1/233. Use of transdermal amitriptyline gel in a patient with chronic pain and depression.A man with severe inflammatory bowel disease suffered from chronic abdominal pain and depression. A transdermal amitriptyline gel preparation was compounded since he was unable to take drugs orally serum concentrations of amitriptyline and its active metabolite nortriptyline were measured over 24 hours. Symptoms of depression were monitored before starting transdermal therapy and at the end of 6 weeks. Pain symptoms and amitriptyline adverse drug events were monitored daily Steady-state serum concentrations of drug and metabolite were within the therapeutic range over 24 hours. The patient reported that his mood was improved but his abdominal pain remained unchanged. Transdermal amitriptyline gel was well tolerated and is an alternative delivery system in patients unable to take drugs orally.- - - - - - - - - - ranking = 1keywords = depression (Clic here for more details about this article) |
2/233. Posterior epidural migration of sequestered lumbar disc fragments. Report of two cases.The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.- - - - - - - - - - ranking = 0.009684154329762keywords = major (Clic here for more details about this article) |
3/233. Low power laser therapy and analgesic action.OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.- - - - - - - - - - ranking = 0.009684154329762keywords = major (Clic here for more details about this article) |
4/233. The longer term effect of pulsed radiofrequency for neuropathic pain.pulse radiofrequency has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of a rise in temperature or subsequent nerve injury. In this set of case reports, the effect of pulsed radiofrequency (PRF) is described in patients with neuropathic pain syndromes which have been poorly controlled with other oral and invasive treatments. Whilst anecdotal, the results have been remarkable and should encourage further research into this technique. Observations from the basic science tend to support the concept that PRF may induce some sort of long-term depression in the spinal cord.- - - - - - - - - - ranking = 0.16666666666667keywords = depression (Clic here for more details about this article) |
5/233. Distensible venous malformations of the orbit: clinical and hemodynamic features and a new technique of management.OBJECTIVE: To investigate distensible venous malformations of the orbit (DVMO) as part of a spectrum of orbital vascular malformations, including some that involved periorbital skin, extraorbital sites (central nervous system or nasal sinuses), or combinations of these. The authors also investigated the effectiveness of a new technique of management for selected cases. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty patients had distensible venous anomalies, of which four were combined distensible venous-lymphatic vascular malformations. Distensible lesions were defined as those showing clinical or radiographic expansion with valsalva maneuver or when the head was placed in a dependent position. These lesions were then classified as superficial (anterior to the equator of the globe), deep (posterior to the globe's equator), combined (deep and superficial), or complex (with intracranial or major extraorbital involvement). INTERVENTION: Surgery was performed on 15 patients (50%), mainly for pain or for cosmetic indications. Six patients underwent this new technique, which involved intraoperative direct venography with control of outflow via pressure at the superior or inferior orbital fissure. The venous malformation was then embolized (by use of cyanoacrylate glue) and excised. RESULTS: The mean age at presentation was 28.2 years (range, 8 months to 75 years). Sixty-six percent of cases involved the left orbit. Superior and medial orbital involvement was most common. Three cases (10%) were classified as superficial, and 13 (43%) as deep. Six patients (20%) had combined superficial and deep components. Eight (27%) had major extraorbital involvement (4 intracranial, 2 facial, and 2 paranasal sinus). Direct venography demonstrated complex multichannel anomalies draining to various sites, including the face and pterygopalatine fossa, without necessarily having a direct connection to the major orbital venous circulation. CONCLUSIONS: Distensible venous malformations of the orbit are part of a spectrum of developmental venous malformations that may be localized to the orbit or involve it as part of a more extensive lesion. The authors describe their clinical and radiologic features and report a new technique of management for selected cases. This method of vascular isolation and embolization of lesions may greatly facilitate excision.- - - - - - - - - - ranking = 0.029052462989286keywords = major (Clic here for more details about this article) |
6/233. Balancing the focus: art and music therapy for pain control and symptom management in hospice care.Pain and symptom management are a major part of hospice care. literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.- - - - - - - - - - ranking = 0.009684154329762keywords = major (Clic here for more details about this article) |
7/233. Primary non-Hodgkin's lymphoma of the liver.The clinicopathological features of a rare case of primary non-Hodgkin's hepatic lymphoma (PHL) are described and compared to those of the other 76 cases reported in the world literature. PHL is mainly a disease of Caucasian, middle-aged males and, in approximately half of the reported cases, was associated with other diseases involving depression or chronic stimulation of the immune system. Right upper abdominal and epigastric pain with loss of weight are the most common presenting symptoms. The tumour is usually a single large mass involving both hepatic lobes and is almost invariably composed of lymphocytes reacting with B-cell markers. Most tumours are of intermediate or high grade according to the classification of the Working Formulation for Clinical Usage. No correlation is apparent between gross appearance of PHL (massive or nodular) and grade of severity. Chemotherapy or radiotherapy alone appears to be ineffective, while relatively good results can be obtained with combination modalities.- - - - - - - - - - ranking = 0.16666666666667keywords = depression (Clic here for more details about this article) |
8/233. Painful pectoralis major myospasm as a result of sternal wound reconstruction: complete resolution with bilateral pectoral neurectomies.We report a patient with a highly unusual and previously unreported complication with the use of the pectoralis major muscle to treat the infected median sternotomy. The diagnosis of painful myospasm was made by a combination of physical findings and exclusion of other conditions such as recurrent infection. Treatment by pectoral denervation was relatively simple and highly successful. Patients with chest-wall pain after sternal wound reconstruction should have myospasm entertained as a possible cause.- - - - - - - - - - ranking = 0.04842077164881keywords = major (Clic here for more details about this article) |
9/233. Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: five case reports.Adverse drug reactions of non-steroidal anti-inflammatory drugs (NSAIDs) are quite prevalent, but there are few reports about possible adverse psychiatric reactions, which may be ignored or underestimated. We describe here five psychiatric outpatients, two with major depressive disorders, one bipolar disorder, one schizophrenic disorder and one anxiety disorder, who were treated with NSAIDs for pain due to rheumatoid arthritis, osteoarthritis or other painful neuromuscular conditions. All five patients developed a moderate to severe depressive state, three patients became obviously paranoid, and four had either thoughts of suicide or an attempt while undergoing co-administration of NSAIDs. The psychiatric symptoms remitted when the NSAIDs were stopped. The depressive and paranoid symptoms returned on seven occasions of re-use or re-challenge with the same or a different type of NSAID in all five patients. When the NSAIDs were stopped again, the patients had another remission of the adverse psychiatric reactions, and eventually recovered to their baseline mental states in clear temporal relationships. The cases presented suggest that NSAIDs can induce or exacerbate idiosyncratic reproducible adverse psychiatric symptoms in certain vulnerable patients, including those with a variety of psychotic or neurotic disorders, and also in elderly persons, but these undesirable side-effects were generally transient and disappeared on withdrawal of the NSAIDs.- - - - - - - - - - ranking = 12.257734062471keywords = major depressive disorder, depressive disorder, major (Clic here for more details about this article) |
10/233. Managing pain and comorbid depression: A public health challenge.Many millions of Americans suffer chronic medical conditions complicated by both depression and pain. chronic pain disorders may be classified as being caused by one or more mechanisms, such as nociceptive (inflammatory), neuropathic (peripheral and central), and myofascial, each associated with a complex substrate of neurophysiologic changes. Specific treatment approaches have been developed for different pain mechanisms. Because all pain sensation is personal and subjective, all pain is affected to some degree by emotional states, and, therefore, by psychosocial factors. Major depression commonly complicates chronic pain and adds to impairment and disability. There is evidence that patients with depression occurring after the onset of chronic pain have the same rates of affective disorders in family members as in the general population, and significantly lower rates than in families of patients with major depression alone. This suggests that it is the stress of living with chronic pain, not personal or family predisposition, that causes depression in these patients. Optimal treatment includes treatment of both pain and depression, together with a focus on symptom control and functional restoration.- - - - - - - - - - ranking = 1.6763508209964keywords = depression, major (Clic here for more details about this article) |
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