disorders with pain as a significant component.

  13. Spinal pain in adolescents

    DEFF Research Database (Denmark)

    Aartun, Ellen; Hartvigsen, Jan; Wedderkopp, Niels


    BACKGROUND: The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain). METHODS: This study was a school......-based prospective cohort study. All 5th and 6th grade students (11-13 years) at 14 schools in the Region of Southern Denmark were invited to participate (N = 1,348). Data were collected in 2010 and again two years later, using an e-survey completed during school time. RESULTS: The lifetime prevalence of spinal pain...... was 86% and 89% at baseline and follow-up, respectively. A group of 13.6% (95% CI: 11.8, 15.6) at baseline and 19.5% (95% CI: 17.1, 22.0) at follow-up reported that they had pain frequently. The frequency of pain was strongly associated with the intensity of pain, i.e., the majority of the participants...

  14. [Neural basis of pain]. (United States)

    Calvino, Bernard


    Main elements concerning the physiology of pain are described, as well as the structures of the nervous system at the origin of the central control of pain: peripheral fibres (small diameter myelinated A delta and unmyelinated C fibres); spinal ascending pathways; cerebral structures relaying nociceptive information (medial and ventro-postero-lateral thalamic relays); SI and SII cortical areas; spinal segmentary and supraspinal excitatory and inhibitory controls; diffuse noxious inhibitory controls (DNIC). Chronic pain is a result of two processes: peripheral and central sensitization, in relation with inflammation and nerve injury at peripheral level and with neuroplasticity at central level. Neurotrophins, mainly NGF and BDNF and their receptors (LNTR, TrkA and TrkB) are involved in these processes. Pain is a result of an unpleasant emotional experience: its various components, mainly the emotional one, may be increased or decreased considering the different characteristics of the stimulus and of the affective state of the patient, as well as the context in which this stimulus is applied. The role of physiological systems, unconnected with those classically involved in the physiology of nociception and pain, such as the motor cortex in phantom limb pain, are described in conclusion, to focus on the extreme complexity of the control systems of pain in humans.

  15. Recognition of Epstein-Barr Virus in Multiple Sclerosis

    NARCIS (Netherlands)

    G.P. van Nierop (Gijs)


    textabstractMultiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Symptoms of MS include cognitive, motoric, sensory and visual impairment, pain and fatigue. The genetic background of the host and infection with the herpesvirus family member Epstein-Barr virus

  16. Early infant male circumcision for human immunodeficiency virus ...

    African Journals Online (AJOL)

    Abstract. Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world at 26% of the adult population. ... Acceptability of medical circumcision was high in this study, but concerns about safety, pain, autonomy and cultural factors reduce the acceptability of infant circumcision more specifically.

  17. Characterizing individual painDETECT symptoms by average pain severity

    Directory of Open Access Journals (Sweden)

    Sadosky A


    Full Text Available Alesia Sadosky,1 Vijaya Koduru,2 E Jay Bienen,3 Joseph C Cappelleri4 1Pfizer Inc, New York, NY, 2Eliassen Group, New London, CT, 3Outcomes Research Consultant, New York, NY, 4Pfizer Inc, Groton, CT, USA Background: painDETECT is a screening measure for neuropathic pain. The nine-item version consists of seven sensory items (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure, a pain course pattern item, and a pain radiation item. The seven-item version consists only of the sensory items. Total scores of both versions discriminate average pain-severity levels (mild, moderate, and severe, but their ability to discriminate individual item severity has not been evaluated.Methods: Data were from a cross-sectional, observational study of six neuropathic pain conditions (N=624. Average pain severity was evaluated using the Brief Pain Inventory-Short Form, with severity levels defined using established cut points for distinguishing mild, moderate, and severe pain. The Wilcoxon rank sum test was followed by ridit analysis to represent the probability that a randomly selected subject from one average pain-severity level had a more favorable outcome on the specific painDETECT item relative to a randomly selected subject from a comparator severity level.Results: A probability >50% for a better outcome (less severe pain was significantly observed for each pain symptom item. The lowest probability was 56.3% (on numbness for mild vs moderate pain and highest probability was 76.4% (on cold/heat for mild vs severe pain. The pain radiation item was significant (P<0.05 and consistent with pain symptoms, as well as with total scores for both painDETECT versions; only the pain course item did not differ.Conclusion: painDETECT differentiates severity such that the ability to discriminate average pain also distinguishes individual pain item severity in an interpretable manner. Pain


    Directory of Open Access Journals (Sweden)

    Tri Wijayanti


    Full Text Available Virus Hanta kurang infeksius, kecuali di dalam lingkungan tertentu. Lamanya waktu virus ini dapat bertahan di lingkungan, setelah keluar dari tubuh tikus tidaklah diketahui secara pasti. Tetapi percobaan laboratorium menunjukkan bahwa, daya infektifitasnya tidak dijumpai setelah dua hari pengeringan. Genus hanta virus terdiri dari 22 spesies virus, dapat menyebabkan hemorrhagic fever with renal syndrome (HFRS dan hanta virus pulmonary syndrome (HPS.

  19. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia. (United States)

    Gerhardt, Andreas; Eich, Wolfgang; Treede, Rolf-Detlef; Tesarz, Jonas


    Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P pain modulation in CLP was significantly higher than that in CWP and FMS (P painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values pain inhibition seem to be more indicated the higher the pain extent.

  20. Nonspecific Arm Pain

    Directory of Open Access Journals (Sweden)

    Ali Moradi


    Full Text Available   Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness.

  1. Nonspecific Arm Pain

    Directory of Open Access Journals (Sweden)

    Ali Moradi


    Full Text Available Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness.

  2. Myofascial pelvic pain. (United States)

    Kotarinos, Rhonda


    Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings.

  3. Attachment Security and Pain

    DEFF Research Database (Denmark)

    Andersen, Tonny Elmose; Lahav, Yael; Defrin, Ruth


    The present study assesses for the first time, the possible disruption effect of posttraumatic stress symptoms (PTSS) with regard to the protective role of attachment on pain, among ex-POWs. While secure attachment seems to serve as a buffer, decreasing the perception of pain, this function may...... be disrupted by PTSS. The study sample included 104 subjects who were combat veterans of the 1973 Yom Kippur War comprising of 60 male ex-prisoners of war (ex-POWs) and 44 comparable male combat veterans. Both attachment and pain were investigated experimentally in the laboratory and via questionnaires. We...

  4. Assessment of pain

    DEFF Research Database (Denmark)

    Forrest, M; Hermann, G; Andersen, B


    .1 cm). The correlation was 0.64 while the differences in dispersion were insignificant. Our findings indicate that it is far from unimportant who makes the pain assessment--the patient who experiences it or the doctor who evaluates it--but they also suggest that the differences could be a matter......In a trial based on 52 patients admitted because of acute abdominal pain, we compared the assessment of pain intensity by doctors and patients according to a visual analogue scale. We found significant differences with regard to the median score of the doctors (3.4 cm) compared to the patients (6...

  5. Sodium channels and pain. (United States)

    Habib, Abdella M; Wood, John N; Cox, James J


    Human and mouse genetic studies have led to significant advances in our understanding of the role of voltage-gated sodium channels in pain pathways. In this chapter, we focus on Nav1.7, Nav1.8, Nav1.9 and Nav1.3 and describe the insights gained from the detailed analyses of global and conditional transgenic Nav knockout mice in terms of pain behaviour. The spectrum of human disorders caused by mutations in these channels is also outlined, concluding with a summary of recent progress in the development of selective Nav1.7 inhibitors for the treatment of pain.

  6. Persistent postsurgical pain

    DEFF Research Database (Denmark)

    Werner, Mads Utke; Bischoff, Joakim Mutahi


    and debilitating impairment in the aftermath of BCS, GHR, and LCS. Data across the three surgical procedures indicate a 35-65 % decrease in prevalence of PPP at 4-6 years follow-up. However, this is outweighed by late-onset PPP, which appears following a pain-free interval. The consequences of PPP include severe...... impairments of physical, psychological, and socioeconomic aspects of life. The pathophysiology underlying PPP consists of a continuing inflammatory response, a neuropathic component, and/or a late reinstatement of postsurgical inflammatory pain. While the sensory profiles of PPP-patients and pain-free...

  7. Multimodal Assessment of Body Pain in Orofacial Pain Patients. (United States)

    Hawkins, James M; Schmidt, John E; Hargitai, Istvan A; Johnson, John F; Howard, Robin S; Bertrand, Peter M


    . Patients with complaints of orofacial pain (OFP) often have other body pain, yet many do not report these to their providers. Uncontrolled pain at any location may impact the successful management of an OFP complaint. The objective of this study was to determine the number of pain regions throughout the body, and the underreporting of pain, in patients who presented to a tertiary military OFP clinic. A retrospective chart review was conducted on 423 consecutive new patients. Patients were given three assessment opportunities to report their pain on a whole-body pain map: 1) prior to evaluation (Pt1), 2) following an explanatory statement by their provider on the relationship between pain and prognosis (Pt2), and 3) during directed pain inquiry of specific body regions (Pro). The pain map was divided into nine anatomical regions that were assessed for the presence of pain after Pt1, Pt2, and Pro. Initially, 60.5% of patients did not report all pain locations (Pt1). Following the explanatory statement (Pt2), 30.5% still did not report all pain. Following the completion of all assessment methods, the most commonly reported number of pain regions was five (17.0%), and 91.5% of patients reported multiple pain regions. Most patients had multiple pain complaints outside the chief complaint, yet the majority did not report these until multiple forms of assessment were utilized. These data encourage the use of a pain map, a verbal pain explanation, and directed pain questioning to more accurately capture pain location and facilitate multidisciplinary care. Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2016. This work is written by US Government employees and is in the public domain in the US.

  8. Low back pain and the post-laminectomy pain syndrome

    African Journals Online (AJOL)

    These include neurofibromas, meningiomas and ependy- momas (e.g. from filum terminale). Tumour can present as back pain plus sciatica or just with incontinence, or with wasted legs without pain. When pain occurs, it can be without signs, and these patients are often labelled neurotic. The pain is, however, characteristic.

  9. Maintenance of pain in children with functional abdominal pain (United States)

    A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdomina...

  10. Lamotrigine in the treatment of pain syndromes and neuropathic pain. (United States)

    Titlic, M; Jukic, I; Tonkic, A; Josipovic-Jelic, Z; Boschi, V; Mihalj, M; Punda, A


    Anti-epileptic drugs are increasingly used in the treatment of pain syndromes and neuropathic pain. Sodium channel blockers can be effective in the treatment of pain. The object of our interest is the efficiency of lamotrigine in treating the pain. A MEDLINE search was conducted to identify pertinent studies, case reports, letters, and reviews in English published from 1986 to May 2007. The search has indicated efficiency in treating a number of painful syndromes and neuropathic pain; central pain, trigeminal neuralgia and trigeminal neuralgia in multiple sclerosis, pain in multiple sclerosis, SUNCT syndrome, cluster headache, glossopharyngeal neuralgia, neuropathic pain, allodynia, neuralgia after nerve section, postherpetic neuralgia, HIV-associated neuropathy. Further researches are required on the role of lamotrigine in treating the spinal cord injury pain, neuralgia after nerve section, postoperative analgesic requirement, and in migraine (Tab. 1, Ref. 46). Full Text (Free, PDF)


    Directory of Open Access Journals (Sweden)

    Gabriela S. Tsankova


    Full Text Available Zika virus (ZIKV is an arbovirus from Flaviviridae family, genus Flavivirus. Like most of the viruses which belong to the Flavivirus genus, it replicates in and is transmitted by mosquitoes. Unlike other arbovirus infections including dengue and chikungunya, Zika virus causes a relatively mild disease. The most common symptoms of ZIKV are mild fever, arthralgia, myalgia, headache, asthenia, abdominal pain, oedema, lymphadenopathy, retro-orbital pain, conjunctivitis, and cutaneous maculopapular rash, which last for several days to a week. Although 80% of the cases with ZIKV are asymptomatic, severe complications such as microcephalia and GBS may be observed. This explains why ZIKV is more dangerous that it was thought to be and why it rapidly evolves in unexpected challenge for the international and national public health authorities.

  12. Pain: Hope through Research (United States)

    ... tendonitis or tenosynovitis , affecting one or more tendons. Sciatica is a generic term representing pain in the ... down into the thighs, legs, ankles, and feet . Sciatica can be caused by a number of factors ...

  13. Managing pain during labor (United States)

    ... gov/ency/patientinstructions/000587.htm Managing pain during labor To use the sharing features on this page, ... URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  14. Nonulcer Stomach Pain (United States)

    ... certain over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others), which can cause stomach problems Smoking Anxiety or depression History of childhood physical or sexual abuse By Mayo ...

  15. Physiotherapy for pain

    DEFF Research Database (Denmark)

    Ginnerup-Nielsen, Elisabeth; Christensen, Robin; Thorborg, Kristian


    OBJECTIVES: To empirically assess the clinical effects of physiotherapy on pain in adults. DESIGN: Using meta-epidemiology, we report on the effects of a 'physiotherapy' intervention on self-reported pain in adults. For each trial, the group difference in the outcome 'pain intensity' was assessed...... as standardised mean differences (SMD) with 95% CIs. Stratified analyses were conducted according to patient population (International Classification of Diseases-10 classes), type of physiotherapy intervention, their interaction, as well as type of comparator group and risks of bias. The quality of the body...... 'no intervention' or of a sham-controlled design were selected. Only articles written in English were eligible. RESULTS: An overall moderate effect of physiotherapy on pain corresponding to 0.65 SD-units (95% CI 0.57 to 0.73) was found based on a moderate inconsistency (I(2)=51%). Stratified...

  16. Pain and your emotions (United States)

    ... gov/ency/patientinstructions/000417.htm Pain and your emotions To use the sharing features on this page, ... or hurting yourself What to do About Your Emotions A common type of therapy for people with ...

  17. Pain in photodynamic therapy

    Directory of Open Access Journals (Sweden)

    Mircea Tampa


    Full Text Available Photodynamic therapy is a modern treatment with applications in several medical specialties, which has been intensely studied in the last years. The main indications in dermatology are actinic keratosis, superficial basal cell carcinoma and Bowen's disease- common skin disorders in which photodynamic therapy proved its efficacy. At present, the use of photodynamic therapy for the treatment of other skin disorders is profoundly researched. Pain is the most common and redoubtable adverse effect of photodynamic therapy and it is the most important factor affecting the patient's adherence to treatment. The aim of this article is to look over the most recent medical studies regarding pain in PDT, with emphasis on the factors affecting the occurrence of pain and the most recent strategies for controlling photodynamic therapy- related pain.

  18. Music for pain relief. (United States)

    Cepeda, M S; Carr, D B; Lau, J; Alvarez, H


    The efficacy of music for the treatment of pain has not been established. To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements. We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction. We included randomized controlled trials that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies. Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music. Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria. In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I(2) = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2). Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13). Three

  19. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... brain. So that to explain a person’s pain one day it may be necessary to look at ... from a range of individual contributors. Last Updated: 1/18/2018 We comply with the HONcode standard ...

  20. Gas and Gas Pains (United States)

    ... Gas and gas pains Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  1. Knee pain (image) (United States)

    ... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

  2. Pain Medications After Surgery (United States)

    ... the perception of pain, include fentanyl, hydromorphone, morphine, oxycodone, oxymorphone and tramadol. Examples of opioids prescribed in pill form after surgery include oxycodone (Oxycontin, Roxicodone, others) and oxycodone with acetaminophen (Percocet, ...

  3. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... but we may be looking in the wrong time. And what I mean by that is that ... pain problem which exists for some period of time can actually change the nervous system so that ...

  4. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources FAQs Glossary ... We comply with the HONcode standard for trustworthy health information: Verify here Certified by: Independent Charities of ...

  5. Palliative care - managing pain (United States)

    ... this page: // Palliative care - managing pain To use the sharing features on this page, please enable JavaScript. Palliative care is a holistic approach to care that focuses ...

  6. How Is Pain Managed? (United States)

    ... Autopsy Program Specific to Individuals of Ashkenazi Jewish Ancestry Specific to African-American population Pain & Quality of ... spinal fluid, similar to what is done for women in labor and delivery. The catheter is usually ...

  7. Patellofemoral Pain Syndrome (United States)

    ... of pounding on your legs, such as running, volleyball or basketball. If you want to keep exercising, ... after activity. This can ease the pain and speed up healing. To keep your hands free, use ...

  8. Prescription Pain Medications (Opioids) (United States)

    ... Rx drug abuse by letting the viewer make choices for the characters. Information on Prescription Drug Video NIDA: How many pain meds should you take? Addiction, compulsive drug use, and prescription drug abuse are ...

  9. specific low back pain

    African Journals Online (AJOL)


    CET) and behavioural graded activity. (BGA) has not been fully established to inform the preference in clinical practice. Objective: To compare CET and BGA on the treat- ment outcome of chronic non-specific low back pain.

  10. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... With chronic pain there may be no apparent physical injury or illness to explain it. The physician ... We comply with the HONcode standard for trustworthy health information: Verify here Certified by: Independent Charities of ...

  11. Migraines: What a Pain! (United States)

    ... My Body? Feeling Too Tall or Too Short Migraines: What a Pain! KidsHealth > For Kids > Migraines: What ... coming and how to avoid them. What's a Migraine? Almost everyone gets headaches . You might have one ...

  12. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources FAQs Glossary ... period of time can actually change the nervous system so that the peripheral nerves are changed, after ...

  13. Complex Regional Pain Syndrome (United States)

    ... leg, such as a crush injury, fracture or amputation. Other major and minor traumas — such as surgery, ... diagnose complex regional pain syndrome, but the following procedures may provide important clues: Bone scan. This procedure ...

  14. Pain management in photoepilation. (United States)

    Aimonetti, Jean-Marc; Ribot-Ciscar, Edith


    The hair follicle is a complex, hormonally active structure with permanent and cyclically renewed parts which are highly innervated by myelinated and unmyelinated afferent fibers. Hair removal, a very ancient practice, affects this sensory network and causes both acute and diffuse pain associated with inflammatory reaction. Optic permanent hair removal is becoming a popular alternative to traditional methods such as shaving, waxing, among other methods. These optical removal devices thermally destroy the target chromophore, that is, melanin, without damaging the surrounding skin. The increase in the skin surface temperature causes mild-to-severe pain, and optical hair removal has to be combined with pain relieving devices. Pain management relies on topical anesthetic agents, cooling devices, or non-noxious cutaneous stimulation whose mechanisms of action and efficiency are discussed in this article. © 2015 Wiley Periodicals, Inc.

  15. Tips for Chronic Pain (United States)

    Patient Education Sheet Tips for Chronic Pain The SSF thanks Stuart S. Kassan, MD, FACP, Clinical Professor of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, for authoring ...

  16. Employees with Chronic Pain (United States)

    ... Stroke, 2011). How is chronic pain treated? Medications, acupuncture, local electrical stimulation, and brain stimulation, as well ... services Provide access to a refrigerator Depression and Anxiety: Develop strategies to deal with work problems before ...

  17. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... went away several years earlier. Narrator: We don’t know everything that there is to know about ... physiological or neurological basis even when we don’t know what it is. Chronic pain is real. ...

  18. Back Pain and Modic

    DEFF Research Database (Denmark)

    Manniche, Claus; Jordan, Alan; Mikkelsen, Connie

    Long awaited breakthrough Approximately 25 years ago a few researchers managed to publish an article in the renowned medical journal, The Lancet. The article demonstrated that intensive exercise was most useful for patients with chronic back pain. Many of our colleagues found this difficult...... a significant step forward with the advent of the new back pain diagnosis, ”Modic changes”. During the coming years, thousands of back pain patients will now be given a precise diagnosis as well as a useful treatment in cases where we previously we unable to provide either a diagnosis or a useful treatment....... Many of these patients will become free of pain and disability! This book provides readers with a thorough review of the latest information regarding Modic changes that the Danish research group was primarily responsible for after 10 years of intensive research. The book explains what the research...

  19. Approach to lower back pain

    African Journals Online (AJOL)

    Alternating buttock pain. • Pain with associated early morning stiffness lasting >1 hour. • Pain not relieved by rest. • Pain improving with exercise or activity ... assessing gross bone density, disc and vertebral body height and alignment. These should include a view of the pelvis. The characteristic radiographic feature of IBP is ...

  20. Systematic pain assessment in horses

    NARCIS (Netherlands)

    de Grauw, J C|info:eu-repo/dai/nl/304822469; van Loon, J P A M|info:eu-repo/dai/nl/304834610


    Accurate recognition and quantification of pain in horses is imperative for adequate pain management. The past decade has seen a much needed surge in formal development of systematic pain assessment tools for the objective monitoring of pain in equine patients. This narrative review describes

  1. Neuropathic pain in primary care

    African Journals Online (AJOL)

    neuropathic pain syndromes.10. Opioid analgesics. In response to severe or persistent pain, interneurons in the dorsal horn release endogenous opioids that work to reduce perceived pain. These endogenous substances. (enkephalins, endorphins and dynorphins) play a major role in the mechanism of pain reduction and ...

  2. Pain expression as a biometric

    DEFF Research Database (Denmark)

    Haque, Mohammad A.; Nasrollahi, Kamal; Moeslund, Thomas B.


    Developing a vision-based efficient and automatic pain intensity measurement system requires the understanding of the relationship between self-reported pain intensity and pain expression in the facial videos. In this paper, we first demonstrate how pain expression in facial video frames may not ...

  3. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.


    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40

  4. Chronic pain in Rehabilitation Medicine

    NARCIS (Netherlands)

    Geertzen, J.H.B.; van Wilgen, C.P.; Schrier, E.; Dijkstra, P.U.

    In this paper the chronicity of pain in non-specific pain syndromes is discussed. Experts in the study of pain with several professional backgrounds in rehabilitation are the authors of this paper. Clinical experience and literature form the basis of the paper. Non-specific low back pain and Complex

  5. Bladder pain syndrome

    DEFF Research Database (Denmark)

    Hanno, Philip; Nordling, Jørgen; Fall, Magnus


    Bladder pain syndrome is a deceptively intricate symptom complex that is diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom. It is a diagnosis of exclusion in a patient who has ex...... can be challenging, and misdiagnosis as a psychological problem, overactive bladder, or chronic urinary infection has plagued patients with the problem....

  6. Complex regional pain syndrome


    V. A. Koryachkin


    Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent mo...

  7. [Cardiac pain in geriatrics]. (United States)

    Ludwig, G


    The atypical symptoms of coronary heart disease combined with an altered pain threshold and pain sensitivity in older patients make it difficult for the geriatrician to diagnose this disease. Clinical diagnostic methods cannot always be used in older patients. Therefore the physician must have a heightened awareness for unspecific symptoms which can signal coronary heart disease in the geriatric patient. In addition one must also use specific geriatric considerations in the management of angina pectoris.

  8. Low back pain (acute). (United States)

    McIntosh, Greg; Hall, Hamilton


    Low back pain affects about 70% of people in resource-rich countries at some point in their lives. Acute low back pain can be self-limiting; however, 1 year after an initial episode, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. Acute low back pain has a high recurrence rate; 75% of those with a first episode have a recurrence. Although acute episodes may resolve completely, they may increase in severity and duration over time. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments for acute low back pain? What are the effects of local injections for acute low back pain? What are the effects of non-drug treatments for acute low back pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics (paracetamol, opioids), back exercises, back schools, bed rest, behavioural therapy, electromyographic biofeedback, epidural corticosteroid injections, lumbar supports, massage, multidisciplinary treatment programmes, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulation, temperature treatments (short-wave diathermy, ultrasound, ice, heat), traction, and transcutaneous electrical nerve stimulation (TENS).

  9. Neck pain with radiculopathy


    Bhagawati, Dimpu; Gwilym, Stephen


    Non-specific neck pain has a postural or mechanical basis, and affects about two-thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but becomes chronic in about 10% of people.Whiplash injuries follow sudden acceleration-deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident.

  10. Perioperative pain management. (United States)

    Pyati, Srinivas; Gan, Tong J


    The under-treatment of postoperative pain has been recognised to delay patient recovery and discharge from hospital. Despite recognition of the importance of effective pain control, up to 70% of patients still complain of moderate to severe pain postoperatively. The mechanistic approach to pain management, based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission, provides newer options for clinicians to manage pain effectively. In this article we review the rationale for a multimodal approach with combinations of analgesics from different classes and different sites of analgesic administration. The pharmacological options of commonly used analgesics, such as opioids, NSAIDs, paracetamol, tramadol and other non-opioid analgesics, and their combinations is discussed. These analgesics have been shown to provide effective pain relief and their combinations demonstrate a reduction in opioid consumption. The basis for using non-opioid analgesic adjuvants is to reduce opioid consumption and consequently alleviate opioid-related adverse effects. We review the evidence on the opioid-sparing effect of ketamine, clonidine, gabapentin and other novel analgesics in perioperative pain management. Most available data support the addition of these adjuvants to routine analgesic techniques to reduce the need for opioids and improve quality of analgesia by their synergistic effect. Local anaesthetic infiltration, epidural and other regional techniques are also used successfully to enhance perioperative analgesia after a variety of surgical procedures. The use of continuous perineural techniques that offer prolonged analgesia with local anaesthetic infusion has been extended to the care of patients beyond hospital discharge. The use of nonpharmacological options such as acupuncture, relaxation, music therapy, hypnosis and transcutaneous nerve stimulation as adjuvants to conventional analgesia should be considered and incorporated to

  11. Anorectal and Pelvic Pain. (United States)

    Bharucha, Adil E; Lee, Tae Hee


    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  12. Prayer and physical pains

    Directory of Open Access Journals (Sweden)

    Nahid Mehran


    Full Text Available Background and Objectives: Prayer is one of the most important religious ordinances and is one of the necessities of Islam. In spite of the progression of medicine science, it is sometimes seen that the mundane subjects become hopeless in curing physical diseases and this time, the hopeless man appeals to the Lord God. This review study was conducted to examine the positive and negative views regarding effectsof prayer on physical pains. Methods: This review article was carried on by studying about 30 related original articles and different scientific texts.  Results:In various studies, it is demonstrated that Islamic worships especially prayer are effective in treating most acute and chronic pains. But despite this, some studies indicate that there is no effectiveness or even there are negative effects of prayer on some physical pains. Conclusion: With regard to the above mentioned results,most studies support the positive effects of prayer on physical pains. So the medical staffs should alsopay attention to this besides medicinal remedies. In addition, by emphasizing on and advertising aboutthe advantages of practices likeprayer in the treatment of chronic pains, it would be possible to prevent people, especially the youth, from taking inadmissible drugs such as alcohol, narcotics or other illegal drugs. Further studies are recommended to explore the effects of prayer on different acute and chronic physical pains.

  13. [Pain management in dentistry]. (United States)

    Kandreli, M G; Vadachkoriia, N R; Gumberidze, N Sh; Mandzhavidze, N A


    The aim of the study was to determine the most effective dose of Ibuprofen - one of the non-steroidal anti-inflammatory drugs frequently used in dental practice for pain management. According to our observations, Ibuprofen markedly softens and quickly reduces procedural pain in 55 (91.67%) patients and post-procedural pain in 44 (73.33%) patients, reduces the post-procedural need for or the amount of the drug, removes the fear of anesthesia and endodontic treatment; with irreversible pulpits significantly increases the efficiency of the inferior alveolar nerve block by local anesthetics. Our clinical observation of taking ibuprofen pre-procedurally demonstrates its effectiveness not only as a means for the relief of pain episodes, but also as an excellent anti-inflammatory treatment for chronic toothache Based on our research, the appointment of non-steroidal anti-inflammatory drugs before dental interventions, in this case - Ibuprofen turned out to be the key to the success of effective pain management. We suggest that administration of analgesics in order to relieve and effectively pre-empt pain before, during or after treatment should start before surgery and furthermore, this treatment should be extended into the postoperative period. Premedication with ibuprofen significantly increased the success rates of inferior alveolar nerve block anesthesia in teeth with irreversible pulpitis.

  14. [Chronic pain in geriatrics]. (United States)

    Kennes, B


    Pain is frequent in communicative or no-communicative, ambulatory, institutionalized or hospitalized veterans. It is associated with severe comorbidity so much more than chronic pain could be neglected and expressed of atypical manner or masked by the absence of classical symptoms in particular in case of dementia or of sensory disorders. Pain detection by clinic examination or by pain assessment's methods and adequate approach by pharmacological and non pharmacological therapies are essential for correct pain management. On pharmacological plan, the strategy of the O.M.S. landings is applicable owing to a more particular attention to secondary effects and drugs interactions. AINS must be manipulated with prudence. There are no reasons to exclude opioides from the therapeutic arsenal but with a reduction of the starting doses, a regular adaptation and a very attentive survey. In drugs of landing 2, tramadol reveals itself as efficient and better tolerated as the codeine and dextropropoxyphene has to be to avoid. The obtaining of a satisfactory result depends on a regular assessment of the pain in a context of polydisciplinar approach (physicians, nurses, paramedicals, other care givers).

  15. Mechanisms of Myofascial Pain (United States)

    Jafri, M. Saleet


    Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of the disorder which involves the integration of cellular signaling, excitation-contraction coupling, neuromuscular inputs, local circulation, and energy metabolism. The difficulties are further exacerbated by the lack of an animal model for myofascial pain to test mechanistic hypothesis. In this review, current theories for myofascial pain are presented and their relative strengths and weaknesses are discussed. Based on new findings linking mechanoactivation of reactive oxygen species signaling to destabilized calcium signaling, we put forth a novel mechanistic hypothesis for the initiation and maintenance of myofascial trigger points. It is hoped that this lays a new foundation for understanding myofascial pain syndrome and how current therapies work, and gives key insights that will lead to the improvement of therapies for its treatment. PMID:25574501

  16. [Myofascial pain syndrome]. (United States)

    Novikova, L B; Akopyan, A P


    To analyze clinical characteristics of pain syndrome in patients with dorsalgia. Authors studied 43 patients (mean age 41.9±1.2 years), 34 women and 9 men, with acute and subacute chronic back pain. The study included neurological examination, MRI and/or CT of the spine, measurement of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), The Brief Pain Inventory (BPI) and the McGill Pain Inventory. Chronic myofascial pain syndrome (MFPS) was frequently associated with anxiety-depressive disorders found in patients with cervical and cervical/pectoral pain, fibromyalgia with minimal neurological symptoms and no signs of neural structure compression according to MRI and CT. The results of the study of chronic MFPS should be taken into account in the choice of tactics of treatment of MFPS patients. The use of amelotex in the combination with compligam B in patients with dorsopathy and MFPS is effective together with correction of emotional disorders and treatment with chondroprotectors.

  17. Viruses Infecting Reptiles (United States)

    Marschang, Rachel E.


    A large number of viruses have been described in many different reptiles. These viruses include arboviruses that primarily infect mammals or birds as well as viruses that are specific for reptiles. Interest in arboviruses infecting reptiles has mainly focused on the role reptiles may play in the epidemiology of these viruses, especially over winter. Interest in reptile specific viruses has concentrated on both their importance for reptile medicine as well as virus taxonomy and evolution. The impact of many viral infections on reptile health is not known. Koch’s postulates have only been fulfilled for a limited number of reptilian viruses. As diagnostic testing becomes more sensitive, multiple infections with various viruses and other infectious agents are also being detected. In most cases the interactions between these different agents are not known. This review provides an update on viruses described in reptiles, the animal species in which they have been detected, and what is known about their taxonomic positions. PMID:22163336

  18. Viruses Infecting Reptiles

    Directory of Open Access Journals (Sweden)

    Rachel E. Marschang


    Full Text Available A large number of viruses have been described in many different reptiles. These viruses include arboviruses that primarily infect mammals or birds as well as viruses that are specific for reptiles. Interest in arboviruses infecting reptiles has mainly focused on the role reptiles may play in the epidemiology of these viruses, especially over winter. Interest in reptile specific viruses has concentrated on both their importance for reptile medicine as well as virus taxonomy and evolution. The impact of many viral infections on reptile health is not known. Koch’s postulates have only been fulfilled for a limited number of reptilian viruses. As diagnostic testing becomes more sensitive, multiple infections with various viruses and other infectious agents are also being detected. In most cases the interactions between these different agents are not known. This review provides an update on viruses described in reptiles, the animal species in which they have been detected, and what is known about their taxonomic positions.

  19. Viruses infecting reptiles. (United States)

    Marschang, Rachel E


    A large number of viruses have been described in many different reptiles. These viruses include arboviruses that primarily infect mammals or birds as well as viruses that are specific for reptiles. Interest in arboviruses infecting reptiles has mainly focused on the role reptiles may play in the epidemiology of these viruses, especially over winter. Interest in reptile specific viruses has concentrated on both their importance for reptile medicine as well as virus taxonomy and evolution. The impact of many viral infections on reptile health is not known. Koch's postulates have only been fulfilled for a limited number of reptilian viruses. As diagnostic testing becomes more sensitive, multiple infections with various viruses and other infectious agents are also being detected. In most cases the interactions between these different agents are not known. This review provides an update on viruses described in reptiles, the animal species in which they have been detected, and what is known about their taxonomic positions.

  20. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle


    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

  1. Cancer pain management: Basic information for the young pain physicians

    Directory of Open Access Journals (Sweden)

    SPS Rana


    Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.

  2. Experimental pain impairs recognition memory irrespective of pain predictability. (United States)

    Forkmann, K; Schmidt, K; Schultz, H; Sommer, T; Bingel, U


    Pain is hardwired to signal threat and tissue damage and therefore automatically attracts attention to initiate withdrawal or defensive behaviour. This well-known interruptive function of pain interferes with cognitive functioning and is modulated by bottom-up and top-down variables. Here, we applied predictable or unpredictable painful heat stimuli simultaneously to the presentation of neutral images to investigate (I) whether the predictability of pain modulated its effect on the encoding of images (episodic memory) and (II) whether subjects remember that certain images have been previously presented with pain (source memory). Twenty-four healthy subjects performed a categorization task in which 80 images had to be categorized into living or non-living objects. We compared the processing and encoding of these images during cued and non-cued pain trials as well as cued and non-cued pain-free trials. Effects on recognition performance and source memory for pain were immediately tested using a surprise recognition task. Painful thermal stimulation impaired recognition accuracy (d', recollection, familiarity). This negative effect of pain was positively correlated with the individual expectation of pain interference and the attentional avoidance of pain-related words. However, the interruptive effect of pain was not modulated by the predictability of pain. Source memory for painful stimulation was at chance level, indicating that subjects did not explicitly remember that images had been paired with pain. Targeting negative expectations and a maladaptive attentional bias for pain-related material might help reducing frequently reported pain-induced cognitive impairments. © 2015 European Pain Federation - EFIC®

  3. Pain Drawings Improve Subgrouping of Low Back Pain Patients. (United States)

    Hüllemann, Philipp; Keller, Thomas; Kabelitz, Maria; Freynhagen, Rainer; Tölle, Thomas; Baron, Ralf


    Subgrouping of low back pain (LBP) patients may be improved when pain drawings are combined with the painDETECT (PD-Q) questionnaire. We hypothesized that (1) different LBP subgroups determined by their pain radiation show different clinical patterns and (2) the occurrence of neuropathic symptoms depends on pain radiation. A total of 19,263 acute ( 3 months) LBP patients were allocated prospectively into 4 groups based on the location of pain drawings on a manikin and compared regarding neuropathic pain components, functionality, depression, pain intensity, and surgical interventions. All items were investigated at baseline and follow-up visits. Group I was composed of patients with axial LBP without radiating pain; group II, LBP with radiation into the thigh; group III, LBP with radiation into the shank; and group IV, LBP with radiation into the feet. Side-dependent pain radiation was assessed additionally. Depression, functionality, and pain intensity showed no clinically relevant differences, whereas PD-Q scores and the probability to rate positive for neuropathic pain increased with more distally radiating pain. Surgery and medication intake were most frequent in group IV. Follow-up analyses showed that only axial LBP became more neuropathic, whereas pain intensity decreased over time. Radicular patterns of pain drawings in LBP patients indicate severe pain conditions with the most neuropathic components, while axial LBP has the fewest. For the categorization of LBP, pain drawings help explain the underlying mechanism of pain, which might further improve mechanism-based treatment when used in clinical routines and research. © 2016 World Institute of Pain.

  4. Head and Neck Cancer Pain. (United States)

    Ing, Jakun W


    Pain is a significant morbidity resulting from head and neck cancer. Pain may also be the result of the treatments directed against head and neck cancer. An experienced practitioner may manage this pain by understanding the multifactorial mechanisms of pain and the various pharmacotherapies available. Pain should be managed with multiple medications in a multimodal approach, and nonpharmacologic therapies should be considered as well. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Epigenetic regulation of persistent pain (United States)

    Bai, Guang; Ren, Ke; Dubner, Ronald


    Persistent or chronic pain is tightly associated with various environmental changes and linked to abnormal gene expression within cells processing nociceptive signaling. Epigenetic regulation governs gene expression in response to environmental cues. Recent animal model and clinical studies indicate that epigenetic regulation plays an important role in the development/maintenance of persistent pain and, possibly the transition of acute pain to chronic pain, thus shedding light in a direction for development of new therapeutics for persistent pain. PMID:24948399

  6. Influence of pain intensity, pain duration and location of pain in the ...

    African Journals Online (AJOL)

    Objective: The association of Leg length discrepancy (LLD) in subjects with chronic low back pain (LBPS) has been a debatable issue. The occurrence of LLD in LBPS and comparing with non-low back pain subjects (NLBS) and the possible influence of the site at which pain was felt, duration of low back pain and intensity ...

  7. Testing for Human Immunodeficiency Virus (United States)

    ... education Fact Sheet PFS005: Testing for Human Immunodeficiency Virus AUGUST 2015 • Reasons for Getting Tested • Who Should ... For More Information • Glossary Testing for Human Immunodeficiency Virus Human immunodeficiency virus (HIV) is the virus that ...

  8. [Schizophrenia and pain reactivity]. (United States)

    Bonnot, Olivier; Tordjman, Sylvie


    Medical practitioners do not for a long time pay enough attention to patient's pain. This approach is in the line of society feelings. Pain was long consider to be a contingency to withstand as showed in Christian's bible or Stoicism's principle. Changes in mentality appear in present times. It Seems obvious that for sociological and scientific reasons pain's care in medical and psychiatric disorders is now an important subject. Recent research in autistic disorders suggest that insensitivity observed in autism is not and analgesic phenomenon but a different behavioural reactivity to pain. Prevalence of schizophrenic disorder is from 0.5 to 1%. It is also a complex disorder that has defied decades of concerted efforts to uncover its origins and attenuate its symptoms. The most promising hypotheses suggest that neurodevelopmental impairment increases the risk of later schizophrenia. Most of recent researches in this topic did focus to trait or state markers. According to the vulnerability models of schizophrenia, trait marker are clinical, psychological, physiological, anatomical or cognitive impairments found in patients with schizophrenia during all the course of the illness and even before the onset. Several lines of evidence (case report, epidemiological studies, experimental studies) suggest that patients with schizophrenia shows a relative insensitivity to physical pain. We will review and critic the scientific literature in this specific topic. We will see if datas are relevant with the neurodevelopmental hypothesis and vulnerability models. An OLDMEDLINE/MEDLINE query was performed to identify 50 articles relevant to our subject. 9 were case report or case series, 21 were clinical or epidemiological studies, 15 were experimental studies and we also found 5 previous review. Clinical and experimental data strongly suggest a decrease of Behavioural Reactivity to Pain (BRP) but there is a lack of argument to prove a real analgesia. Because schizophrenia is a

  9. Virus Infection

    Directory of Open Access Journals (Sweden)

    Hiroshi Abe


    Full Text Available Of 168 patients with chronic hepatitis B virus (HBV infection-related liver disease, 20 patients who had received 100 mg of lamivudine plus 10 mg/day of adefovir dipivoxil (ADV (ADV group and 124 patients who had received 0.5 mg/day of entecavir or 100 mg/day of lamivudine (non-ADV group for >1 year were enrolled. For comparative analyses, 19 well-matched pairs were obtained from the groups by propensity scores. At the time of enrollment, serum creatinine and phosphate concentrations were similar between the ADV and non-ADV groups; however, urinary phosphate ( and serum bone-specific alkaline phosphatase (BAP ( concentrations were significantly higher in the ADV group than in the non-ADV group. Serum BAP was significantly higher at the time of enrollment than before ADV administration in the ADV group (, although there was no significant change in serum BAP concentration in the non-ADV group. There was a significant positive correlation between the period of ADV therapy and ΔBAP (, . Serum BAP concentration increased before increase in serum creatinine concentration and was useful for early detection of adverse events and for developing adequate measures for continuing ADV for chronic HBV infection-related liver disease.

  10. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus


    Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively...... during the first postoperative week. Nine patients developed chronic unexplained pain 12months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained...... chronic pain 12months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low...

  11. Interventional pain medicine: retreat from the biopsychosocial model of pain. (United States)

    Roth, Randy S; Geisser, Michael E; Williams, David A


    The field of pain medicine has shifted from multidisciplinary rehabilitation to procedure-focused interventional pain medicine (IPM). Considerable controversy exists regarding the efficacy of IPM and its more narrow focus on nociception as an exclusive target of pain treatment. This topical review aims to examine pain research and treatment outcome studies that support a biopsychosocial model of pain, and to critique the clinical practice of IPM given its departure from the premises of a biopsychosocial model. A modern definition of pain and findings from clinical and basic science studies indicate that pain-related psychological factors are integral to pain perception. The clinical viability of IPM is challenged based upon its biomedical view of peripheral nociception as a primary source of pain and the potential of this viewpoint to foster maladaptive pain attributions and discourage the use of pain coping strategies among chronic pain patients. IPM should adopt a biopsychosocial perspective on pain and operate within a framework of multidisciplinary pain rehabilitation to improve its effectiveness.

  12. [The prevalence of pain and different pain treatments in adults]. (United States)

    Kuru, Tuğba; Yeldan, Ipek; Zengin, Ayşe; Kostanoğlu, Alis; Tekeoğlu, Anil; Akbaba, Yildiz Analay; Tarakçi, Devrim


    The aim of this study was to determine prevalence of pain (p) in adults and their preference for pain treatment, by using questionnaire. First 7 questions of "Brief Pain Inventory-Short Form" and "Cornell Musculoskeletal Discomfort Questionnaire" were applied to 250 participants in face to face interview. A hundred eighty of the individuals were women (38.3±14.0 years old) and 70 were men (36.6±13.2 years old). Data analysis were performed using SPSS, version 10. Eighteen individuals (7.2%) had no pain and 232 (92.8%) of them had pain in different parts of the body. A hundred fourty five individuals had lowback p, 116 neck p, 101 dorsal p, 152 shoulder p, 69 upperarm p, 66 forearm p, 75 wrist p, 59 hip p, 69 upper leg p, 98 knee p, 81 crus pain. Their mean pain score was 3.6±1.8, mean pain score at its worst in the last 24 hours was 4.4±2.6. Thirty three percent of individuals had used non-steroidal anti-inflammatory and/or analgesic drugs to relieve pain, 22.7% had physical therapy, 4.1% had other pain-relief methods, 1.2% had surgery, and 38% had nothing. Our results showed that 92.8% adults had pain. Although shoulder has highest pain prevalance, severe pain was mostly described in lowback area. Knee pain was largely interfered work ability. An important percent of persons experiencing pain has recieved no treatment and first preference for treatment was drug. Inspite of high pain prevalence in our study, slightly uncomfortable pain severity and no need for treatment can be explain a result of individual differences in pain perception.

  13. Pharmacologic attenuation of pelvic pain in a murine model of interstitial cystitis

    Directory of Open Access Journals (Sweden)

    Schaeffer Anthony J


    Full Text Available Abstract Background Interstitial cystitis/painful bladder syndrome (IC/PBS is a bladder disease that causes debilitating pelvic pain of unknown origin, and IC/PBS symptoms correlate with elevated bladder lamina propria mast cell counts. Similar to IC/PBS patients, pseudorabies virus (PRV infection in mice induces a neurogenic cystitis associated with bladder lamina propria mast cell accumulation and pelvic pain. We evaluated several drugs to determine the effectiveness of reducing PRV-induced pelvic pain. Methods Neurogenic cystitis was induced by the injection of Bartha's strain of PRV into the abductor caudalis dorsalis tail base muscle of female C57BL/6 mice. Therapeutic modulation of pelvic pain was assessed daily for five days using von Frey filament stimulation to the pelvic region to quantify tactile allodynia. Results Significant reduction of PRV-induced pelvic pain was observed for animals treated with antagonists of neurokinin receptor 1 (NK1R and histamine receptors. In contrast, the H1R antagonist hydroxyzine, proton pump inhibitors, a histamine receptor 3 agonist, and gabapentin had little or no effect on PRV-induced pelvic pain. Conclusion These data demonstrate that bladder-associated pelvic pain is attenuated by antagonists of NK1R and H2R. Therefore, NK1R and H2Rrepresent direct therapeutic targets for pain in IC/PBS and potentially other chronic pain conditions.

  14. The cartography of pain: the evolving contribution of pain maps. (United States)

    Schott, Geoffrey D


    Pain maps are nowadays widely used in clinical practice. This article aims to critically review the fundamental principles that underlie the mapping of pain, to analyse the evolving iconography of pain maps and their sometimes straightforward and sometimes contentious nature when used in the clinic, and to draw attention to some more recent developments in mapping pain. It is concluded that these maps are intriguing and evolving cartographic tools which can be used for depicting not only the spatial features but also the interpretative or perceptual components and accompaniments of pain. Copyright 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  15. Cannabinoids and Pain

    Directory of Open Access Journals (Sweden)

    J Michael Walker


    Full Text Available Cannabinoids have been used to treat pain for many centuries. However, only during the past several decades have rigorous scientific methods been applied to understand the mechanisms of cannabinoid action. Cannabinoid receptors were discovered in the late 1980s and have been found to mediate the effects of cannabinoids on the nervous system. Several endocannabinoids were subsequently identified. Many studies of cannabinoid analgesia in animals during the past century showed that cannabinoids block all types of pain studied. These effects were found to be due to the suppression of spinal and thalamic nociceptive neurons, independent of any actions on the motor systems. Spinal, supraspinal and peripheral sites of cannabinoid analgesia have been identified. Endocannabinoids are released upon electrical stimulation of the periaqueductal gray, and in response to inflammation in the extremities. These observations and others thus suggest that a natural function of cannabinoid receptors and their endogenous ligands is to regulate pain sensitivity. The therapeutic potential of cannabinoids remains an important topic for future investigations, with previous work suggesting utility in clinical studies of cancer and surgical pain. New modes of delivery and/or new compounds lacking the psychotropic properties of the standard cannabinoid ligands offer promise for cannabinoid therapeutics for pain.

  16. 15. Amygdala pain mechanisms (United States)

    Neugebauer, Volker


    A limbic brain area the amygdala plays a key role in emotional responses and affective states and disorders such as learned fear, anxiety and depression. The amygdala has also emerged as an important brain center for the emotional-affective dimension of pain and for pain modulation. Hyperactivity in the laterocapsular division of the central nucleus of the amygdala (CeLC, also termed the “nociceptive amygdala”) accounts for pain-related emotional responses and anxiety-like behavior. Abnormally enhanced output from the CeLC is the consequence of an imbalance between excitatory and inhibitory mechanisms. Impaired inhibitory control mediated by a cluster of GABAergic interneurons in the intercalated cell masses (ITC) allows the development of glutamate- and neuropeptide-driven synaptic plasticity of excitatory inputs from the brainstem (parabrachial area) and from the lateral-basolateral amygdala network (LA-BLA, site of integration of polymodal sensory information). BLA hyperactivity also generates abnormally enhanced feedforward inhibition of principal cells in the medial prefrontal cortex (mPFC), a limbic cortical area that is strongly interconnected with the amygdala. Pain-related mPFC deactivation results in cognitive deficits and failure to engage cortically driven ITC-mediated inhibitory control of amygdala processing. Impaired cortical control allows the uncontrolled persistence of amygdala pain mechanisms. PMID:25846623

  17. Sex Differences in Pain. (United States)

    Sorge, Robert E; Totsch, Stacie K


    Females greatly outnumber males as sufferers of chronic pain. Although social and psychological factors certainly play a role in the differences in prevalence and incidence, biological differences in the functioning of the immune system likely underlie these observed effects. This Review examines the current literature on biological sex differences in the functioning of the innate and adaptive immune systems as they relate to pain experience. With rodent models, we and others have observed that male mice utilize microglia in the spinal cord to mediate pain, whereas females preferentially use T cells in a similar manner. The difference can be traced to differences in cell populations, differences in suppression by hormones, and disparate cellular responses in males and females. These sex differences also translate into human cellular responses and may be the mechanism by which the disproportionate chronic pain experience is based. Recognition of the evidence underlying sex differences in pain will guide development of treatments and provide better options for patients that are tailored to their physiology. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. Back pain and parenthood. (United States)

    Finkelstein, M M


    To test the hypothesis that reports of back pain in a working population are associated with parenthood. A questionnaire survey of back pain in municipal fire fighters and police officers in a municipality in Ontario, Canada. The questionnaire was distributed to current employees of fire and police departments. The survey was completed by 129 fire fighters (68% of the active force) and 346 police officers (74% of the force). 36% of the respondents complained of a back problem. The prevalence increased from 13% among men aged 19 to 28 to 47% among men aged 49 to 59. The complaint was more common among firefighters (42%) than among police officers (33%). In a logistic regression analysis, back problems were significantly associated with the duration of employment, cigarette smoking, and the number of children. Back pain is a multifactorial problem with significant impact on the working population. This survey has found that parenthood, a risk factor not previously described among men, is associated with self reported back pain. The mechanism presumably involves lifting of children or recreational factors. Fatherhood seems to be a confounder that should be controlled for in studies of occupational causes of back pain.

  19. Women's sexual pain disorders. (United States)

    van Lankveld, Jacques J D M; Granot, Michal; Weijmar Schultz, Willibrord C M; Binik, Yitzchak M; Wesselmann, Ursula; Pukall, Caroline F; Bohm-Starke, Nina; Achtrari, Chahin


    Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches.

  20. Patellofemoral pain in athletes

    Directory of Open Access Journals (Sweden)

    Petersen W


    Full Text Available Wolf Petersen,1 Ingo Rembitzki,2 Christian Liebau3 1Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin; 2German Sport University Cologne, 3Asklepios Clinic, Bad Harzburg, Germany Abstract: Patellofemoral pain (PFP is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS. Older patients usually present with signs of patellofemoral osteoarthritis (PFOA. A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs, passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities. Keywords: anterior knee pain, dynamic valgus, hip strength, rearfoot eversion, single leg squat, hip strength 

  1. VIRUS FAMILIES – contd

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. VIRUS FAMILIES – contd. Minus strand RNA viruses. Rhabdovirus e.g. rabies. Paramyxovirus e.g. measles, mumps. Orthomyxovirus e.g. influenza. Retroviruses. RSV, HTLV, MMTV, HIV. Notes:

  2. Zika Virus Fact Sheet (United States)

    ... Fact files Questions & answers Features Multimedia Contacts Zika virus Fact sheet Updated 6 September 2016 Key facts ... last for 2-7 days. Complications of Zika virus disease Based on a systematic review of the ...

  3. Hepatitis virus panel (United States)

    ... this page: // Hepatitis virus panel To use the sharing features on this page, please enable JavaScript. The hepatitis virus panel is a series of blood tests used ...

  4. Virus Assembly and Maturation (United States)

    Johnson, John E.


    We use two techniques to look at three-dimensional virus structure: electron cryomicroscopy (cryoEM) and X-ray crystallography. Figure 1 is a gallery of virus particles whose structures Timothy Baker, one of my former colleagues at Purdue University, used cryoEM to determine. It illustrates the variety of sizes of icosahedral virus particles. The largest virus particle on this slide is the Herpes simplex virus, around 1200Å in diameter; the smallest we examined was around 250Å in diameter. Viruses bear their genomic information either as positive-sense DNA and RNA, double-strand DNA, double-strand RNA, or negative-strand RNA. Viruses utilize the various structure and function "tactics" seen throughout cell biology to replicate at high levels. Many of the biological principles that we consider general were in fact discovered in the context of viruses ...

  5. Respiratory syncytial virus (RSV) (United States)

    RSV; Palivizumab; Respiratory syncytial virus immune globulin; Bronchiolitis - RSV ... Crowe JE. Respiratory syncytial virus. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ...

  6. Zika Virus Fact Sheet (United States)

    ... sheets Fact files Questions & answers Features Multimedia Contacts Zika virus Fact sheet Updated 6 September 2016 Key facts ... and last for 2-7 days. Complications of Zika virus disease Based on a systematic review of the ...

  7. Zika Virus - Multiple Languages (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Zika Virus URL of this page: ... V W XYZ List of All Topics All Zika Virus - Multiple Languages To use the sharing features on ...

  8. Viruses and Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lawson, James S., E-mail:; Heng, Benjamin [School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney (Australia)


    Viruses are the accepted cause of many important cancers including cancers of the cervix and anogenital area, the liver, some lymphomas, head and neck cancers and indirectly human immunodeficiency virus associated cancers. For over 50 years, there have been serious attempts to identify viruses which may have a role in breast cancer. Despite these efforts, the establishment of conclusive evidence for such a role has been elusive. However, the development of extremely sophisticated new experimental techniques has allowed the recent development of evidence that human papilloma virus, Epstein-Barr virus, mouse mammary tumor virus and bovine leukemia virus may each have a role in the causation of human breast cancers. This is potentially good news as effective vaccines are already available to prevent infections from carcinogenic strains of human papilloma virus, which causes cancer of the uterine cervix.

  9. West Nile Virus (United States)

    West Nile virus (WNV) is an infectious disease that first appeared in the United States in 1999. Infected mosquitoes ... and usually go away on their own. If West Nile virus enters the brain, however, it can be life- ...

  10. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... My ACOG ACOG Departments Donate Shop Career Connection Home Clinical Guidance & Publications Practice Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and Pregnancy Page Navigation ▼ ...

  11. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... Resources & Publications Practice Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and Pregnancy Page Navigation ▼ ACOG Pregnancy ...

  12. Zika Virus and Pregnancy

    Medline Plus

    Full Text Available ... My ACOG ACOG Departments Donate Shop Career Connection Home Resources & Publications Practice Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and Pregnancy Page Navigation ▼ ...

  13. Human Parainfluenza Viruses (United States)

    ... Search Form Controls Cancel Submit Search The CDC Human Parainfluenza Viruses (HPIVs) Note: Javascript is disabled or ... . Recommend on Facebook Tweet Share Compartir Human parainfluenza viruses (HPIVs) commonly cause respiratory illnesses in ...

  14. [Mumps vaccine virus transmission]. (United States)

    Otrashevskaia, E V; Kulak, M V; Otrashevskaia, A V; Karpov, I A; Fisenko, E G; Ignat'ev, G M


    In this work we report the mumps vaccine virus shedding based on the laboratory confirmed cases of the mumps virus (MuV) infection. The likely epidemiological sources of the transmitted mumps virus were children who were recently vaccinated with the mumps vaccine containing Leningrad-Zagreb or Leningrad-3 MuV. The etiology of the described cases of the horizontal transmission of both mumps vaccine viruses was confirmed by PCR with the sequential restriction analysis.

  15. Sex differences underlying orofacial varicella zoster associated pain in rats. (United States)

    Stinson, Crystal; Deng, Mohong; Yee, Michael B; Bellinger, Larry L; Kinchington, Paul R; Kramer, Phillip R


    Most people are initially infected with varicella zoster virus (VZV) at a young age and this infection results in chickenpox. VZV then becomes latent and reactivates later in life resulting in herpes zoster (HZ) or "shingles". Often VZV infects neurons of the trigeminal ganglia to cause ocular problems, orofacial disease and occasionally a chronic pain condition termed post-herpetic neuralgia (PHN). To date, no model has been developed to study orofacial pain related to varicella zoster. Importantly, the incidence of zoster associated pain and PHN is known to be higher in women, although reasons for this sex difference remain unclear. Prior to this work, no animal model was available to study these sex-differences. Our goal was to develop an orofacial animal model for zoster associated pain which could be utilized to study the mechanisms contributing to this sex difference. To develop this model VZV was injected into the whisker pad of rats resulting in IE62 protein expression in the trigeminal ganglia; IE62 is an immediate early gene in the VZV replication program. Similar to PHN patients, rats showed retraction of neurites after VZV infection. Treatment of rats with gabapentin, an agent often used to combat PHN, ameliorated the pain response after whisker pad injection. Aversive behavior was significantly greater for up to 7 weeks in VZV injected rats over control inoculated rats. Sex differences were also seen such that ovariectomized and intact female rats given the lower dose of VZV showed a longer affective response than male rats. The phase of the estrous cycle also affected the aversive response suggesting a role for sex steroids in modulating VZV pain. These results suggest that this rat model can be utilized to study the mechanisms of 1) orofacial zoster associated pain and 2) the sex differences underlying zoster associated pain.

  16. Lumbar discogenic pain

    Directory of Open Access Journals (Sweden)

    A. I. Isaikin


    Full Text Available The paper deals with the role of a discogenic factor in the development of lumbar pain. It gives the updated CTF classification (2014 that describes disc pathological changes and the MSU classification of disc herniation. The pathogenesis and clinical manifestations of two most common manifestations of lumbar discogenic abnormalities (axial discogenic pain and disc radicle conflict, and additional methods for their diagnosis and differential (medical and surgical treatment are discussed. Emphasis is laid on the role of inflammation in the development and maintenance of discogenic pain and in the regression of disc herniation. The paper provides the materials of the first evidence-based guideline developed by the Expert Group of the North American Spine Society (NASS (2012 for the diagnosis and treatment of disc herniation with symptoms of radiculopathy.

  17. [Leading symptom shoulder pain]. (United States)

    Wittke, R


    Pain in the shoulder should prompt a systematic clinical examination that adheres closely to the functional anatomy. The basic examination of the shoulder joint comprises active and passive movements and isometric resistance tests with the aid of which external and internal rotation and abduction/adduction can be investigated. The results of these tests provide the physician with a "pattern of findings" which unequivocally identifies the pain-triggering structure. Accordingly, shoulder pain can be classified into four categories as proposed by Cyriax. As treatment, intra-articular injections of corticoids or local anesthetics as determined by findings, where necessary supported by physiotherapeutic measures. Rupture of a tendon, in particular in the case of an active patient, is an indication for surgery.

  18. Nairobi sheep disease virus/Ganjam virus. (United States)

    M D, Baron; B, Holzer


    Nairobi sheep disease virus (NSDV) is a tick-borne virus which causes a severe disease in sheep and goats, and has been responsible for several outbreaks of disease in East Africa. The virus is also found in the Indian subcontinent, where it is known as Ganjam virus. The virus only spreads through the feeding of competent infected ticks, and is therefore limited in its geographic distribution by the distribution of those ticks, Rhipicephalus appendiculata in Africa and Haemaphysalis intermedia in India. Animals bred in endemic areas do not normally develop disease, and the impact is therefore primarily on animals being moved for trade or breeding purposes. The disease caused by NSDV has similarities to several other ruminant diseases, and laboratory diagnosis is necessary for confirmation. There are published methods for diagnosis based on polymerase chain reaction, for virus growth in cell culture and for other simple diagnostic tests, though none has been commercialised. There is no established vaccine against NSDV, although cell-culture attenuated strains have been developed which show promise and could be put into field trials if it were deemed necessary. The virus is closely related to Crimean-Congo haemorrhagic fever virus, and studies on NSDV may therefore be useful in understanding this important human pathogen.


    Directory of Open Access Journals (Sweden)

    M. C. Rajesh


    Full Text Available BACKGROUND Pain management in Polytrauma is a poorly-addressed concern at the time of active resuscitation. But, very often, pain assessment is also a challenge! Opioids belong to conventional analgesics of choice in any acute pain conditions. But, recently application of regional anaesthesia techniques and subanaesthetic doses of ketamine are satisfactorily employed. A clear understanding of neuropathic element of pain must be made as they require specific therapy. It must be emphasised that effective pain therapy is a multidisciplinary team work with active involvement of pain psychologist.

  20. Exercise Based- Pain Relief Program

    DEFF Research Database (Denmark)

    Zadeh, Mahdi Hossein

    Exercise-based pain management programs are suggested for relieving from musculoskeletal pain; however the pain experienced after unaccustomed, especially eccentric exercise (ECC) alters people´s ability to participate in therapeutic exercises. Subsequent muscle pain after ECC has been shown...... in the current study was to use exercise induced- muscle damage followed by ECC as an acute pain model and observe its effects on the sensitivity of the nociceptive system and blood supply in healthy subjects. Then, the effect of a repeated bout of the same exercise as a healthy pain relief strategy...

  1. [Testicular pain, a diagnostic challenge?]. (United States)

    Monney, Christophe; Schnegg, Annatina; Favrat, Bernard; Amstutz, Vincent


    Scrotal pain is frequently encountered in practice, as it affects 4 men in 1000, with a peak of incidence between the ages of 45 and 50. After excluding an urological or gastrointestinal cause, referred pain of musculoskeletal origin should be considered, even in the absence of back pain. Described by Dr. Robert Maigne, this referred pain originates from a minor intervertebral dysfunction of the thoracolumbar junction. Imaging of the spine is not helpful. Rather, the diagnosis is made by seeking pain triggered by the mobilization of the lumbar vertebrae; the pinch and roll skin manoeuvre will highlight this referred pain. Treatment is symptomatic, though manual therapies by spine specialists are also recommended.

  2. Surveillance of respiratory viruses.

    African Journals Online (AJOL)

    Surveillance of respiratory viruses. A 10-year laboratory-based study. J. M. McAnerney, S. Johnson, B. D. Schoub. Respiratory virus isolates made at the National Institute for. Virology from 1982 to 1991 were studied. An active virus surveillance programme, 'viral watch', which recruits throat swab specimens from a network ...

  3. Characteristic of pandemic virus

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. Characteristic of pandemic virus. The virus was highly transmissible. Risk of hospitalization was 2X and risk of death was about 11X more in comparison to seasonal influenza. Virus continues to be susceptible to Osaltamivir, the only drug available. Vaccines are available but ...

  4. ICTV Virus Taxonomy Profile

    DEFF Research Database (Denmark)

    Simmonds, Peter; Becher, Paul; Bukh, Jens


    borne, and many are important human and veterinary pathogens (e.g. yellow fever virus, dengue virus). This is a summary of the current International Committee on Taxonomy of Viruses (ICTV) report on the taxonomy of the Flaviviridae, which is available at

  5. Computer Virus Protection (United States)

    Rajala, Judith B.


    A computer virus is a program--a piece of executable code--that has the unique ability to replicate. Like biological viruses, computer viruses can spread quickly and are often difficult to eradicate. They can attach themselves to just about any type of file, and are spread by replicating and being sent from one individual to another. Simply having…

  6. Tolerability of NGX-4010, a capsaicin 8% patch for peripheral neuropathic pain

    Directory of Open Access Journals (Sweden)

    Peppin JF


    Full Text Available John F Peppin1, Kristine Majors2, Lynn R Webster3, David M Simpson4, Jeffrey K Tobias5, Geertrui F Vanhove51The Pain Treatment Center of the Bluegrass, Lexington, KY, USA; 2Integrated Clinical Trial Services, Inc, West Des Moines, IA, USA; 3Lifetree Clinical Research and Pain Clinic, Salt Lake City, UT, USA; 4Mount Sinai Medical Center, New York, NY, USA; 5NeurogesX, Inc, San Mateo, CA, USABackground/purpose: NGX-4010 (QUTENZA™; NeurogesX Inc, San Mateo, CA, a capsaicin 8% dermal patch, is licensed in the European Union for the treatment of peripheral neuropathic pain (PNP in nondiabetic adults and in the United States for the treatment of neuropathic pain associated with postherpetic neuralgia (PHN. While NGX-4010 treatment is associated with a low risk of systemic adverse events, patch application-related pain is common and may be managed with local cooling and/or oral analgesics. This article characterizes the tolerability of NGX-4010 and will help to guide any pain management.Methods: This integrated analysis of tolerability data collected from the NGX-4010 clinical study program included 1696 patients with PNP. Patch application-related pain on the treatment day was captured as Numeric Pain Rating Scale (NPRS “pain now” scores while “average pain for the past 24 hours” NPRS scores were analyzed for 7 days following treatment. Other tolerability assessments included the percentage of patients completing ≥90% of the intended treatment duration and patients using medication for patch application-related pain.Results: The mean maximum change in “pain now” NPRS scores from pretreatment levels during and after patch application was 2.6 for all patients. This pain was transient and resolved following patch removal. Mean “average pain for the past 24 hours” NPRS scores returned to baseline by the evening of the treatment day for patients with PHN, and the evening of day 2 for patients with human immunodeficiency virus

  7. Pain management in ER

    Directory of Open Access Journals (Sweden)

    Anna Burattin


    Full Text Available For over 30 years, the International Association for the Study of Pain has defined pain as «an unpleasant sensorial and emotional experience associated to real or potential tissue damage». Today, evident shortcomings still exist in the use of adequate analgesia, especially in the emergency medicine context: pain is the most common symptom amongst the Emergency Department patients (reaching a prevalence of over 60%, however, statistics reported in literature show that only 45% of patients receive analgesic prescriptions on discharge. In recent years, the influence of changes connected to accreditation standards has generated new expectations of healthcare professionals; although this aspect connected to the evolution of public health provides a stimulus to the evolution of the practical aspect of everyday clinical work, we must not forget that doctors take the Hippocratic oath, the ethical obligation to treat suffering and pain, which is especially pertinent to doctors working in Emergency conditions. The quality of the service provided with regard to pain-relief in ED cannot exclude an analysis of the local situation, the definition of roles, the extrinsication of potential with the ultimate aim of providing a service as close as possible to user hopes. Organisational efforts must be directed at reaching excellent quality levels, in which the monitoring of the activities performed takes place through the registration and periodic re-evaluation of the deriving data. Through this observational, prospective study, we intend to evaluate the effective prevalence of the pain symptom in the Emergency Department and the impact of the use of different classes of analgesia, also estimating the latency between the onset of the symptom and triage in order to quantify the efficacy of the analgesia practiced.

  8. Complex regional pain syndrome

    Directory of Open Access Journals (Sweden)

    Sandeep J Sebastin


    Full Text Available Complex regional pain syndrome (CRPS previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent modifications to diagnostic criteria have enabled clinicians to diagnose this disease more consistently. This review gives a synopsis of CRPS and discusses the diagnosis, pathophysiology, and treatment options based on the limited evidence in the literature.

  9. [Groin pain in athletes]. (United States)

    Ziltener, J-L; Leal, S


    Groin pain is a common problem in athletes who engage in sports involving accelerations, decelerations and sudden direction changes. It is still a frustrating pathology which has significant overlap and multiple problems coexist frequently. The pathogeny remains unclear, but the hypothesis that imbalances between abdominal muscles and adductors exist, has a certain success. Some anatomic and biomechanic factors may play a role in this pathology. A good clinical examination is an important part of the diagnosis and imaging may be helpful to eliminate other causes of groin pain that wouldn't be mechanic. The conservative treatment is long and difficult and must be focused on functional strengthening and core stabilisation.

  10. Congenital indifference to pain

    Directory of Open Access Journals (Sweden)

    Kapasi A


    Full Text Available A 9-month old female infant developed a non-healing deep necrotic ulcer on the tongue in apposition with the central incisors. There was no response to painful stimuli. Investigations revealed normal blood biochemistry, sweat, histamine and capsaicin tests. Nerve conduction studies and light microscopy of sural nerve and skin were normal. The child was diagnosed as a case of congenital indifference to pain and was treated with teeth extraction and plastic repair of the tongue. In next 2 years the child had recurrent ulcers of the tongue leading to fibrosis and shortening of tongue hampering the speech.

  11. Myofascial pain syndrome treatments. (United States)

    Borg-Stein, Joanne; Iaccarino, Mary Alexis


    Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Reward and motivation in pain and pain relief. (United States)

    Navratilova, Edita; Porreca, Frank


    Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain.

  13. Noradrenaline increases pain facilitation from the brain during inflammatory pain

    NARCIS (Netherlands)

    Martins, I.; de Vries, M. G.; Teixeira-Pinto, A.; Fadel, J.; Wilson, S. P.; Westerink, B. H. C.; Tavares, I.

    Antidepressants that inhibit the recapture of noradrenaline have variable effects in chronic pain which may be related to the complex role of noradrenaline in pain modulation. Whereas at the spinal cord noradrenaline blocks nociceptive transmission, both antinociception and pronociception were

  14. Quantitative Evaluation of Pain with Pain Index Extracted from Electroencephalogram

    Directory of Open Access Journals (Sweden)

    Jian-Xiong An


    Conclusions: Pi significantly correlates with VAS/NRS score, might be used to evaluate the subjective pain symptoms in patients and has good research and application value as an objective pain assessment tool.

  15. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris


    Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...... document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr...

  16. Altering gender role expectations: effects on pain tolerance, pain threshold, and pain ratings. (United States)

    Robinson, Michael E; Gagnon, Christine M; Riley, Joseph L; Price, Donald D


    The literature demonstrating sex differences in pain is sizable. Most explanations for these differences have focused on biologic mechanisms, and only a few studies have examined social learning. The purpose of this study was to examine the contribution of gender-role stereotypes to sex differences in pain. This study used experimental manipulation of gender-role expectations for men and women. One hundred twenty students participated in the cold pressor task. Before the pain task, participants were given 1 of 3 instructional sets: no expectation, 30-second performance expectation, or a 90-second performance expectation. Pain ratings, threshold, and tolerance were recorded. Significant sex differences in the "no expectation" condition for pain tolerance (t = 2.32, df = 38, P gender-specific tolerance expectations, men and women did not differ in their pain tolerance, pain threshold, or pain ratings. This is the first empirical study to show that manipulation of expectations alters sex differences in laboratory pain.

  17. Pain Mechanisms and Centralized Pain in Temporomandibular Disorders (United States)

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


    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

  18. Managing Back Pain During Pregnancy. (United States)



    The incidence of low-back pain during pregnancy is thought to be about 50%. It occurs most commonly after the sixth month and can last until the sixth month postpartum. The major predictors are back pain prior to pregnancy and multiparity. Several biomechanical and physiologic changes during pregnancy contribute to back pain. As the woman's abdominal muscles are stretched and tone is diminished, they lose their ability to contribute to neutral posture. During pregnancy, production of the hormone relaxin increases ten-fold. The hormone creates joint laxity, which not only allows the pelvis to accommodate the enlarging uterus, but also weakens the ability of static supports in the lumbar spine to withstand shearing forces. In the pelvis, joint laxity is most prominent in the symphysis pubis and the sacroiliac joints. On physical exam, neither lumbar nor sacroiliac back pain is generally associated with any evidence of neurologic deficit or hip pathology. In cases of lumbar back pain, the physical exam will be most consistent with discogenic pain and/or facet element pain. Therefore, a pregnant woman's pain may be most pronounced on flexion and standing. Among the tests that can be used to evaluate lower-back pain are the posterior pelvic provocation test; ventral gapping test; dorsal gapping test; sacroiliac joint fixation test; Patrick's test, or FABERE's maneuver (flexion, abduction, external rotation, and extension); and Derbolowski's test. The most common types of back pain during pregnancy are lumbar pain, sacroiliac pain, and nocturnal back pain.

  19. Pain: A Culturally Informed Experience

    Directory of Open Access Journals (Sweden)

    David Ng


    Full Text Available I was raised in North America - a culture and society in which the education emphasizes knowledge about science, its methods and its principles. The scientific method of understanding, coupled with the rudimentary knowledge that I was taught in high school biology, resulted in my conceptualization of pain as an objective truth. Pain, as I believed for a long time, was a bodily sensation with an expression that was more or less universal; to me, pain was simply the sensation that the brain experiences as a response to noxious stimuli. The pain sensation protects us from things that can hurt us; it is a warning sign that something in us is physically amiss. Thus, everybody physically reacts to the touch of a flame or experiences abdominal pain when there is appendicitis. Even now, in medical school, the pain education that I have received so far has only involved the physiology or mechanics of pain. Pain, as a physiological condition, operates independent of cultural context. However, in considering the experience of pain that my grandmother has endured, I realize that pain is much more than a mechanical bodily sensation effected by the nervous system in response to stimulus. Pain is a human experience, and as such, it is highly individualized and subjective. The proper diagnosis, care and treatment of pain necessitate a holistic understanding of pain, its physiology and its context (1.

  20. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain. (United States)

    Kashi, Yafit; Ratmansky, Motti; Defrin, Ruth


    Hemiplegic shoulder pain (HSP) following stroke significantly affects the individual's function and quality of life. The mechanism of HSP is not clearly understood; hence, it is unclear why HSP resolves spontaneously or following routine care in some patients, while in others it becomes persistent. The aim was therefore to study whether HSP is associated with deficient pain modulation. Thirty post-stroke patients-16 with HSP and 14 without HSP-and 20 matched controls participated. Pain adaptation and conditioned pain modulation (CPM) were measured as indicators of pain modulation, in the affected (hemiplegic) and contralateral shoulder as well as in the affected shin among post-stroke patients, and in comparable body regions among controls. Post-stroke patients also underwent functional and physical evaluation of the shoulder. Pain adaptation was absent among HSP patients, in both the painful shoulder and the affected shin, but existed in the 2 control groups. In addition, the affected shoulder and shin among the HSP group had reduced thermal sensibility compared to the contralateral regions. CPM was similar across groups. Shoulder functional status and physical status were similar for the 2 post-stroke groups. The results suggest that HSP is associated with a lack of pain adaptation, characteristic not only of the painful shoulder but also of the affected side. Although we cannot determine whether lack of pain adaptation precedes the HSP or results from it, interventions that enhance descending pain inhibition may improve management and prevent HSP chronification. © 2017 World Institute of Pain.

  1. Acute pain management in general practice: steps to effective pain ...

    African Journals Online (AJOL)

    Pain is one of the most common complaints that general practitioners encounter in everyday practice. The swift and effective management of pain is a medical mandate, not only to fulfil an ethical obligation to the patient, but also to prevent long-term complications, such as chronic pain. General practitioners are often ...

  2. Remembering the pain: accuracy of pain recall in endometriosis. (United States)

    Nunnink, Sarah; Meana, Marta


    Endometriosis diagnosis and treatment planning are guided primarily by retrospective pain recall, despite the facts that (1) there is only a tenuous relationship between pain reports and physical pathology, and (2) the accuracy of pain recall has never been assessed in this population. The current study investigated the accuracy of endometriotic pain recall for pain experienced over a 30-day period, as well as potential psychological mediators of pain recall accuracy, including psychological wellbeing, distress specific to infertility, passive and active coping, and pain present at time of recall in 100 women with endometriosis. Findings indicated that women were relatively accurate in their recall of pain. Only passive coping and pain present at recall were predictive of accuracy, with greater passive coping and lower pain at recall predictive of overestimation of past pain. Study implications are discussed, including: (1) report of pain over a 30-day duration appears credible for the majority of patients with endometriosis and (2) women exhibiting greater passive coping may benefit from psychological treatment in addition to medical intervention.

  3. Acute pain management in general practice: Steps to effective pain ...

    African Journals Online (AJOL)

    Pain is one of the most common complaints that general practitioners encounter in everyday practice. The swift and effective management of pain is a medical mandate, not only to fulfil an ethical obligation to the patient, but also to prevent long-term complications, such as chronic pain. General practitioners are often ...

  4. Parental Perceptions about Pain and Pain Management Practices in ...

    African Journals Online (AJOL)

    Background: Pain management in neonates remains sub-optimal in sub-Saharan countries like Kenya due to lack of resources to procure pharmacological analgesics. There, however, exist low-cost, mother-driven pain management strategies such as breastfeeding and kangaroo care that can be used for pain relief in ...

  5. Pain on Propofol Injection: The Gender Differences in Pain Perception

    African Journals Online (AJOL)

    Background: Injection pain, which distresses patients, is a major disadvantage of propofol as an induction agent. Lignocaine pretreatment is the most popular method for reducing this pain but this drug alone cannot eliminate the problem. The aim of this study was to investigate the gender differences in pain ...

  6. Blueberry (Vaccinium corymbosum)-Virus Diseases (United States)

    At least six viruses have been found in highbush blueberry plantings in the Pacific Northwest: Blueberry mosaic virus, Blueberry red ringspot virus, Blueberry scorch virus, Blueberry shock virus, Tobacco ringspot virus, and Tomato ringspot virus. Six other virus and virus-like diseases of highbush b...

  7. Characterizing neuropathic pain profiles: enriching interpretation of painDETECT

    Directory of Open Access Journals (Sweden)

    Cappelleri JC


    Full Text Available Joseph C Cappelleri,1 Vijaya Koduru,2 E Jay Bienen,3 Alesia Sadosky4 1Pfizer Inc, Groton, CT, USA; 2Eliassen Group, New London, CT, USA; 3Outcomes Research Consultant, New York, NY, USA; 4Pfizer Inc, New York, NY, USA Purpose: To psychometrically evaluate painDETECT, a patient-reported screening questionnaire for neuropathic pain (NeP, for discriminating among sensory pain symptoms (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure. Methods: The seven-item version of painDETECT provides an overall score that targets only sensory symptoms, while the nine-item version adds responses on two items to the overall score, covering pain course pattern and pain radiation. Both versions have relevance in terms of characterizing broad NeP. The nine- and seven-item versions of painDETECT were administered to subjects with confirmed NeP across six conditions identified during office visits to US community-based physicians. Responses on the sensory symptom items were dichotomized into “at least moderate” (ie, moderate, strongly, very strongly relative to the combined other responses (never, hardly noticed, slightly. Logistic regression of dichotomized variables on the total painDETECT score provided probabilities of experiencing each symptom across the range of painDETECT scores. Results: Both painDETECT versions discriminated among the symptoms with similar probabilities across the score ranges. Using these data, the probability of moderately experiencing each pain sensory item was estimated for a particular score, providing a pain profile. Additionally, the likelihood of experiencing each sensation was determined for a discrete increase in score, ie, the odds of at least a moderate sensation of burning (versus less than a moderate sensation was 1.29 for a 1-point increase, 3.52 for a 5-point increase, and 12.42 for every 10-point increase in the nine-item painDETECT score

  8. Cognitive hypnotherapy for pain management. (United States)

    Elkins, Gary; Johnson, Aimee; Fisher, William


    Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management.

  9. MRI and low back pain (United States)

    ... this page, please enable JavaScript. Back pain and sciatica are common health complaints. Almost everyone has back ... Back Pain Read more MRI Scans Read more Sciatica Read more A.D.A.M., Inc. is ...

  10. Pain reduces discrimination in helping

    NARCIS (Netherlands)

    van Leeuwen, E.; Ashton-James, C.; Hamaker, R.J.


    Because of their shared neurobiological underpinnings, factors increasing physical pain can also increase feelings of social disconnection ("social pain"). Feelings of connection with a social group are reflected in the term social identification, and social identity is commonly associated with

  11. Pain treatment: a historical overview. (United States)

    Sabatowski, R; Schäfer, D; Kasper, S M; Brunsch, H; Radbruch, L


    Pain is a common experience of mankind. Pain theories and the management of pain have been modified throughout the history of mankind. This article gives a brief review on pain, pain believes and pain management from early magico-demonic and magico-religious ideas and procedures to more empiric-scientific models; from ancient times and primitive cultures to the 20th century. Due to new anatomical, physiological and biochemical insights, modern pain theories developed in the 19th and 20th century. Modern analgesics were synthesized and new invasive procedures were approved having a major impact on pain management strategies. However, older traditional beliefs and attitudes have not been replaced completely and have survived to some degree in modern patients.

  12. Radiographic Assessment for Back Pain (United States)

    ... of Spine Treatment Spondylolisthesis BLOG FIND A SPECIALIST Treatments Radiographic Assessment for Back Pain Patient Education Committee Patient Education Committee Radiographic assessments for low back pain involve the use of X-rays ...

  13. Vertebroplasty for Spine Fracture Pain (United States)

    ... and break.How are spinal fractures treated?Most fractures of the spine are treated with bed rest until the pain goes away. Pain medicines, back braces and physical therapy may also be used. For some patients, doctors ...

  14. Dealing with Pain during Childbirth (United States)

    ... Ice, and Snow Safety Dealing With Pain During Childbirth KidsHealth > For Parents > Dealing With Pain During Childbirth ... of taking tranquilizers first with your doctor. Natural Childbirth Some women choose to give birth using no ...

  15. Pain management in veterinary patients

    Directory of Open Access Journals (Sweden)

    H. S. Vedpathak

    Full Text Available The veterinary practitioner has an ethical obligation to help alleviate animal pain. Although most veterinarians accept the fact that animals feel pain, still, postoperative pain relief is not a routine practice in all veterinary hospitals and clinics today. Nociception is a physiological process which involves transduction, transmission, modulation and perception of the noxious stimuli. Chemical mediators are important components of the nociceptive reflex and offer a target of pharmacologic modulation. Assessment of pain in animals is the most important step in the successful management of pain. Choosing appropriate method of pain control would depend upon the type of procedure followed, severity of pain and economic considerations for each individual circumstance. Our understanding of the pain in its manifestation, mechanisms, assessment and alleviation in animals is still although improving, limited. [Vet World 2009; 2(9.000: 360-363

  16. Pain in patients with cancer

    NARCIS (Netherlands)

    Vissers, K.C.P.; Besse, K.; Wagemans, M.; Zuurmond, W.; Giezeman, M.J.; Lataster, A.; Mekhail, N.; Burton, A.W.; Kleef, M. van; Huygen, F.


    Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate

  17. Prevalent knee pain and sport

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders


    STUDY OBJECTIVE: To estimate the prevalence of knee pain in active athletes and to investigate potential associations to type, amount and duration of sports participation. MEASUREMENTS: 339 athletes gave information about occupation, sports activity and different features of knee pain, based...... on a self-filled questionnaire. MAIN RESULTS: The prevalence of knee pain within the preceding 12 months, constant or recurrent knee pain, absence from sport and absence from work due to knee pain, was 54%, 34%, 19% and 4%, respectively. Knee pain was positively associated with years of jogging...... and with weekly hours of participation in competitive gymnastics but negatively with weekly hours of tennis. Constant or recurrent knee pain was positively associated with years of swimming. Absence from sport due to knee pain was positively associated with weekly hours of soccer participation. CONCLUSIONS: Knee...

  18. Pain prevalence in hospitalized children

    DEFF Research Database (Denmark)

    Walther-Larsen, S; Pedersen, M T; Friis, S M


    BACKGROUND: Pain management in hospitalized children is often inadequate. The prevalence and main sources of pain in Danish university hospitals is unknown. METHODS: This prospective mixed-method cross-sectional survey took place at four university hospitals in Denmark. We enrolled 570 pediatric...... patients who we asked to report their pain experience and its management during the previous 24 hours. For patients identified as having moderate to severe pain, patient characteristics and analgesia regimes were reviewed. RESULTS: Two hundred and thirteen children (37%) responded that they had experienced...... pain in the previous 24 hours. One hundred and thirty four (24%) indicated moderate to severe pain and 43% would have preferred an intervention to alleviate the pain. In children hospitalized for more than 24 hours, the prevalence of moderate/severe pain was significantly higher compared to children...

  19. Persistent facial pain conditions

    DEFF Research Database (Denmark)

    Forssell, Heli; Alstergren, Per; Bakke, Merete


    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...

  20. Chronic pelvic pain

    African Journals Online (AJOL)

    tract; and the vascular, neural and musculoskeletal systems. The pain can be continual, cyclical, provoked or unprovoked, and is frequently multifocal. A woman ..... support and therapy is an important part of this approach, but should be broached in an appropriate patient-centred context. Bibliography. 1. Graziottin A, Murina ...

  1. Radiology of back pain

    Energy Technology Data Exchange (ETDEWEB)

    Wackenheim, A.; Dietemann, J.L.


    The authors give an overview of causes of back pain which may be detected by radiological examinations. They insist on practical points of view such as: main cause, accessory cause, problems arising by multiple causes, congenital malformation of the vertebral arch such as anisocoria, canalar stenosis, cheirolumbar dysostosis. They describe two new signs: the pedicular scalloping and the framed articular process.

  2. Surgical management of pain

    African Journals Online (AJOL)

    [4] In this article, the reader is referred back to this ... This article gives an overview of the neurosurgical management of pain. S Afr Med J 2016 ... gia), nerve compression syndromes (carpal tunnel syndrome is the most common), and radicular ...

  3. Pain in Malaria

    African Journals Online (AJOL)

    Dr Olaleye

    Study Design: This was a hospital-based, cross-sectional study at two major health facilities in Ibadan, southwest Nigeria, involving out- patients diagnosed of ..... Table 5. Respondents' Perceived Effect of Malaria Pain on Selected Life Activities. Life Activity. Does not interfere. Freq. (%). Mildly interfere. Freq. (%). Moderately.

  4. Pain and microcrystalline arthritis

    Directory of Open Access Journals (Sweden)

    R. Ramonda


    Full Text Available Microcrystals are responsible for some of the most common and complex arthropathies which are often accompanied by intense, severe pain and inflammatory reactions. The main pathogens are crystals of monosodium urate (MSU, responsible for the gout, calcium pyrophosphate (CPP, which deposits also in various clinical forms of arthopathies, and basic calcium phosphate associated with osteoarthritis. In this context, the microcrystal arthritis is characterized by multiple, acute attacks followed by chronic pain, disability, impaired quality of life, and increased mortality. Given their chronic nature, they represent an ever more urgent public health problem. MSU and CPP crystals are also able to activate nociceptors. The pain in mycrocrystalline arthritis (MCA is an expression of the inflammatory process. In the course of these diseases there is an abundant release of inflammatory molecules, including prostaglandins 2 and kinins. Interleukin-1 represents the most important cytokine released during the crystal-induced inflammatory process. Therefore, clinically, pain is the most important component of MCA, which lead to functional impairment and disability in a large proportion of the population. It is fundamental to diagnose these diseases as early as possible, and to this aim, to identify appropriate and specific targets for a timely therapeutic intervention.

  5. Women's Sexual Pain Disorders

    NARCIS (Netherlands)

    van Lankveld, Jacques J. D. M.; Granot, Michal; Schultz, Willibrord C. M. Weijmar; Binik, Yitzchak M.; Wesselmann, Ursula; Pukall, Caroline F.; Bohm-Starke, Nina; Achtrari, Chahin

    Introduction. Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. Aim. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and

  6. Chronic arthritis in chikungunya virus infection. (United States)

    Mateo, Lourdes; Roure, Silvia


    Chikungunya virus infection causes arthralgia and arthritis in the acute phase of the disease but, in more than half of the cases, musculoskeletal manifestations can be prolonged over time and, in some cases, become chronic. Although polyarthralgia is the most frequent chronic manifestation, forms with polyarthritis, tenosynovitis and enthesopathy are also common. To analyze the clinical characteristics of patients with persistent articular manifestations after infection with the Chikungunya virus. Report of 3 cases of chronic arthritis after infection with chikungunya virus diagnosed at outpatient care in a university hospital of Catalonia, all of them imported after exposure in areas of epidemic infection between 2013-2015. All three patients had inflammatory joint pain for more than one year after acute disease (3, 2 and 1 years, respectively). In all cases, it appeared as polyarthritis with involvement of small joints of hands and feet (pseudorheumatoid arthritis-like). Laboratory tests showed a slight elevation of acute phase reactants, and analyses for immune markers were negative. Two of the patients required treatment with glucocorticoids and hydroxychloroquine. The course led to slow clinical improvement, but only one of them came to be completely asymptomatic. In the differential diagnosis of chronic polyarthritis, Chikungunya virus disease should also be considered in areas in which it is not endemic. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  7. [Pain, from symptom to syndrome]. (United States)

    Piano, Virginie


    Acute pain is a symptom enabling us to implement a response when faced with an attack. Chronic pain is complex and multifactorial. The care of the patient by a multidisciplinary team comprises the diagnosis of the pain and the putting in place of a treatment for each of its components. This includes physical reconditioning, adaptation strategies and work on the psychological elements relating to the representation of the pain. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Methadone for cancer pain. (United States)

    Nicholson, Alexander B; Watson, Graeme R; Derry, Sheena; Wiffen, Philip J


    This is an updated review originally published in 2004 and first updated in 2007. This version includes substantial changes to bring it in line with current methodological requirements. Methadone is a synthetic opioid that presents some challenges in dose titration and is recognised to cause potentially fatal arrhythmias in some patients. It does have a place in therapy for people who cannot tolerate other opioids but should be initiated only by experienced practitioners. This review is one of a suite of reviews on opioids for cancer pain. To determine the effectiveness and tolerability of methadone as an analgesic in adults and children with cancer pain. For this update we searched CENTRAL, MEDLINE, Embase, CINAHL, and, to May 2016, without language restriction. We also checked reference lists in relevant articles. We sought randomised controlled trials comparing methadone (any formulation and by any route) with active or placebo comparators in people with cancer pain. All authors agreed on studies for inclusion. We retrieved full texts whenever there was any uncertainty about eligibility. One review author extracted data, which were checked by another review author. There were insufficient comparable data for meta-analysis. We extracted information on the effect of methadone on pain intensity or pain relief, the number or proportion of participants with 'no worse than mild pain'. We looked for data on withdrawal and adverse events. We looked specifically for information about adverse events relating to appetite, thirst, and somnolence. We assessed the evidence using GRADE and created a 'Summary of findings' table. We revisited decisions made in the earlier version of this review and excluded five studies that were previously included. We identified one new study for this update. This review includes six studies with 388 participants. We did not identify any studies in children.The included studies differed so much in their methods and

  9. Chikungunya virus infection in developing countries - What should we do?

    Directory of Open Access Journals (Sweden)

    Md. Tanvir Rahman


    Full Text Available Chikungunya fever, a serious global public health problem, is a mosquito-borne disease caused by Chikungunya virus belonging to the family Togaviridae. The virus was first detected in Tanzania in1953. At present, the virus has been detected over 60 countries across the globe. The virus is transmitted mainly through Aedes mosquitoes. Although not fatal, the affected persons suffer a lot from high fever, severe pain and other complications. Currently there is no effective treatment or vaccine for the Chikungunya virus. The situation is severe in developing countries that lack sufficient diagnostic facilities and control measures. Adequate coordinated efforts comprising active surveillance, early detection, vector control and public awareness at local, national and international level need to be adopted in endemic areas for the effective control of Chikungunya virus infection. This mini review highlights some of the advances recently have made in our understanding of Chikungunya virus. [J Adv Vet Anim Res 2017; 4(2.000: 125-131

  10. Pain and consciousness. (United States)

    Garcia-Larrea, Luis; Bastuji, Hélène


    The aversive experience we call "pain" results from the coordinated activation of multiple brain areas, commonly described as a "pain matrix". This is not a fixed arrangement of structures but rather a fluid system composed of several interacting networks: A 'nociceptive matrix' includes regions receiving input from ascending nociceptive systems, and ensures the bodily characteristics of physical pain. A further set of structures receiving secondary input supports the 'salience' attributes of noxious stimuli, triggers top-down cognitive controls, and -most importantly- ensures the passage from pre-conscious nociception to conscious pain. Expectations and beliefs can still modulate the conscious experience via activity in supramodal areas and regions with widespread cortical projections such as the ventral tegmental area. Intracortical EEG responses in humans show that nociceptive cortical processing is initiated in parallel in sensory, motor and limbic areas; it progresses rapidly to the recruitment of anterior insular and fronto-parietal networks, and finally to the activation of perigenual, posterior cingulate and hippocampal structures. Functional connectivity between sensory and high-level networks increases during the first second post-stimulus, which may be determinant for access to consciousness. A model is described, progressing from unconscious sensori-motor and limbic processing of spinothalamic and spino-parabrachial input, to an immediate sense of awareness supported by coordinated activity in sensorimotor and fronto-parieto-insular networks, and leading to full declarative consciousness through integration with autobiographical memories and self-awareness, involving posterior cingulate and medial temporal areas. This complete sequence is only present during full vigilance states. We contend, however, that even in unconscious subjects, repeated limbic and vegetative activation by painful stimuli via spino-amygdalar pathways can generate implicit memory

  11. Treatment of myofascial pain. (United States)

    Esenyel, M; Caglar, N; Aldemir, T


    To investigate the effectiveness of ultrasound treatment and trigger point injections in combination with neck-stretching exercises on myofascial trigger points of the upper trapezius muscle. Depression and anxiety associated with chronic pain were assessed using the Beck Depression Inventory (BDI) and the Taylor Manifest Anxiety Scale (TMAS). The study population comprised 102 patients who had myofascial trigger points in one side of the upper trapezius. The patients were randomly assigned to one of three groups: group 1 received ultrasound therapy to trigger points in conjunction with neck-stretching exercises; group 2 received trigger point injections and performed neck-stretching exercises; and group 3, the control group, performed neck-stretching exercises only. Treatment effectiveness was assessed using subjective pain intensity (PI) with a visual analog scale, pressure pain threshold (PT) with algometry, and range of motion (with a goniometer) of the upper trapezius muscle. Compared with the control group, patients in groups 1 and 2 had a statistically significant reduction in PI, an increase in PT, and an increase in range of motion. There were no statistically significant differences between treatment groups 1 and 2. Although not statistically significant, patients in the control group had better results at the 3-mo follow-up. The BDI scores indicated depression in 22.9% of the patient, with 4.8% of the patients having severe depression. High anxiety scores on the TMAS were present in 89.3% of the patients. When BDI and TMAS scores were compared with PI or PT levels, no significant correlations were found, but when compared with pain duration before treatment, correlations were significant. Patients with myofascial pain syndrome had higher scores for anxiety than for depression. When combined with neck stretching exercises, ultrasound treatment and trigger point injections were found to be equally effective.

  12. Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability.

    NARCIS (Netherlands)

    Swinkels-Meewisse, I.E.; Roelofs, J.; Oostendorp, R.A.B.; Verbeek, A.L.M.; Vlaeyen, J.W.S.


    Pain-related fear and pain catastrophizing are associated with disability and actual performance in chronic pain patients. In acute low back pain (LBP), little is known about the prediction of actual performance or perceived disability by pain-related fear and pain catastrophizing. This

  13. Virus, Oncolytic Virus and Human Prostate Cancer. (United States)

    Liu, Guang Bin; Zhao, Liang; Zhang, Lifang; Zhao, Kong-Nan


    Prostate cancer (PCa), a disease, is characterized by abnormal cell growth in the prostate - a gland in the male reproductive system. Although older age and a family history of the disease have been recognized as the risk factors of PCa, the cause of this cancer remains unclear. Currently, PCa is one of the leading causes of cancer death among men of all races. In this review study, we first discuss the controversy of the contribution of virus infection to PCa, and subsequently summarize the development of oncolytic virotherapy for PCa in the past several years. Mounting evidence suggests that infections with various viruses are causally linked to PCa pathogenesis. Published studies have provided strong evidence that at least two viruses (RXMV and HPV) contribute to prostate tumourigenicity and impact on the survival of patients with malignant PCa. Traditional therapies including chemotherapy and radiotherapy are unable to distinguish cancer cells from normal cells, which are a significant drawback and leads to toxicities for PCa patients undergoing treatment. So far, few other options are available for treating patients with advanced PCa. For PCa treatment, oncolytic virotherapy appears to be much more attractive, which uses live viruses to selectively kill cancer cells. Oncolytic viruses can be genetically engineered to induce cancer cell lysis through virus replication and expression of cytotoxic proteins. Virotherapy is being developed to be a novel therapy for cancers, which uses oncotropic and oncolytic viruses with their abilities to find and destroy malignant cells in the body. As oncolytic viruses are a relatively new class of anti-cancer immunotherapy agents, several important barriers still exist on the road to the use of oncolytic viruses for PCa therapy. Copyright© Bentham Science Publishers; For any queries, please email at

  14. Age differences in children's pain. (United States)

    Lander, J; Fowler-Kerry, S


    A cross-sectional study of venipuncture pain and anxiety was conducted with 180 consecutively referred children and their parents. Analysis indicated that younger children report more venipuncture pain than older children. Anxiety was related to both age and pain. As well, anxiety was lowest among children with no previous venipuncture experience and among those with the greatest experience.

  15. [Analgesic treatment of cancer pain]. (United States)

    Ghimouz, Abdelmalek


    Cancer pain can be nociceptive, neuropathic or mixed. It is linked to the tumour, to the metastases and to the treatments for the disease and is managed by multimodal analgesia corresponding to the pain relief drugs of the WHO's pain ladder, antidepressants, antiepileptic drugs and local anaesthetics. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Handout on Health: Back Pain (United States)

    ... when used as a part of a comprehensive treatment plan for low back pain. Acupressure . A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for back pain. Surgical treatments may be necessary in some cases, including: Herniated ( ...

  17. Electronic momentary assessment in chronic pain (II): pain and psychological pain responses as predictors of pain disability.

    NARCIS (Netherlands)

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J.J.; Verhaak, P.F.M.; Bensing, J.M.


    Objectives and Methods: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain

  18. Neck pain: causes, diagnosis, treatment


    Aleksey Ivanovich Isaikin


    Neck pain is frequently encountered in clinical practice. In most cases, it is unassociated with a serious problem and ends with complete recovery. Nonspecific (mechanical, axial) pain is most common; posttraumatic pain associated with whiplash injury is less frequently encountered; compression (radicular and myelopathic) syndromes are much less frequent. Analysis of complaints and medical histories and neuroorthopedic and neurological examin...

  19. Phantom pain after eye amputation

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B


    Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation,...... appears to be similar to the phantom pain suffered by limb amputees. Patients should be informed about this potential complication before surgery....


    Directory of Open Access Journals (Sweden)

    Nikolay Yanev


    Full Text Available The article clarifies that pain in obesity is not obesity and pain. The authors reviewed the literature and surveyed the clinical data about pain in people with abnormal body weight. The conclusion was made that pain in obese patients needs adequate management. Data for pharmacokinetic and pharmacodynamics characteristics of frequently used analgesic drugs are summarized. The authors include useful schemas of pharmacotherapy with non-opioid as well as opioid analgesics and practical guidelines for pain management in clinical ward or outpatient departments.

  1. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short‐Form McGill Pain Questionnaire (SF‐MPQ), Chronic Pain Grade Scale (CPGS), Short Form‐36 Bodily Pain Scale (SF‐36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)

    National Research Council Canada - National Science Library

    Hawker, Gillian A; Mian, Samra; Kendzerska, Tetyana; French, Melissa


    ..., Chronic Pain Grade Scale, and Short Form‐36 Bodily Pain Scale), and finally an arthritis‐specific pain questionnaire (Measure of Intermittent and Constant Osteoarthritis Pain). Composite measures of arthritis symptoms, including pain and associated disability, specifically the Western Ontario and McMaster Universities Osteoarthritis Index and the Arthritis...

  2. A multidisciplinary approach to nonpharmacologic pain management. (United States)

    Golden, Barbara A


    The multidisciplinary pain management team is the optimal method for delivery of comprehensive treatment to patients in pain. The biopsychosocial model of pain considers multiple factors for assessment, diagnosis, and treatment of pain. A structured approach to nonpharmacologic pain management includes medical and psychological interventions to educate and to empower patients to manage pain. Relaxation training, biofeedback, hypnosis, imagery, and cognitive-behavioral therapy are nonpharmacologic treatment modalities recommended by multidisciplinary pain management teams for effective pain control.

  3. Electronic momentary assessment in chronic pain 1: psychological pain responses as predictors of pain intensity

    NARCIS (Netherlands)

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J.J.; Verhaak, P.F.M.; Bensing, J.

    Objectives and Methods: Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent

  4. Pain Scores Are Not Predictive of Pain Medication Utilization

    Directory of Open Access Journals (Sweden)

    Suzanne Galloway


    Full Text Available Objective. To compare Visual Analogue Scale (VAS scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94. We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA or RN administered (intravenous or oral medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management.

  5. Measurement properties of painDETECT by average pain severity

    Directory of Open Access Journals (Sweden)

    Cappelleri JC


    Full Text Available Joseph C Cappelleri,1 E Jay Bienen,2 Vijaya Koduru,3 Alesia Sadosky4 1Pfizer, Groton, CT, 2Outcomes research consultant, New York, NY, 3Eliassen Group, New London, CT, USA; 4Pfizer, New York, NY, USA Background: Since the burden of neuropathic pain (NeP increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. This study evaluated whether painDETECT, a screening questionnaire to identify patients with NeP, can distinguish pain severity. Materials and methods: Subjects (n=614, 55.4% male, 71.8% white, mean age 55.5 years with confirmed NeP were identified during office visits to US community-based physicians. The Brief Pain Inventory – Short Form stratified subjects by mild (score 0–3, n=110, moderate (score 4–6, n=297, and severe (score 7–10, n=207 average pain. Scores on the nine-item painDETECT (seven pain-symptom items, one pain-course item, one pain-irradiation item range from -1 to 38 (worst NeP; the seven-item painDETECT scores (only pain symptoms range from 0 to 35. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory – Short Form (0–10 scale, was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted (age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities mean painDETECT scores. Cumulative distribution functions on painDETECT scores by average pain severity were compared (Kolmogorov–Smirnov test. Cronbach's alpha assessed internal consistency reliability. Results: Unadjusted mean scores were 15.2 for mild, 19.8 for moderate, and 24.0 for severe pain for the nine items, and 14.3, 18.6, and 22.7, respectively, for the seven items. Adjusted nine-item mean scores for mild, moderate, and severe pain were 17.3, 21.3, and 25.3, respectively; adjusted seven-item mean scores were 16.4, 20.1, and 24.0, respectively. All pair

  6. Neuroimaging of chronic pain: phantom limb and musculoskeletal pain. (United States)

    Wiech, K; Preissl, H; Birbaumer, N


    New developments in brain imaging lead to a better understanding of cortical and subcortical processes involved in pain perception and the establishment of chronic pain. For different forms of chronic pain long-term changes in cortical structures have been described. In patients with phantom limb pain and back pain alterations in the somatotopic organization of the primary somatosensory (SI) could be observed. The amount of this reorganization is correlated with the subjective pain rating. These changes, which are based on processes of neuronal plasticity, can partially be reversed by analgesic interventions. For the investigation of cortical processes concerning reorganization, EEG and MEG methods are most suitable because of their high temporal and spatial resolution. In conclusion, these findings open a new way for therapeutic interventions to prevent the development of chronic pain.

  7. Canadian Pain Society Position Statement on Pain Relief

    Directory of Open Access Journals (Sweden)

    Judith H Watt-Watson


    Full Text Available The present report outlines key requirements that are central to helping patients manage pain effectively. Although current standards are available as guides for practice, the prevalence of pain suggests that many health professionals do not know and/or cannot relate to these standards. Therefore, a brief, pragmatic statement may be more useful initially for health professionals and patients learning about problematic pain outcomes. The principles in the brief statement produced by the Canadian Pain Society clarify and emphasize key underlying assumptions that have directed the development of many pain standards. The aim of the present paper is to increase awareness of ineffective pain practices and the importance of pain relief, and to stimulate further work in this area.

  8. Qualitative pain classification in hospice and pain therapy unit. (United States)

    Raffaeli, William; Andruccioli, Jessica; Florindi, Stefania; Ferioli, Isabella; Monterubbianesi, Maria Cristina; Sarti, Donatella; Castellani, Francesca; Giarelli, Guido


    In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram."

  9. Sleep position and shoulder pain. (United States)

    Zenian, John


    The overuse theory for musculoskeletal joint pain cannot explain adequately the occurrence of shoulder pain in those who do not engage in activities that involve repeated and stressful use of the shoulder since the percentage of the painful right shoulders usually does not match the percentage of dominant right arms in such individuals. An alternative hypothesis is presented to propose that shoulder pain is caused by postural immobility in the decubitus or side position during sleep. Prolonged pressure on the shoulder caused by the weight of the thorax can produce enough damage to cause subsequent shoulder pain. In order to test this hypothesis, a preliminary study was carried out to compare the laterality of shoulder pain with the laterality of sleep position. The calculated laterality ratios for sleep position and shoulder pain were found to be strikingly similar, suggesting a causal relationship between the two phenomena. However, the prevalence of shoulder pain in the general population was found to be smaller than the percentage of the time people would spend sleeping in the decubitus position. This discrepancy could be explained by the idea that in order for shoulder pain to develop subjects may have to spend longer times in the same decubitus position before changing to another position than the average person would. Additional evidence from published clinical studies also supports the postural theory of shoulder pain. More studies can be done to test this hypothesis by focusing on the sleep habits of patients with shoulder pain. According to the present hypothesis shoulder pain should for the most part occur on the side that the patient preferred to sleep on before the onset of shoulder pain. The postural theory of shoulder pain provides the possibility for a new and noninvasive method to treat shoulder pain by the modification of posture during sleep. (c) 2009 Elsevier Ltd. All rights reserved.

  10. Successful management of chronic pain syndrome.


    Clifford, J. C.


    Managing patients with chronic pain syndrome can be frustrating and unrewarding. Much of the difficulty experienced when managing these patients stems from an incomplete understanding of pain, especially the difference between acute and chronic pain. Pain theory and treatment of chronic pain syndrome are reviewed. An alternative management strategy for chronic pain syndrome is presented and the literature is reviewed.


    Blažeković, Ivan; Bilić, Ervina; Žagar, Marija; Anić, Branimir


    Complex regional pain syndrome (CRPS) represents a state of constant and often disabling pain, affecting one region (usually hand) and often occurs after a trauma whose severity does not correlate with the level of pain. The older term for this condition of chronic pain associated with motor and autonomic symptoms is reflex sympathetic dystrophy or causalgia. The aim of this review, based on contemporary literature, is to show the epidemiology and etiology, proposed pathophysiological mechanisms, method of diagnosis and treatment options, prevention and mitigation of this under-recognized disease. CRPS I occurs without known neurological damage, unlike CRPS II, where the history of trauma is present and in some cases damage to the peripheral nervous system can be objectively assessed using electromyoneurography. New diagnostic methods, such as quantitative sensory testing (CST), challenge this division because the CST findings in patients with CRPS I can suggest damage to Adelta peripheral nerve fibers. Except for distinguishing type I and type II disease, it is important to bear in mind the diversity of clinical presentation of CRPS in acute and chronic phase of the disease. This regional pain syndrome typically includes the autonomic and motor signs and thus differs from other peripheral neuropathic pain syndromes. The complexity of the clinical presentation indicates the likely presence of different pathophysiological mechanisms underlying this disease. Previous studies have demonstrated the autonomic dysfunction, neurogenic inflammation and neuroplastic changes. The diagnosis of CRPS is based on anamnesis and clinical examination on the basis of which the disease can be graded according to the Budapest Criteria. A valuable aid in differentiating subtypes of the disease is electromyoneurography. The treatment of CRPS is as complex as the clinical picture and the pathophysiology of the disease and requires interdisciplinary cooperation and individual approach

  12. Painful Temporomandibular Disorder (United States)

    Slade, G.D.; Ohrbach, R.; Greenspan, J.D.; Fillingim, R.B.; Bair, E.; Sanders, A.E.; Dubner, R.; Diatchenko, L.; Meloto, C.B.; Smith, S.; Maixner, W.


    In 2006, the OPPERA project (Orofacial Pain: Prospective Evaluation and Risk Assessment) set out to identify risk factors for development of painful temporomandibular disorder (TMD). A decade later, this review summarizes its key findings. At 4 US study sites, OPPERA recruited and examined 3,258 community-based TMD-free adults assessing genetic and phenotypic measures of biological, psychosocial, clinical, and health status characteristics. During follow-up, 4% of participants per annum developed clinically verified TMD, although that was a “symptom iceberg” when compared with the 19% annual rate of facial pain symptoms. The most influential predictors of clinical TMD were simple checklists of comorbid health conditions and nonpainful orofacial symptoms. Self-reports of jaw parafunction were markedly stronger predictors than corresponding examiner assessments. The strongest psychosocial predictor was frequency of somatic symptoms, although not somatic reactivity. Pressure pain thresholds measured at cranial sites only weakly predicted incident TMD yet were strongly associated with chronic TMD, cross-sectionally, in OPPERA’s separate case-control study. The puzzle was resolved in OPPERA’s nested case-control study where repeated measures of pressure pain thresholds revealed fluctuation that coincided with TMD’s onset, persistence, and recovery but did not predict its incidence. The nested case-control study likewise furnished novel evidence that deteriorating sleep quality predicted TMD incidence. Three hundred genes were investigated, implicating 6 single-nucleotide polymorphisms (SNPs) as risk factors for chronic TMD, while another 6 SNPs were associated with intermediate phenotypes for TMD. One study identified a serotonergic pathway in which multiple SNPs influenced risk of chronic TMD. Two other studies investigating gene-environment interactions found that effects of stress on pain were modified by variation in the gene encoding catechol O

  13. Pain-related catastrophizing in pain patients and people with pain in the general population.

    NARCIS (Netherlands)

    Boer, M.J. de; Struys, M.M.; Versteegen, G.J.


    BACKGROUND: Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to

  14. Pain-related catastrophizing in pain patients and people with pain in the general population

    NARCIS (Netherlands)

    de Boer, M. J.; Struys, M. M. R. F.; Versteegen, G. J.

    Background Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to

  15. Interventional therapy for neuropathic pain

    Directory of Open Access Journals (Sweden)

    YANG Yang


    Full Text Available Neuropathic pain (NP is a common clinical refractory pain for which there are limited methods to treat. In this article, based on typical diseases, such as postherpetic neuralgia (PHN, trigeminal neuralgia, complex regional pain syndrome (CRPS, lower back pain with radiculopathy and failed back surgery syndrome (FBSS, phantom pain, the general treatment principle and method for NP are expatiated. Interventional methods for NP, including intraspinal block, radiofrequeney rhizotomy of trigeminal neuralgia, selective nerve root block, spinal cord stimulation (SCS and motor cortex stimulation (MCS are introduced, especially their indications, complications and matters needing attention.

  16. Pain after groin hernia repair

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Nielsen, R


    -90 years, pain was scored (none, light, moderate or severe) at rest, while coughing and during mobilization, daily for the first postoperative week and after 4 weeks. Pain scores were added together over the first postoperative week. RESULTS: On days 1, 6 and 28, 66, 33 and 11 per cent respectively had...... moderate or severe pain while coughing or mobilizing. Total pain scores were higher while coughing or mobilizing than at rest (P mobilizing (P0... between types of surgery or hernia. CONCLUSION: Pain remained a problem despite the pre-emptive use of opioids, non-steroidal anti-inflammatory drugs and local anaesthesia, irrespective of surgical technique....

  17. The burden of chronic pain

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per; Juel, Knud


    sample consisted of 25,000 individuals (≥16 years old) living in Denmark. In all, 60.7% completed a mailed or online questionnaire. Associations were examined with multiple logistic regression analysis. The study population consisted of 14,925 individuals in whom a high prevalence of chronic pain (26......Chronic pain is currently considered a public health problem with high costs to the individual and society. To improve prevention and treatment of chronic pain, epidemiologic studies are mandatory for assessing chronic pain. The aims of this study were to estimate the prevalence of chronic pain...

  18. Knee pain in competitive swimming. (United States)

    Rodeo, S A


    The high volume of training in competitive swimming results in cumulative overload injuries. Knee pain ranks second to shoulder pain as a common complaint in competitive swimmers. Most knee pain occurs on the medial side of the knee and, most commonly, in breaststroke swimmers; however, knee pain may accompany all strokes. This article reviews the incidence of knee pain, the biomechanic and anatomic factors predisposing to injury, specific injury patterns, injury diagnosis, and the treatment and prevention of injury to the knee in swimmers.

  19. Neck pain in different cephalalgias


    E. A. Chechet; G. R. Tabeeva


    The paper reviews the literature related to the investigations of neck pain (cervicalgia) in patients with headache (cephalalgia). Neck pain is second to lower back pain as a reason for considerable socioeconomic damage to society. The prevalence of cervicalgia in the population ranges from 5.9 to 38%; the annual incidence is 10.4–21.3%; 14.2 to 71% of people report to have neck pain at some time in their lifetime. Neck pain is concurrent with cephalalgia in 70% of cases. In patients with cer...

  20. Diagnosis of myofascial pain syndrome. (United States)

    Gerwin, Robert D


    Myofascial pain is one of the most common causes of pain. The diagnosis of myofascial pain syndrome (MPS) is made by muscle palpation. The source of the pain in MPS is the myofascial trigger point, a very localized region of tender, contracted muscle that is readily identified by palpation. The trigger point has well-described electrophysiologic properties and is associated with a derangement of the local biochemical milieu of the muscle. A proper diagnosis of MPS includes evaluation of muscle as a cause of pain, and assessment of associated conditions that have an impact on MPS. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Postmortem stability of Ebola virus. (United States)

    Prescott, Joseph; Bushmaker, Trenton; Fischer, Robert; Miazgowicz, Kerri; Judson, Seth; Munster, Vincent J


    The ongoing Ebola virus outbreak in West Africa has highlighted questions regarding stability of the virus and detection of RNA from corpses. We used Ebola virus-infected macaques to model humans who died of Ebola virus disease. Viable virus was isolated <7 days posteuthanasia; viral RNA was detectable for 10 weeks.

  2. Virus-Vectored Influenza Virus Vaccines


    Tripp, Ralph A.; Tompkins, S. Mark


    Despite the availability of an inactivated vaccine that has been licensed for >50 years, the influenza virus continues to cause morbidity and mortality worldwide. Constant evolution of circulating influenza virus strains and the emergence of new strains diminishes the effectiveness of annual vaccines that rely on a match with circulating influenza strains. Thus, there is a continued need for new, efficacious vaccines conferring cross-clade protection to avoid the need for biannual reformul...

  3. Pain and quality of life. (United States)

    Niv, D; Kreitler, S


    This paper deals with the impact of pain on quality of life (QOL). Two major factors have contributed to the enhanced importance of QOL in recent years: the increasing frequency of pain and the resources devoted to its treatment, and the growing theoretical insight that pain affects the person as a whole. QOL is defined as the person's evaluation of his or her well-being and functioning in different life domains. It is a subjective, phenomenological, multidimensional, dynamic, evaluative, and yet quantifiable, construct. Commonly used scales for its assessment (eg, WHOQOL, SF-36) are described. Studies show that pain affects most domains of QOL, primarily physical and emotional functioning. The effect depends on the extent, duration, acuteness, intensity, affectivity, and meaning of the pain as well as on the underlying disease and the individual's characteristics. QOL is sensitive also to the treatment of pain and treatment modalities, as shown particularly by studies on cancer pain. Pain reduction is not always attended by the expected improvement in QOL. Pain is not synonymous with poor QOL and constitutes only one important factor determining QOL. The main conclusions are that treatment of pain should be multidisciplinary, considering the impact of pain and the treatment on QOL and targetting also improvement of the affected domains of QOL.

  4. Pain evaluation in dairy cattle

    DEFF Research Database (Denmark)

    Gleerup, Karina Charlotte Bech; Andersen, Pia Haubro; Munksgaard, Lene


    Pain compromises the welfare of animals. A prerequisite for being able to alleviate pain is that we are able to recognize it. Potential behavioural signs of pain were investigated for dairy cattle with the aim of constructing a pain scale for use under production conditions. Forty-three cows were...... selected and fifteen different behaviours were scored, subsequently a clinical examination was performed to allocate the cows to a pain and non-pain group. The animals were then treated with an analgesic or a placebo and after a resting period the cows were re-scored by two observers blinded......, piloerection, was also significant but seemed difficult to use as it changed rapidly; p Pain Scale is the sum of the score for the aforementioned behaviours. For each individual animal before and after treatment, it was significantly lower after analgesic treatment (p = 0...

  5. Mild analgesics in postoperative pain. (United States)

    Tammisto, T; Tigerstedt, I


    1 The intensity of postoperative pain is influenced by many factors, for example, individual variation, site of incision and type of operation, anaesthetic technique, and the interval from the end of operation to the appearance of pain. 2 These factors affect the efficacy of analgesics. 3 Mild analgesics provide adequate pain relief in half of our patients in the immediate postoperative phase when the pain is slight to moderate. 4 The maximum effect of mild analgesics corresponds to that produced by morphine 6-10 mg. Adequate analgesia may not therefore be provided for the treatment of severe postoperative pain unless narcotic analgesics have been used peroperatively. 5 When mild analgesics are combined with narcotics synergism is achieved. 6 As postoperative pain decreases with time, mild analgesics usually provide adequate pain relief on the first and following postoperative days.

  6. Trajectories of low back pain

    DEFF Research Database (Denmark)

    Axén, Iben; Leboeuf-Yde, Charlotte


    Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories...... indicates that the low back pain 'episode' is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have...... low back pain, but most have it on and off or persistently. Thus, the low back pain 'condition' is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted...

  7. Management of chronic musculoskeletal pain. (United States)

    Uhl, Richard L; Roberts, Timothy T; Papaliodis, Dean N; Mulligan, Michael T; Dubin, Andrew H


    Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain.

  8. Neurophysiological characterization of postherniotomy pain

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Brandsborg, B.; Christensen, B.


    postoperatively. A quantitative sensory testing protocol was used, assessing sensory dysfunction type, location and severity. We assessed the protocol test-retest variability using data from healthy control subjects. All patients (pain and pain-free) had signs of nerve damage, seen as sensory dysfunction....... Detection thresholds for tactile and warmth stimulation were significantly increased while cold detection and pressure pain detection thresholds were significantly decreased in pain patients compared to controls. Repetitive punctuate and brush stimulation resulted in significantly more frequent and intense......). The specific finding of reduced pain detection threshold over the external inguinal annulus is consistent with damage to the cutaneous innervation territory of nervous structures in the inguinal region. The correspondence between pain location and sensory disturbance suggests that the pain is neuropathic...

  9. Pain in the hip joint

    Directory of Open Access Journals (Sweden)

    Yuri Aleksandrovich Olyunin


    Full Text Available Pathological changes that develop in the hip joints (HJ have different origins and mechanisms of development, but their main manifestation is pain. The nature of this pain cannot be well established on frequent occasions. The English-language medical literature currently classifies such disorders as greater trochanter pain syndrome (GTPS. Its major signs are chronic pain and local palpatory tenderness in the outer part of HJ. The development of GTPS may be associated with inflammation of the synovial bursae situated in the greater tronchanter, as well as with tendinitis, myorrhexis, iliotibial band syndrome, and other local changes in the adjacent tissues or with systemic diseases. So GTPS may be characterized as regional pain syndrome that frequently mimics pain induced by different diseases, including myofascial pain syndrome, osteoarthrosis, spinal diseases, etc.

  10. [Multidisciplinary treatment of orofacial pain]. (United States)

    Geurts, J W; Haumann, J; van Kleef, M


    The diagnosis and treatment of orofacial pain can be complex. The differential diagnosis is very extensive. Therefore, multidisciplinary diagnosis and treatment are often indicated. The diagnosis of chronic pain also entails the investigation of psychological factors. This is because psychological problems can play a role in the chronification of pain, but they can also be a consequence of chronic pain. Patients with persistent orofacial complaints should be seen by a medical team consisting of an oral and maxillofacial surgeon, a neurologist, an anaesthesiologist/pain specialist, a dentist-gnathologist, an orofacial physical therapist, and a psychologist or psychiatrist specialising in orofacial pain. Treatment options should be discussed, taking into account literature concerning their effectiveness. The general conclusion is that much research remains to be done into the causes of, and treatments for, orofacial pain.

  11. A cross-sectional study examining the psychometric properties of the painDETECT measure in neuropathic pain

    Directory of Open Access Journals (Sweden)

    Cappelleri JC


    Full Text Available Joseph C Cappelleri,1 Vijaya Koduru,2 E Jay Bienen,3 Alesia Sadosky41Pfizer Inc, Groton, CT, USA; 2Eliassen Group, New London, CT, USA; 3Outcomes Research Consultant, New York, NY, USA; 4Pfizer Inc, New York, NY, USABackground: Similarities and differences on the nine-item and seven-item versions of painDETECT, a patient-reported screener to identify neuropathic pain (NeP, have not been psychometrically explored across NeP conditions.Methods: Scores on the nine-item painDETECT (seven pain symptom items, one pain course pattern item, one pain radiation item range from -1 to 38; scores ≥19 indicate NeP is likely (>90% probability. The seven-item version (only pain symptoms score range is 0 to 35. painDETECT was administered to subjects with confirmed diagnoses of human immunodeficiency virus-related peripheral NeP (HIVP (n=103, spinal cord injury-related NeP (SCI (n=103, small fiber neuropathy (n=100, painful diabetic peripheral neuropathy (n=112, posttrauma/postsurgical NeP (n=100, and NeP in chronic low back pain (n=106 identified during office visits to US community-based physicians. Analysis of covariance compared mean scores (adjusted for age, sex, race, ethnicity, time since NeP diagnosis, and number of comorbidities on the nine-item and seven-item versions of painDETECT. Cronbach's alpha assessed internal consistency reliability, and corrected item-to-total correlations assessed item-level discrimination.Results: The adjusted mean nine-item scores ranged from 21.0 (SCI to 24.3 (small fiber neuropathy. Differences between conditions were either trivial or small-to-medium in magnitude. Cronbach's alpha gave overall internal consistency reliability of 0.76, with a range of 0.63 (SCI to 0.82 (HIVP. Mean scores and Cronbach's alphas for the seven-item version were generally similar to the nine-item version. Corrected item-to-total correlations adequately discriminated all pain symptom items on both painDETECT versions for each condition (0.3

  12. Electrotherapy for neck pain. (United States)

    Kroeling, Peter; Gross, Anita; Graham, Nadine; Burnie, Stephen J; Szeto, Grace; Goldsmith, Charles H; Haines, Ted; Forget, Mario


    Neck pain is common, disabling and costly. The effectiveness of electrotherapy as a physiotherapeutic option remains unclear. This is an update of a Cochrane review first published in 2005 and previously updated in 2009. This systematic review assessed the short, intermediate and long-term effects of electrotherapy on pain, function, disability, patient satisfaction, global perceived effect, and quality of life in adults with neck pain with and without radiculopathy or cervicogenic headache. We searched CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to August 2012; handsearched relevant conference proceedings; and consulted content experts. Randomized controlled trials (RCTs), in any language, investigating the effects of electrotherapy used primarily as unimodal treatment for neck pain. Quasi-RCTs and controlled clinical trials were excluded. We used standard methodological procedures expected by The Cochrane Collaboration. We were unable to statistically pool any of the results, but we assessed the quality of the evidence using an adapted GRADE approach. Twenty small trials (1239 people with neck pain) containing 38 comparisons were included. Analysis was limited by trials of varied quality, heterogeneous treatment subtypes and conflicting results. The main findings for reduction of neck pain by treatment with electrotherapeutic modalities were as follows.Very low quality evidence determined that pulsed electromagnetic field therapy (PEMF) and repetitive magnetic stimulation (rMS) were more effective than placebo, while transcutaneous electrical nerve stimulation (TENS) showed inconsistent results.Very low quality evidence determined that PEMF, rMS and TENS were more effective than placebo.Low quality evidence (1 trial, 52 participants) determined that permanent magnets (necklace) were no more effective than placebo (standardized mean difference (SMD) 0.27, 95% CI -0.27 to 0.82, random-effects model

  13. Pain, Affect, and Attachment

    Directory of Open Access Journals (Sweden)

    Carl Eduard Scheidt


    Full Text Available Various psychodynamic processes may underlie the development of psychogenic pain disorder such as conversion, the displacement of affect, or narcissistic defenses. However, many of the processes suggested are related to a disorder of affect regulation. The term affect regulation in psychoanalytic literature refers to phenomena which are often described by the concept of alexithymia. Empirical observations suggest that alexithymia is correlated to insecure attachment, especially an insecure dismissing representation of attachment. Psychodynamic psychotherapy in psychogenic pain disorder should focus on the reintegration of split-off affects which may provoke intensive counter-transference and which in order to be used therapeutically must be linked to attachment experiences within and outside of the therapeutic relationship.

  14. Multidisciplinary pain facility treatment outcome for pain-associated fatigue. (United States)

    Fishbain, David A; Lewis, John; Cole, Brandly; Cutler, Brian; Smets, Eve; Rosomoff, Hubert; Rosomoff, Rennee Steele


    Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. A total of 85 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory on admission. In addition, an information tool was completed on each CPP by the senior author. This tool listed demographic information, primary and secondary pain diagnoses, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric diagnoses assigned, pain location, pain precipitating event, type of injury, years in pain, number of surgeries, type of surgery, type of pain pattern, opioids consumed per day in morphine equivalents, worker compensation status, and whether, according to the clinical examination, the CPP had a neuropathic pain component. At completion of the multidisciplinary multimodal treatment, each CPP again completed the MFI. Student's t-test was utilized to test for statistical changes on the MFI five scales from pre- to post-treatment. Pearson and point-biserial correlations were utilized to determine which variables significantly correlated with MFI change scores. Variables found significant at less than or equal to 0.01 were utilized in a stepwise aggression analysis to find variables predictive of change in MFI scores. Multidisciplinary pain facility. Chronic LBP and chronic neck pain patients. Multidisciplinary multimodal treatment significantly improved CPP fatigue as measured by the MFI. The available variables utilized to predict fatigue best explained only a small percentage

  15. Anterior knee pain. (United States)

    LLopis, Eva; Padrón, Mario


    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  16. Anterior knee pain

    Energy Technology Data Exchange (ETDEWEB)

    LLopis, Eva [Hospital de la Ribera, Alzira, Valencia (Spain) and Carretera de Corbera km 1, 46600 Alzira Valencia (Spain)]. E-mail:; Padron, Mario [Clinica Cemtro, Ventisquero de la Condesa no. 42, 28035 Madrid (Spain)]. E-mail:


    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  17. Neck Pain following Laminoplasty


    Mesfin, Addisu; Park, Moon-Soo; Piyaskulkaew, Chaiwat; Chuntarapas, Tapanut; Song, Kwang Sup; Kim, Han Jo; Riew, K. Daniel


    Study Design?Retrospective evaluation of prospectively collected data. Objective?To compare preoperative and postoperative neck pain following laminoplasty using the Neck Disability Index (NDI). Methods?Seventy-two patients undergoing laminoplasty from 2006 to 2009 at a single institution were identified. Thirty-four patients with a minimum 1-year follow-up who completed preoperative, 6-week, and 1-year postoperative NDI questionnaires were enrolled. Demographic data and surgical data includi...

  18. Happy Despite Pain (United States)

    Smeets, Elke; Feijge, Marion; van Breukelen, Gerard; Andersson, Gerhard; Buhrman, Monica; Linton, Steven J.


    Objectives: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive-behavioral program. Materials and Methods: A randomized controlled trial was carried out with 3 conditions: an internet-delivered positive psychology program, an internet-delivered cognitive-behavioral program and waitlist control. A total of 276 patients were randomized to 1 of the 3 conditions and posttreatment data were obtained from 206 patients. Primary outcomes were happiness, depression, and physical impairments at posttreatment and at 6-month follow-up. Intention-to-treat analyses were carried out using mixed regression analyses. Results: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared with waitlist. Improvements in happiness and depression were maintained until 6-month follow-up. There were no overall differences in the efficacy of the 2 active interventions but effects seemed to be moderated by education. Patients with a higher level of education profited slightly more from the positive psychology intervention than from the cognitive-behavioral program. Discussion: The results suggest that an internet-based positive psychology and cognitive-behavioral self-help interventions for the management of chronic pain are clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs. PMID:28379873

  19. Pain Management Task Force (United States)


    increased infection, tumor spread or recurrence. Muscular Muscle weakness, limitation of movement, muscle atrophy, fatigue . Psychological Anxiety, Primary Care: A Cluster Randomized Trial. JAMA . 2009;301(12):1242-1252. Dowden S, McCarthy M, and Chalkiadis G. (2008). Achieving Primary Care Patients With Depression and Musculoskeletal Pain JAMA . 2009;301(20):2099-2110. Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cif DX

  20. [Chronic myofacial pain. Reduced pain through psychoeducation and physiotherapy]. (United States)

    Jochum, H; Baumgartner-Gruber, A; Brand, S; Zeilhofer, H-F; Keel, P; Leiggener, C S


    Psychological factors are associated with the emergence and persistence of pain perception. The aim of this pilot study was to assess the psychological factors relating to pain perception in patients with chronic myofacial pain and to investigate the influence of patient information, education and physiotherapy on pain perception and functional jaw opening examined over a 6-month period. In accordance with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), 40 patients (31 females and 9 males, mean age 38.6 years) with chronic myofacial pain were assessed at 3 time points: on admission (T1), after 3 months (T2) and 6 months (T3). The study included a structured interview and five psychological questionnaires. At all time points patients were informed about the development of pain and the relationship between chronification of pain and psychological risk factors. After 6 months significant improvements in jaw function and quality of life, as well as a decrease in psychological parameters, such as fear and depression were found. Improvement was related to the severity of pain chronification. The results show the necessity of early identification of patients with severe pain chronification and the need for psychological pain therapy.

  1. DNA Virus Replication Compartments (United States)

    Schmid, Melanie; Speiseder, Thomas; Dobner, Thomas


    Viruses employ a variety of strategies to usurp and control cellular activities through the orchestrated recruitment of macromolecules to specific cytoplasmic or nuclear compartments. Formation of such specialized virus-induced cellular microenvironments, which have been termed viroplasms, virus factories, or virus replication centers, complexes, or compartments, depends on molecular interactions between viral and cellular factors that participate in viral genome expression and replication and are in some cases associated with sites of virion assembly. These virus-induced compartments function not only to recruit and concentrate factors required for essential steps of the viral replication cycle but also to control the cellular mechanisms of antiviral defense. In this review, we summarize characteristic features of viral replication compartments from different virus families and discuss similarities in the viral and cellular activities that are associated with their assembly and the functions they facilitate for viral replication. PMID:24257611

  2. Viruses of the Archaea

    DEFF Research Database (Denmark)

    Basta, T.; Garrett, Roger Antony; Prangishvili,, David


    Double-stranded deoxyribonucleic acid (DNA) viruses that infect members of the third domain of life, the Archaea, are diverse and exceptional in both their morphotypes and their genomic properties. The majority of characterized species infect hyperthermophilic hosts and carry morphological features...... which have not been observed for viruses from the other domains of life, the Bacteria and the Eukarya. This exceptional status of the archaeal viruses is reinforced by the finding that a large majority of their predicted genes yield no sequence matches in public sequence databases, and their functions...... remain unknown. One of the viruses, the bicaudavirus ATV (Acidianus two-tailed virus), is quite unique in that it undergoes a major morphological change, growing long tail structures, extracellularly. A small minority of archaeal viruses, which exclusively infect mesophilic or moderately thermophilic...

  3. Constructing computer virus phylogenies

    Energy Technology Data Exchange (ETDEWEB)

    Goldberg, L.A. [Warwick Univ., Coventry (United Kingdom) Dept. of Computer Science; Goldberg, P.W. [Aston Univ., Birmingham (United Kingdom) Dept. of Applied Mathematics; Phillips, C.A. [Sandia National Labs., Albuquerque, NM (United States); Sorkin, G.B. [International Business Machines Corp., Yorktown Heights, NY (United States). Thomas J. Watson Research Center


    There has been much recent algorithmic work on the problem of reconstructing the evolutionary history of biological species. Computer virus specialists are interested in finding the evolutionary history of computer viruses--a virus is often written using code fragments from one or more other viruses, which are its immediate ancestors. A phylogeny for a collection of computer viruses is a directed acyclic graph whose nodes are the viruses and whose edges map ancestors to descendants and satisfy the property that each code fragment is ``invented`` only once. To provide a simple explanation for the data, we consider the problem of constructing such a phylogeny with a minimal number of edges. In general, this optimization problem cannot be solved in quasi-polynomial time unless NQP=QP; we present positive and negative results for associated approximated problems. When tree solutions exist, they can be constructed and randomly sampled in polynomial time.

  4. Zika virus infection. (United States)

    Pougnet, Laurence; Thill, Chloé; Pougnet, Richard; Auvinet, Henri; Giacardi, Christophe; Drouillard, Isabelle


    A 21-year old woman from New-Caledonia had 40 ̊C fever with vomiting, arthralgia, myalgia, and measles-like rash. Etiological analyses showed primary infection with Zika virus. Because of severe clinical presentation, she was hospitalized in the intensive care unit of the Brest military Hospital. Zika virus is mainly transmitted by Aedes mosquitoes. If they settle in Metropolitan France, Zika virus might also spread there.

  5. Personal computer viruses

    Energy Technology Data Exchange (ETDEWEB)

    Cremonesi, C.; Martella, G. (Milan Univ. (Italy). Dipt. di Scienza dell' Informazione)


    This article reveals the origin and nature of what is known as the 'computer virus'. For illustrative purposes, the most common types of computer viruses are described and classified; the relative contagion and damage mechanisms are analyzed. Then techniques are presented to assist wary users in detecting and removing viruses, as well as, in protecting their computer systems from becoming contaminated.

  6. Electron microscopy of viruses. (United States)

    Laue, Michael


    Electron microscopy is widely used in virology because viruses are generally too small for a direct inspection by light microscopy. Analysis of virus morphology is necessary in many circumstances, e.g., for the diagnosis of a virus in particular clinical situations or the analysis of virus entry and assembly. Moreover, quality control of virus particle integrity is required if a virus is propagated in cell culture, particularly if the virus genome has changed. In most cases already the basic methodology for transmission electron microscopy, i.e., negative staining and ultrathin sectioning, is sufficient to give relevant information on virus ultrastructure. This chapter gives detailed information on the principles of these basic methodologies and provides simple but reliable protocols for a quick start. Moreover, the description of standard protocols for negative staining and ultrathin sectioning are supplemented by protocols on immuno-negative staining and rapid ultrathin sectioning. Finally, principles of methods for an extended ultrastructural research using more elaborate techniques, such as cryotechniques or methods to reveal the three-dimensional virus architecture, are briefly reviewed. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Viruses infecting marine molluscs. (United States)

    Arzul, Isabelle; Corbeil, Serge; Morga, Benjamin; Renault, Tristan


    Although a wide range of viruses have been reported in marine molluscs, most of these reports rely on ultrastructural examination and few of these viruses have been fully characterized. The lack of marine mollusc cell lines restricts virus isolation capacities and subsequent characterization works. Our current knowledge is mostly restricted to viruses affecting farmed species such as oysters Crassostrea gigas, abalone Haliotis diversicolor supertexta or the scallop Chlamys farreri. Molecular approaches which are needed to identify virus affiliation have been carried out for a small number of viruses, most of them belonging to the Herpesviridae and birnaviridae families. These last years, the use of New Generation Sequencing approach has allowed increasing the number of sequenced viral genomes and has improved our capacity to investigate the diversity of viruses infecting marine molluscs. This new information has in turn allowed designing more efficient diagnostic tools. Moreover, the development of experimental infection protocols has answered some questions regarding the pathogenesis of these viruses and their interactions with their hosts. Control and management of viral diseases in molluscs mostly involve active surveillance, implementation of effective bio security measures and development of breeding programs. However factors triggering pathogen development and the life cycle and status of the viruses outside their mollusc hosts still need further investigations. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Yeast for virus research (United States)

    Zhao, Richard Yuqi


    Budding yeast (Saccharomyces cerevisiae) and fission yeast (Schizosaccharomyces pombe) are two popular model organisms for virus research. They are natural hosts for viruses as they carry their own indigenous viruses. Both yeasts have been used for studies of plant, animal and human viruses. Many positive sense (+) RNA viruses and some DNA viruses replicate with various levels in yeasts, thus allowing study of those viral activities during viral life cycle. Yeasts are single cell eukaryotic organisms. Hence, many of the fundamental cellular functions such as cell cycle regulation or programed cell death are highly conserved from yeasts to higher eukaryotes. Therefore, they are particularly suited to study the impact of those viral activities on related cellular activities during virus-host interactions. Yeasts present many unique advantages in virus research over high eukaryotes. Yeast cells are easy to maintain in the laboratory with relative short doubling time. They are non-biohazardous, genetically amendable with small genomes that permit genome-wide analysis of virologic and cellular functions. In this review, similarities and differences of these two yeasts are described. Studies of virologic activities such as viral translation, viral replication and genome-wide study of virus-cell interactions in yeasts are highlighted. Impacts of viral proteins on basic cellular functions such as cell cycle regulation and programed cell death are discussed. Potential applications of using yeasts as hosts to carry out functional analysis of small viral genome and to develop high throughput drug screening platform for the discovery of antiviral drugs are presented. PMID:29082230

  9. Pain determinants of pain in autosomal dominant polycystic kidney disease

    Directory of Open Access Journals (Sweden)

    José Luiz Nishiura


    Full Text Available Pain is the most common symptom reported by ADPKD patients, afflicting approximately 60% of cases and may result from renal hemorrhage, calculi, urinary tract infections, cyst rupture, or due to stretching of the capsule or traction of the renal pedicle. We have recently investigated pain patterns in AD-PKD patients using a translated version of a pain questionnaire specific for AD-PKD population. The questionnaire revealed that 67% patients with ADPKD exhibited some type of pain. The findings of that study emphasized that pain appeared early in the course of ADPKD, when patients still exhibited preserved renal function. In the present study, a multivariate logistic regression analysis disclosed that renal volume (9-fold increased risk and nephrolithiasis (4-fold increased risk were the most important determinant factors for pain in ADPKD patients with preserved renal function, after adjustments for the presence of hypertension and duration of the disease.

  10. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M


    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

  11. Integrative medicine for chronic pain (United States)

    Saha, Felix J.; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger


    Abstract Introduction: Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods: Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients’ pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results: A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction. PMID:27399133

  12. Pain: history, culture and philosophy. (United States)

    Khan, Murad Ahmad; Raza, Fauzia; Khan, Iqbal Akhtar


    Pain, one of the universals of existence, has a long and venerable history, its origin initially attributed to godly punishment for disbelievers; and, with improved understanding, to physical and psycho-social factors. "Pain is emotion or sensation?" has been a debatable issue. Razes developed pleasure-pain theory, founded on the theories of Socrates, Plato, Aristotle and Epicurus. Descartes' Dualism shifted the centre of pain from the heart to the brain but negated the psychological contribution to its pathogenesis. Gate Control Theory, fascinated with the idea of "neurological gates", highlighted the important role of the brain in dealing with the messages received. The International Association of the Study of Pain, in 1979, coined a definition of pain which is currently in use and was last updated on 6th October 2014. Its validity has been challenged and a new definition has been suggested. Whereas the experience is personalized, immeasurable and unsharable, different cultural groups react differently to pain from relative tolerance to over-reaction. Gender and ethnic differences in the perception of pain are well proven and the effects of various religious beliefs adequately scored. Despite extensive research over centuries, understanding of pain mechanisms is still far from optimal. Untiring efforts to identify a paincentre in the brain have been futile. Had it been possible, millions of pain sufferers would have been relieved of their physical agony and mental anguish by the prick of needle.

  13. Advanced dementia pain management protocols. (United States)

    Montoro-Lorite, Mercedes; Canalias-Reverter, Montserrat


    Pain management in advanced dementia is complex because of neurological deficits present in these patients, and nurses are directly responsible for providing interventions for the evaluation, management and relief of pain for people suffering from this health problem. In order to facilitate and help decision-makers, pain experts recommend the use of standardized protocols to guide pain management, but in Spain, comprehensive pain management protocols have not yet been developed for advanced dementia. This article reflects the need for an integrated management of pain in advanced dementia. From the review and analysis of the most current and relevant studies in the literature, we performed an approximation of the scales for the determination of pain in these patients, with the observational scale PAINAD being the most recommended for the hospital setting. In addition, we provide an overview for comprehensive management of pain in advanced dementia through the conceptual framework «a hierarchy of pain assessment techniques by McCaffery and Pasero» for the development and implementation of standardized protocols, including a four-phase cyclical process (evaluation, planning/performance, revaluation and recording), which can facilitate the correct management of pain in these patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  14. Comparison of pain, disorder, back performance, and psychological factors in patients with low back pain and radicular pain. (United States)

    Kim, Seunghwan; Kim, Jung Hyun; Kim, You Lim; Lee, Suk Min


    [Purpose] This study investigated the relationship between pain intensity, lumber disability, and psychological factors in patients with low back pain. [Subjects and Methods] A total of 166 outpatients (116 female, 50 male) with chronic low back pain presenting for physical therapy participated in this study. Patients were divided into two groups: those with low back pain alone and those with both low back pain and radicular pain. Pain intensity and lumbar disability were measured using a visual analogue scale and the Roland-Morris Disability Questionnaire. Psychological factors, such as self-efficiency, fear avoidance, and depression were measured using the Chronic Pain Self-efficacy Scale, Fear-Avoidance Beliefs Questionnaire, and Beck Depression Index, respectively. [Results] Patients with low back pain with radicular pain had greater pain and lumber disability and lower psychological factors compared with patients with chronic low back pain alone. [Conclusion] Our findings indicate the presence of low back pain with radicular pain is more related to pain, LBP disability index, Back performance, Self-efficiency (Pain, Function, Symptom), Fear-avoidance (body, work) and depression factors than low back pain. Considering the relationships between in pain, LBP disability index, Back performance, Self-efficiency (Pain, Function, Symptom), Fear-avoidance (body, work) and depression factors in patients with low back pain, therapeutic intervention for not only pain and dysfunction, but also psychological factors is needed.

  15. Pain tolerance and pain perception in adolescents born extremely preterm. (United States)

    Vederhus, Bente Johanne; Eide, Geir Egil; Natvig, Gerd Karin; Markestad, Trond; Graue, Marit; Halvorsen, Thomas


    Neonatal pain experiences have been associated with altered processing and perception of pain in later life, but findings tend to vary among studies. We have compared experimental pain tolerance and subjective health complaints in a population-based cohort of adolescents born extremely preterm to that of matched term controls. Subjects performed a standardized cold pressor task (hand in ice water) and completed validated questionnaires regarding current subjective health complaints, including pain issues. Thirty-one (89%) of 35 eligible preterm subjects (mean gestational age 26.8 weeks) and 28 (80%) term controls participated in this follow-up study at mean age 17.8 years. Ten (32%) subjects born preterm versus 17 (61%) born at term reached the ceiling time of 180 seconds immersion time in the ice water, a hazard ratio for early withdrawal of 2.05 (95% confidence interval, 1.72 to 2.44), with males explaining most of the difference. For subjects born preterm, the risk of early withdrawal decreased significantly with more days of mechanical ventilation, more pain events, and more doses of morphine during the newborn period. Subjective pain ratings during the cold pressor task as well as health-related complaints and pain issues reported in the questionnaires were similar in the preterm and term groups. Despite reduced tolerance to experimental pain, subjects born preterm scored their pain experiences similarly to those of term controls. Surprisingly, preterm subjects exposed to most painful and invasive neonatal experiences and also to most doses of morphine had a pain response at follow-up most closely resembling that of the control group. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

  16. Pain in hospitalized HIV-positive patients: clinical and therapeutical issues

    Directory of Open Access Journals (Sweden)

    Elisa Miranda Aires

    Full Text Available Pain is frequently reported by patients infected with Acquired Immunodeficiency Virus (HIV, and its causes and specific treatment should be appropriately investigated. We evaluated 197 hospitalized HIV-positive patients with serial interviews and analysis of prescriptions and clinical evolution charts. The main characteristics of pain reported by these patients were: high intensity (60.7%, high frequency (72.0% and well-known causes (88.8%. Fifty-two per cent of the patients reported persistent or frequent pain during the two weeks before hospital admission. Parameters such as gender, educational level and Karnofsky Index showed no direct relation to the presence or absence of pain. The most commonly affected sites were the head (28.0% and the abdomen (26.2%. The frequency of indications of pain in the clinical evolution charts (46.2% was considerably lower than the frequency of complaints reported by patients during the interviews (76.3%. Pain was undertreated in 83.2% of patients, both due to poor efficacy of the prescribed medications and to the excessive and inefficient use of standing order ("if necessary" regimens. We observed that pain was better managed during the hospitalization period, although this cannot be explained by improvement of the analgesic treatment; it might be due to successful treatment of the underlying disease. We concluded that pain reported by hospitalized HIV-positive patients is often underestimated and inadequately treated by assisting doctors, in spite of its severity and frequency.

  17. Situational but Not Dispositional Pain Catastrophizing Correlates With Early Postoperative Pain in Pain-Free Patients Before Surgery. (United States)

    Grosen, Kasper; Drewes, Asbjørn Mohr; Pilegaard, Hans Kristian; Pfeiffer-Jensen, Mogens; Brock, Birgitte; Vase, Lene


    Pain catastrophizing may be assessed as a dispositional measure using a previous painful experience as a reference or as a situational measure using an actual ongoing pain as a reference. The latter has shown more robust correlations with pain-related outcomes; the relative influence of dispositional and situational pain catastrophizing remains unknown in relation to populations with no pain before surgery. Forty-two consecutive patients who underwent corrective surgery for funnel chest were asked to complete the Pain Catastrophizing Scale with reference to 1) a previous painful experience (dispositional pain catastrophizing), 2) experimental pain during a 2-minute cold pressor test (situational experimental pain catastrophizing), and 3) clinical pain 3 days after surgery (situational clinical pain catastrophizing) to investigate whether these measures predicted immediate pain intensity and unpleasantness in the early postoperative period. Thirty-four patients were available for analyses. Dispositional pain catastrophizing was unrelated to situational experimental and situational clinical pain catastrophizing and to postoperative pain and unpleasantness (P > .05). In contrast, the 2 situation-specific pain catastrophizing measures were strongly associated (ρ = .59, P = .0002). In analyses adjusted for preoperative anxiety, depression, and cold pressor pain sensitivity, situational experimental and situational clinical pain catastrophizing correlated with postoperative movement-evoked pain (β = 1.36, P = .01 and β = 1.24, P = .02, respectively) and unpleasantness (β = 1.32, P = .01 and β = 1.36, P = .01, respectively). Pain catastrophizing should be captured in relation to specific painful events in otherwise healthy patients. Future studies might benefit from assessing situational pain catastrophizing to identify patients at risk for increased postoperative pain to optimize stratified pain treatment. Copyright © 2016 American Pain Society

  18. Noradrenaline increases pain facilitation from the brain during inflammatory pain. (United States)

    Martins, I; de Vries, M G; Teixeira-Pinto, A; Fadel, J; Wilson, S P; Westerink, B H C; Tavares, I


    Antidepressants that inhibit the recapture of noradrenaline have variable effects in chronic pain which may be related to the complex role of noradrenaline in pain modulation. Whereas at the spinal cord noradrenaline blocks nociceptive transmission, both antinociception and pronociception were reported after noradrenaline release in the brain. To study the role of noradrenaline in pain modulatory areas of the brain, we elected the dorsal reticular nucleus (DRt), a key pain facilitatory area located at the medulla oblongata. Three studies were performed. First, we show that the infusion in the DRt of nomifensine, which increases local extracellular levels of noradrenaline as shown by in vivo microdialysis, also enhances pain behavioral responses during both phases of the formalin test, a classic inflammatory pain model. Then, we demonstrate that the formalin test triggers the release of noradrenaline in the DRt in a biphasic pattern that matches the two phases of the test. Finally, we show that reducing noradrenaline release into the DRt, using an HSV-1 vector which decreases the expression of tyrosine hydroxylase in noradrenergic DRt-projecting neurons, attenuates pain behavioral responses in both phases of the formalin test. The increased noradrenaline levels induced by the infusion of nomifensine at the DRt, along with the hyperalgesic effects of noradrenaline released at the DRt upon noxious stimulation, indicates that noradrenaline may enhance pain facilitation from the brain. It is important to evaluate if antidepressants that inhibit noradrenaline recapture enhance pain facilitation from the brain herein attenuating their analgesic effects. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Beyond Acute Pain: Understanding Chronic Pain in Infancy

    Directory of Open Access Journals (Sweden)

    Miranda DiLorenzo


    Full Text Available This topical review presents the current challenges in defining chronic pain in infants, summarizes evidence from animal and human infant studies regarding the biological processes necessary for chronic pain signaling, and presents observational/experiential evidence from clinical experts. A literature search of four databases (CINAHL, EMBASE, PsycINFO, and MEDLINE was conducted, along with hand searches of reference lists. Evidence from animal studies suggest that important neurophysiological mechanisms, such as the availability of key neurotransmitters needed for maintenance of chronic pain, may be immature or absent in the developing neonate. In some cases, human infants may be significantly less likely to develop chronic pain. However, evidence also points to altered pain perception, such as allodynia and hyperalgesia, with significant injury. Moreover, clinicians and parents in pediatric intensive care settings describe groups of infants with altered behavioral responses to repeated or prolonged painful stimuli, yet agreement on a working definition of chronic pain in infancy remains elusive. While our understanding of infant chronic pain is still in the rudimentary stages, a promising avenue for the future assessment of chronic pain in infancy would be to develop a clinical tool that uses both neurophysiological approaches and clinical perceptions already presented in the literature.

  20. Chronic pain management: nonpharmacological therapies for chronic pain. (United States)

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried


    Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Although these can be used as stand-alone therapies, nonpharmacologic treatments often are used to augment and complement pharmacologic treatments (ie, multimodal therapy). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence. Clinicians should become familiar with these interventions so that they can offer patients flexibility in the pain management approach. Effective noninvasive treatment modalities for CP include behavioral therapy for short-term pain relief; cognitive behavioral therapy for reducing long-term pain and disability; hypnosis as adjunctive therapy; guided imagery, diaphragmatic breathing, and muscle relaxation, especially for cancer-related pain; mindfulness-based stress reduction for patients with chronic low back pain; acupuncture for multiple pain conditions; combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain; animal-assisted therapy; and S-adenosyl-L-methionine for joint pain. Guidelines for use of these treatment modalities are based on expert panel recommendations in combination with data from randomized controlled trials. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  1. Pain without Nociceptors? Nav1.7-Independent Pain Mechanisms (United States)

    Minett, Michael S.; Falk, Sarah; Santana-Varela, Sonia; Bogdanov, Yury D.; Nassar, Mohammed A.; Heegaard, Anne-Marie; Wood, John N.


    Summary Nav1.7, a peripheral neuron voltage-gated sodium channel, is essential for pain and olfaction in mice and humans. We examined the role of Nav1.7 as well as Nav1.3, Nav1.8, and Nav1.9 in different mouse models of chronic pain. Constriction-injury-dependent neuropathic pain is abolished when Nav1.7 is deleted in sensory neurons, unlike nerve-transection-related pain, which requires the deletion of Nav1.7 in sensory and sympathetic neurons for pain relief. Sympathetic sprouting that develops in parallel with nerve-transection pain depends on the presence of Nav1.7 in sympathetic neurons. Mechanical and cold allodynia required distinct sets of neurons and different repertoires of sodium channels depending on the nerve injury model. Surprisingly, pain induced by the chemotherapeutic agent oxaliplatin and cancer-induced bone pain do not require the presence of Nav1.7 sodium channels or Nav1.8-positive nociceptors. Thus, similar pain phenotypes arise through distinct cellular and molecular mechanisms. Therefore, rational analgesic drug therapy requires patient stratification in terms of mechanisms and not just phenotype. PMID:24440715

  2. Pain without Nociceptors? Nav1.7-Independent Pain Mechanisms

    Directory of Open Access Journals (Sweden)

    Michael S. Minett


    Full Text Available Nav1.7, a peripheral neuron voltage-gated sodium channel, is essential for pain and olfaction in mice and humans. We examined the role of Nav1.7 as well as Nav1.3, Nav1.8, and Nav1.9 in different mouse models of chronic pain. Constriction-injury-dependent neuropathic pain is abolished when Nav1.7 is deleted in sensory neurons, unlike nerve-transection-related pain, which requires the deletion of Nav1.7 in sensory and sympathetic neurons for pain relief. Sympathetic sprouting that develops in parallel with nerve-transection pain depends on the presence of Nav1.7 in sympathetic neurons. Mechanical and cold allodynia required distinct sets of neurons and different repertoires of sodium channels depending on the nerve injury model. Surprisingly, pain induced by the chemotherapeutic agent oxaliplatin and cancer-induced bone pain do not require the presence of Nav1.7 sodium channels or Nav1.8-positive nociceptors. Thus, similar pain phenotypes arise through distinct cellular and molecular mechanisms. Therefore, rational analgesic drug therapy requires patient stratification in terms of mechanisms and not just phenotype.

  3. Descriptive Study of a Military Pain Clinic (United States)


    pain syndromes (Wu & Grzesiak, 1987). The clinic generally accepts only patients with all types of pain syndromes lasting greater than six...Dystrophy (RSD) 2 4 Sciatic pain 2 4 Disseminated Varicella I 2 Myofascial pain I 2 Pathologic Rib Fracture I 2 RCM pain I 2 Rt sided pain I 2 Sickle...Philadelphia: W.B. Saunders Co. Clifford, J.C. (1993) . Successful management of chronic pain syndrome . Canadian Family Physician. 39. (3), 549- 559.

  4. Diagnosis and treatment of abnormal dental pain


    Fukuda, Ken-ichi


    Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, ...

  5. Intrathecal ziconotide for refractory pain. (United States)

    Doggrell, Sheila A


    For cancer and AIDS patients, 10-30% of pain is refractory to strong opioids, requiring intraspinal administration for pain management. Ziconotide is a selective N-type calcium channel blocker, which inhibits neurotransmitter release, and following intrathecal administration will affect primary nociceptive afferents. In 108 patients with previously unmanaged refractory pain despite the use of systemic or intrathecal opioids, in the initial titration phase, the mean Visual Analogue Scale of Pain Intensity scores improved more in the ziconotide group (53%) than the placebo group (18%). Serious adverse effects were more common in the ziconotide group (31%) than placebo group (10%) in the initial titration phase. In the 48 patients receiving ziconotide, who proceeded to the maintenance phase, the benefit of ziconotide was continued. Until a new approach with a better effectiveness/adverse effects profile than ziconotide for refractory pain emerges, further optimisation of ziconotide for use in the treatment of refractory pain should be undertaken.

  6. [Neurosurgical treatment of chronic pain]. (United States)

    Fontaine, D; Blond, S; Mertens, P; Lanteri-Minet, M


    Neurosurgical treatment of pain used two kind of techniques: 1) Lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (drezotomy, cordotomy, tractotomy…). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain. 2) Neuromodulation techniques try to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation…) is used to treat chronic neuropathic pain. Intrathecal infusion of analgesics (morphine, ziconotide…), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, selected patients with severe and chronic pain, refractory to all other treatments. The quality of the analgesic outcome depends on the relevance of the indications. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  7. Pain Management in Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Michael Erdek


    Full Text Available A majority of pancreatic cancer patients present with pain at the time of diagnosis. Pain management can be challenging in light of the aggressive nature of this cancer. Apart from conventional pharmacotherapy, timely treatment with neurolytic celiac plexus block (NCPB has been shown to be of benefit. NCPB has demonstrated efficacious pain control in high quality studies with analgesic effects lasting one to two months. NCPB has also shown to decrease the requirements of narcotics, and thus decrease opioid related side effects. Another option for the control of moderate to severe pain is intrathecal therapy (IT. Delivery of analgesic medications intrathecally allows for lower dosages of medications and thus reduced toxicity. Both of the above mentioned interventional procedures have been shown to have low complication rates, and be safe and effective. Ultimately, comprehensive pancreatic cancer pain management necessitates understanding of pain mechanisms and delivery of sequential validated therapeutic interventions within a multidisciplinary patient care model.

  8. [Low back pain during gestation]. (United States)

    Novaes, Flavia Silva; Shimo, Antonieta Keiko Kakuda; Lopes, Maria Helena Baena de Moraes


    This research qualitatively analyzed the contents of national and international scientific publications, indexed in the period from 1999 to 2005, about low back pain in gestation. Around 50 % of pregnant women complain about low back pain. The physiologic modifications that occur happen in pregnancy alter the posture of pregnant women and the largest incidence of low back pain usually happens in the last three months. Specific causes remain unknown. However, treatment involves analgesics, antiphlogistics, exercises and physiotherapy. Low back pain during gestation is a symptom that causes great discomfort and, depending on the level of pain, it generates motor disability and impairs daily activities, besides causing problems to take care of the baby after birth. Some discomfort of low back pain can continue for a period of up to three years after childbirth. We see a great need for further research in this subject area, in order to provide a better quality of life for pregnant women.

  9. Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain. (United States)

    Tang, Yuan-Zhang; Shannon, Moore-Langston; Lai, Guang-Hui; Li, Xuan-Ying; Li, Na; Ni, Jia-Xiang


    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. 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. 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 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.

  10. Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold. (United States)

    Defrin, Ruth; Shramm, Libby; Eli, Ilana


    Gender role expectations of pain (GREP) was suggested to predict sex differences in pain perception. Our aim was to explore sex differences in GREP and investigate its relationship with heat-pain threshold (HPT) and heat-pain tolerance limit (HPTL). University students (115 males, 134 females) filled the GREP questionnaire. HPT and HPTL were measured in a sample of 72 students. Additionally, GREP values of the present sample were compared with those of the original, American sample to explore possible cultural effects. Both males and females perceive themselves (and their own sex in general) to be less sensitive to pain and less willing to report of pain than the opposite sex. Males perceived themselves and other men, to endure pain relatively similar to women whereas females perceived themselves and other women as less endurable to pain than men. HPT was similar for the two sexes but males had higher HPTL than females. Within each sex, HPTL correlated mainly with self's perception of pain sensitivity. The American and Israeli samples differed in that Israeli males and females presented stronger stereotypical views towards same and opposite sexes. Both males and females held stereotypical "macho" attitude towards themselves with regard to pain sensitivity and willingness to report of pain however only females held stereotypical, "macho" attitude towards themselves with regard to pain endurance. The sex differences in GREP and in HPTL and the correlations between GREP items and experimental thresholds suggest that the relationship between GREP and experimental pain is complex and sex-specific. It also appears that GREP is affected by culture.

  11. Pain management in cancer survivorship

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per


    of the 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...... survivors. Pain management strategies are discussed according to the biopsychosocial model and with the rapidly growing number of cancer survivors the establishment of multidisciplinary clinics as a part of comprehensive cancer centers are proposed....

  12. Cryoanalgesia: effect on postherniorrhaphy pain

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Thorup, J


    , and during mobilization to the sitting position for 1 wk and weekly for 8 wk on a four-point verbal rank scale. Use of supplementary analgesics and sensory disturbances were recorded. Assessments were made for allodynia, hyperalgesia, and mechanical pain detection thresholds 8 wk postoperatively. Cumulative......-blind, randomized study. No difference in pain scores was found. Sensory disturbances were seen in treatment and control patients. Freezing cannot be recommended for pain relief after hernia repair....



    Yogitha Bali


    Neck pain is one of the very common complaints across the globe. Common neck pain occurs due to problems in the neck muscles, ligaments and discs due to faulty neck postures and daily neck misadventures accounting for more than 80% of neck pains around the globe. Conventional treatment methods which include drugs, physiotherapy, exercises & operative care have their own limitations and are not entirely effective. Alternative therapeutic approach could complement or supplement the existing tre...

  14. Blue Tongue Virus

    African Journals Online (AJOL)


    bluetongue virus (BTV) infection cycle is initiated when the virus core is delivered into the cytoplasm of ... products available for the consumer market; therefore, .... BTV life cycle. BTV interacts with the target cell surface via VP2 timers which is then internalized in endosomes via a clathrin- dependent endocytosis pathway ...

  15. Viral Haemorrhagic Septicaemia Virus

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen; Skall, Helle Frank


    This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus.......This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus....

  16. Schmallenberg virus infection

    NARCIS (Netherlands)

    Wernike, K.; Elbers, A.R.W.; Beer, M.


    Since Schmallenberg virus, an orthobunyavirus of the Simbu serogroup, was identified near the German-Dutch border for the first time in late 2011 it has spread extremely quickly and caused a large epidemic in European livestock. The virus, which is transmitted by Culicoides biting midges, infects

  17. Avian influenza virus (United States)

    Avian influenza virus (AIV) is type A influenza that is adapted to avian host species. Although the virus can be isolated from numerous avian species, the natural host reservoir species are dabbling ducks, shorebirds and gulls. Domestic poultry species (poultry being defined as birds that are rais...

  18. Surveillance of respiratory viruses.

    African Journals Online (AJOL)

    Respiratory virus isolates made at the National Institute for. Virology from 1982 to 1991 were studied. An active virus surveillance programme, 'viral watch', which recruits throat swab specimens from a network of monitoring centres - mainly in the Witwatersrand and Vereeniging area with one centre in Middelburg - that ...

  19. Viruses in reptiles. (United States)

    Ariel, Ellen


    The etiology of reptilian viral diseases can be attributed to a wide range of viruses occurring across different genera and families. Thirty to forty years ago, studies of viruses in reptiles focused mainly on the zoonotic potential of arboviruses in reptiles and much effort went into surveys and challenge trials of a range of reptiles with eastern and western equine encephalitis as well as Japanese encephalitis viruses. In the past decade, outbreaks of infection with West Nile virus in human populations and in farmed alligators in the USA has seen the research emphasis placed on the issue of reptiles, particularly crocodiles and alligators, being susceptible to, and reservoirs for, this serious zoonotic disease. Although there are many recognised reptilian viruses, the evidence for those being primary pathogens is relatively limited. Transmission studies establishing pathogenicity and cofactors are likewise scarce, possibly due to the relatively low commercial importance of reptiles, difficulties with the availability of animals and permits for statistically sound experiments, difficulties with housing of reptiles in an experimental setting or the inability to propagate some viruses in cell culture to sufficient titres for transmission studies. Viruses as causes of direct loss of threatened species, such as the chelonid fibropapilloma associated herpesvirus and ranaviruses in farmed and wild tortoises and turtles, have re-focused attention back to the characterisation of the viruses as well as diagnosis and pathogenesis in the host itself.

  20. Hepatitis viruses overview

    African Journals Online (AJOL)

    Hepatitis is major cause of morbidity or mortality worldwide, particularly in the developing world. The major causes of infective hepatitis are hepatitis viruses. A, B, C, D or E. In the acute phase, there are no clinical features that can reliably differentiate between these viruses. Infection may be asymptomatic or can present as.