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Pain pathway

Karissa N Arca, Rashmi B Halker Singh
PURPOSE OF REVIEW: The purpose of this review is to provide an update on the clinical features, diagnosis, pathogenesis, epidemiology, and treatment of the rare primary headache disorders short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA). Together these entities are known as short-lasting unilateral neuralgiform headache attacks (SUNHA). RECENT FINDINGS: Recent case reports of secondary SUNCT and SUNA due to medullary infarcts support the theory that the trigeminohypothalamic pathway is involved in the pathophysiology of SUNHA...
June 21, 2018: Current Pain and Headache Reports
Bodil Ivarsson, Ami Hommel, Magnus Sandberg, Desirée Sjöstrand, Anders Johansson
BACKGROUND: Hip fractures are described to have a significant impact on patients' well-being and different fast-track concepts could result in a reduction of the patient's psychological and emotional reactions before pre- and intrahospital care. AIMS AND OBJECTIVES: This study aimed to elucidate perceived situations of significance experienced by patients with hip fracture during the prehospital- and in-hospital care. DESIGN: The study used a qualitative approach using a critical incident technique (CIT), 14 patients with hip fractures were included...
May 15, 2018: International Journal of Orthopaedic and Trauma Nursing
Pei-Yue Jiang, Xiao-Jun Zhu, Yi-Na Zhang, Fei-Fei Zhou, Xiao-Fu Yang
Endometritis is a puzzling disease that often associates with severe pelvic pain. In this study, we aimed to detect whether apigenin had protective effect against LPS-induced endometritis, if so, the underlying mechanism was further investigated. Apigenin was administrated 1 h before LPS treatment. The levels of inflammatory cytokines were measured by ELISA. The expression of NF-κB and Nrf2 were detected by Western blot analysis. The results showed that LPS treatment induced severe histological alteration of uterus and this change was attenuated by the treatment of apigenin...
June 18, 2018: Microbial Pathogenesis
Elizabeth K Seng, Alexander J Kuka, Sarah Jo Mayson, Todd A Smitherman, Dawn C Buse
OBJECTIVE: To evaluate relationships between psychiatric symptoms, acceptance, and migraine-related disability in a sample of people with migraine presenting at a tertiary care headache center. BACKGROUND: Migraine is a chronic disease that can be severely disabling. Despite a strong theoretical basis and evidence in other pain conditions, little is known about relationships between acceptance, psychiatric symptoms, and migraine-related disability. METHODS: Ninety patients with physician-diagnosed migraine completed surveys assessing demographics, headache symptoms, severe migraine-related disability (Migraine Disability Assessment Scale total score dichotomized at ≥ 21), depression (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder-7), and acceptance (Chronic Pain Acceptance Questionnaire; subscales: Pain Willingness and Activity Engagement)...
June 2018: Headache
M Alexander Stanczyk, Ram Kandasamy
Opioids alleviate pain, but adverse effects severely limit their usefulness. To solve this problem, biased ligands favoring 1 signaling pathway downstream of the μ-opioid receptor over another are being developed. In the target article, the authors synthesize compounds that preferentially activate G-protein or β-arrestin signaling. They find that increased bias towards G-protein signaling produces better antinociception with minimal side effects in mice models. G-protein-biased opioids may provide a safer treatment strategy...
May 2018: Pain Reports (Baltimore, Md.)
Iram Irshad, Pegah Varamini
BACKGROUND: Breast cancer is the most frequently diagnosed malignancy in women worldwide. Breast cancer tends to metastasize to bone. Around 70% of the breast cancer patients eventually develop bone metastasis. After the bone invasion, metastatic cells disrupt the balance between osteoblastic and osteoclastic activities, leading to skeletal complications, characterized by pain and pathological fractures and hence worsening the patient's quality of life. Once tumor invades the bone, it is hard to treat it with, the so-far available treatments options (e...
June 19, 2018: Current Pharmaceutical Design
Jason P Stopyra, Robert F Riley, Brian C Hiestand, Gregory B Russell, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Stephanie B Elliott, David M Herrington, Gregory L Burke, Chadwick D Miller, Simon A Mahler
OBJECTIVE: To determine the impact of the HEART Pathway on healthcare utilization and safety outomes at 1 year in patients with acute chest pain. METHODS: Adult Emergency Department (ED) patients with chest pain (N=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3-hours) to risk stratify patients. Usual care was based on ACC/AHA guidelines. Major adverse cardiac events (MACE: cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year...
June 19, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Mohammad Jafferany, Maryam E Davari
Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch...
June 19, 2018: International Journal of Dermatology
Samaira Younis, Anders Hougaard, Casper Emil Christensen, Mark Bitsch Vestergaard, Esben Thade Petersen, Olaf Bjarne Paulson, Henrik Bo Wiberg Larsson, Messoud Ashina
BACKGROUND: Studies involving human pharmacological migraine models have predominantly focused on the vasoactive effects of headache-inducing drugs, including sildenafil and calcitonin gene-related peptide (CGRP). However, the role of possible glutamate level changes in the brainstem and thalamus is of emerging interest in the field of migraine research bringing forth the need for a novel, validated method to study the biochemical effects in these areas. METHODS: We applied an optimized in vivo human pharmacological proton (1 H) magnetic resonance spectroscopy (MRS) protocol (PRESS, repetition time 3000 ms, echo time 37...
June 18, 2018: Journal of Headache and Pain
Benjamin M Nowotny, Erwin Loh, Katherine Lorenz, Euan M Wallace
Learning from medical errors to prevent their recurrence is an important component of any healthcare system's quality and safety improvement functions. Traditionally, this been achieved principally from review of adverse clinical outcomes. The opportunity to learn systematically and in a system manner from patient complaints and litigation has been less well harnessed. Herein we describe the pathways and processes for both patient complaints and medicolegal claims in Victoria, and Australia more broadly, and assess the potential for these to be used for system improvement...
June 19, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Helen Richmond, Clare Lait, Cynthia Srikesavan, Esther Williamson, Jane Moser, Meredith Newman, Lauren Betteley, Beth Fordham, Sophie Rees, Sarah E Lamb, Julie Bruce
BACKGROUND: Musculoskeletal shoulder problems are common after breast cancer treatment. There is some evidence to suggest that early postoperative exercise is safe and may improve shoulder function. We describe the development and delivery of a complex intervention for evaluation within a randomised controlled trial (RCT), designed to target prevention of musculoskeletal shoulder problems after breast cancer surgery (The Prevention of Shoulder Problems Trial; PROSPER). METHODS: A pragmatic, multicentre RCT to compare the clinical and cost-effectiveness of best practice usual care versus a physiotherapy-led exercise and behavioural support intervention in women at high risk of shoulder problems after breast cancer treatment...
June 18, 2018: BMC Health Services Research
Torsten Gordh, Bertil Vinnars, Håkan Fischer, Hans Blomberg, Jan Modig, Mats Fredrikson, Per Hartvig
Background Brain activation resulting from acute postoperative pain has to our knowledge not previously been studied using positron emission tomography, except from one case study. The aim of this study was to monitor activation in brain sensory pathways during acute pain after surgery of the hand. A secondary aim was to compare brain activation in clinical postoperative pain to that previously reported, by the same research group, for a model of experimental pain from the same body area. Increase in regional cerebral blood flow (rCBF) is presumed to indicate neuronal activation and decrease in blood flow decreased neuronal firing...
December 29, 2017: Scandinavian Journal of Pain
Elisabeth Hansson
Nociceptive and neuropathic pain signals are known to result from noxious stimuli, which are converted into electrical impulses within tissue nociceptors. There is a complex equilibrium of pain-signalling and pain-relieving pathways connecting PNS and CNS. Drugs against long-term pain are today directed against increased neuronal excitability, mostly with less success. An injury often starts with acute physiological pain, which becomes inflammatory, nociceptive, or neuropathic, and may be transferred into long-term pain...
December 29, 2017: Scandinavian Journal of Pain
K K Lemberg, T E Heiskanen, M Neuvonen, V K Kontinen, P J Neuvonen, M-L Dahl, E A Kalso
Oxycodone is a strong opioid and it is increasingly used in the management of acute and chronic pain. The pharmacodynamic effects of oxycodone are mainly mediated by the μ-opioid receptor. However, its affinity for the μ-opioid receptor is significantly lower compared with that of morphine and it has been suggested that active metabolites may play a role in oxycodone analgesia. Oxycodone is mainly metabolized by hepatic cytochrome (CYP) enzymes 2D6 and 3A4. Oxycodone is metabolized to oxymorphone, a potent μ-opioid receptor agonist by CYP2D6...
December 29, 2017: Scandinavian Journal of Pain
Maria Gullander, Stein Knardahl, Dagfinn Matre
Aabstract Background and purpose Women exhibit higher prevalence of most painful disorders. Several explanations have been proposed for this discrepancy, one being that endogenous pain modulatory pathways, which affect incoming nociceptive signals, act differently in men and women. A less efficient pain inhibitory system has been proposed as a contributing factor to explain why women exhibit higher prevalence of most painful disorders. The present study determined whether muscle pain, induced experimentally by electrical stimulation, is inhibited by a painful heat stimulus...
December 29, 2017: Scandinavian Journal of Pain
K K Frederiksen, P Kristensen, P H Honoré, G Gegelashvili, O J Bjerrum
Introduction An unmet medical need for more effective therapies of neuropathic pain exits. Here modulation of the glutaminergic system represents an unexplored possibility. Down-regulation ofglutamate transporters potentiates pain transmission by delaying the removal of glutamate from the synapse. In the spinal cord, glutamate transporter 1 (GLT-1) is responsible for more than 90% of the glutamate uptake. Ceftriaxone, a β-lactam, is believed to induce the expression of GLT-1 through the transcriptional factor (NF-ºB) pathway, which results in induced promoter activity and thereby increased synthesis of GLT-1 protein...
December 29, 2017: Scandinavian Journal of Pain
L Bittencourt da Silva, D Kulas, A Karshenas, B E Cairns, F W Bach, L Arendt-Nielsen, P Gazerani
Background/aims Analgesic effects of BoNTA develop within few hours in animal studies and within days in human studies. We have previously shown that BoNTA can block glutamate-induced mechanical sensitization and neurogenic vasodilation in rat temporalis muscle within 3 h. The present translational study was designed to explore the time-course of analgesic effects of BoNTA on pain, sensitization and vasomotor responses in a glutamateevoked human pain model. Methods BoNTA (5U) and saline were injected (30 min interval) into the left and right temporalis muscles of 12 healthy males (24...
December 29, 2017: Scandinavian Journal of Pain
B Rittig-Rasmussen, H Kasch, A Fuglsang-Frederiksen, T S Jensen, P Svensson
Objective To test the effect of different neck training methods on motor evoked potentials (MEPs) from the trapezius muscle. We hypothesized that training of the trapezius muscle would significantly increase MEPs, indicating facilitation of the corticomotor pathways. Additional experiments investigated the influence of muscle strength, muscle fatigue, and correlations between MEP amplitudes and behavioral aspects of motor learning. Methods Transcranial magnetic stimulation (TMS) was used to elicit MEPs from the trapezius muscle and the abductor pollicis brevis (APB) muscle in 60 healthy subjects in three conditions: (1) specific trapezius training, (2) coordination training of the neck, and (3) no training...
December 29, 2017: Scandinavian Journal of Pain
Elisabeth Hansson, Linda Block, Johan Forshammar, Christopher Lundborg, Björn Biber
Background Long-term or chronic pain represents a major health problem and is associated with significant socio-economic costs. During injury, pain can be dissociated from its normal physiological role. It can persist for a longer period of time, even after the primary noxious stimulus has more or less subsided. Analgesic drugs, with predominant neuronal sites of actions, seem to be relatively ineffective. Chronic pain is probably partly a consequence of ongoing neuroinflammation. The mechanisms behind these phenomena, and how the neuronal and non-neuronal activities evoked by painful stimuli and inflammation are processed in the brain and throughout the CNS, are not well understood...
December 29, 2017: Scandinavian Journal of Pain
Jan Brun, Christina Brock, Jens B Frøkjær, Eirik Söfteland, Magnus Simrén, Hans Gregersen, Asbjørn M Drewes
Background Abnormal visceral sensory function has been demonstrated in patients with diabetes mellitus and diabetic autonomic neuropathy seems to be involved in the development and progression of gastrointestinal tract dysfunction. The possibility of multimodal (e.g. mechanical, electrical, thermal and chemical) stimulation in, e.g. the esophagus has developed visceral pain research. The major advantage is involvement of distinctive receptors, various sensory nerves and different pain pathways mimicking clinical pain that favours investigation of central pain mechanisms involved in allodynia and hyperalgesia...
December 29, 2017: Scandinavian Journal of Pain
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