Feature of pain

Hypothyroid myopathy occurs in about 30% of patients with hypothyroidism irrespective of its cause. Muscle pain, cramps, and stiffness may be seen, and are often exacerbated by cold weather. Pseudomyotonic features of delayed muscle contraction and relaxation are common. Myoedema (the mounding phenomenon) is due to the painless, electrically silent contracture produced on direct percussion. Muscle biopsy often shows a predominance of type 1 (slow-twitch) fibers, again analogous to that seen in experimental hypothyroidism (Figure 22). Muscle hypertrophy with weakness and slowness of movement occurs in the Debre-Semelaigne syndrome seen in severely hypothyroid children, and Hoffman s syndrome is a similar condition seen in adults with hypothyroidism, but is also accompanied by painful spasms. 

Primary hyperparathyroidism occurs as a result of hyperplasia or the occurrence of adenoma. Secondary hyperparathyroidism may result from renal failure because of the associated phosphate retention, resistance to the metabolic actions of PTH, or impaired vitamin D metabolism. The last-mentioned factor is primarily responsible for the development of osteomalacia. Muscle symptoms are much more common in patients with osteomalacia than in primary hyperparathyroidism. Muscle biopsy has revealed disseminated atrophy, sometimes confined to type 2 fibers, but in other cases involving both fiber types. Clinical features of osteomalacic myopathy are proximal limb weakness and associated bone pain the condition responds well to treatment with vitamin D. 

Drug-induced and toxic myopathies are probably more common than is generally realized, but the distinctive feature of these conditions is that muscle damage is usually resolved rapidly once the causal agent is removed. The specific causes of damage vary considerably as does the presence of pain and discomfort. 

Disturbed intestinal motility appears to be a central feature of IBS, which leads to altered stool consistency. Studies suggest that the colon of IBS sufferers is abnormally sensitive to normal stimuli.13 This enhanced visceral sensitivity manifests as pain, especially related to gut distention. 

IBS-C can often be distinguished from chronic constipation primarily by the presence of abdominal pain and discomfort. Although pain and discomfort may be present in some patients with chronic constipation, it is an expected feature of IBS. 

NSAIDs are a reasonable alternative when acetaminophen fails to provide an acceptable analgesic response. Some authorities recommend NSAIDs over acetaminophen for patients presenting with severe pain or signs and symptoms of inflammation, but this is a matter of much contention. The rationale for this recommendation is that acetaminophen s central mechanism of action renders it ineffective against peripheral joint inflammation, and therefore, less effective.18 Consensus guidelines support the use of NSAIDs as an alternative to acetaminophen if clinical features of peripheral inflammation or severe pain are detected.11,12 Unfortunately there is no validated mechanism to identify patients who are more likely to respond to NSAIDs than acetaminophen. 

Expectancy in the Placebo Response , Pain 43 (1990) 121-28 Waber, Rebecca L., Baba Shiv, Ziv Carmon and Dan Ariely, Commercial Features of Placebo and Therapeutic EfficacyJournal of the American Medical Association 299, no. 9 (2008) 1016-17 Wager, Tor D., The Neural Bases of Placebo Effects in Pain , Current Directions in Psychological Science 14, no. 4 (2005) 175-79... 

Pye SR et al (2004) Radiographic features of lumbar disc degeneration and self-reported back pain. J Rheumatol 31(4) 753-758... 

Schwarzer AC et al (1995) The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 20(17) 1878-1883... 

There is some evidence that long-term cyclic administration of rifaximin combined with fiber supplementation is effective for inducing symptomatic relief in patients with uncomplicated diverticular disease of the colon. A therapeutic gain of approximately 30% compared to fiber supplementation only can be expected. The drug is well tolerated and no relevant side effects have been reported. Symptoms attributed to diverticula (abdominal pain or discomfort, bloating, disturbance of bowel habits) are nonspecific symptoms and are also features of irritable bowel syndrome. It has been suggested that irritable bowel syndrome and diverticular disease of the colon may coexist in many people and when bowel symptoms occur with diverticulosis coli, they may be due to a coexistent irritable bowel rather to the diverticula themselves [47, 48]. This hypothesis is supported by the fact that many patients with symptomatic diverticular disease show co-... 

Features of central sensitization are pain in response to normally innocuous tactile stimuli, and the spread of pain sensitivity beyond the site of tissue injury. Central sensitization plays a major role in acute post-traumatic pain, and also in migraine, neuropathic pain (see below) and some diffuse chronic pain syndromes, such as fibromyalgia and irritable bowel syndrome. In these conditions, which have no detectable peripheral trigger, an autonomous central sensitization may be the pathology, increasing the gain in neuronal activity in the CNS and thereby producing abnormal responses to normal inputs. 

Ectopic activity in C fibers elicits central sensitization in the dorsal horn, contributing to the generation of tactile allodynia, a prominent feature of neuropathic pain. 

Plague. Clinical features of pneumonic plague include fever, cough with muco-purulent sputum (gram-negative rods may be seen on gram stain), hemoptysis, and chest pain. A chest radiograph will show evidence of bronchopneumonia. 

Glaucoma is characterised by an increase in intraocular pressure. Clinical features of glaucoma include ocular pain, visual disturbances, headache and sometimes nausea and vomiting. 

Aspirin is acetylsalicylic acid and is used as an antiplatelet agent and for pain relief. Its use for anti-inflammatory effects is limited by the occurrence of side-effects, which include tinnitus and deafness, both features of salicylate poisoning. 

The intermediate metabolites formed during the biotransformation in the liver are believed to be responsible for the hepatoxicity that results in overdosage. Nausea and vomiting are early features of poisoning. With time, hepatic necrosis develops and is often associated with the onset of right subcostal pain and tenderness. 

Toxicology. Arsine is a severe hemolytic agent abdominal pain and hematuria are cardinal features of arsine poisoning and are frequently accompanied by jaundice. 

In this chapter, we discuss the basic principles of modern liquid chromatography, which have been slowly and painfully recognized as valid over the past ten years. After presenting the main features of the optimization model together with the relevant equations, we shall point out the practical consequences of this approach and the way the analyst can use the optimization scheme in practice (5-26). 

Basbaum Al (1999) Distinct neurochemical features of acute and persistent pain. Proc Natl Acad Sci U S A 96 7739-7743... 

The idea of reduced adrenal capacity as a possible model for PTSD has also been recently raised by Heim et ah, who concluded that low cortisol may not be a unique feature of PTSD, but may represent a more universal phenomenon related to bodily disorders, having an etiology related to chronic stress (Heim et al. 2000). There are numerous stress-related disorders such as chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, chronic pain syndromes, and other disorders that are characterized by hypocortisolism. In one study, Heim et al. showed decreased cortisol responses to low-dose DEX, but failed to observe blunted ACTH responses to CRF in women with chronic pelvic pain, some of whom had PTSD, compared to women with infertility (Heim et al. 1998). Since the data were not analyzed on the basis of the subgroup with and without trauma and/or PTSD, it is not possible to directly compare results of that study to other reports examining PTSD directly. 

The continued use of opioids results in the development of physical dependence, as demonstrated by the appearance of a characteristic abstinence syndrome upon interruption or cessation of use. The symptoms of withdrawal include hyperactivity, anxiety, restlessness, yawning, diarrhea, vomiting, chills, fever, lacrimation, and runny nose. Piloerection (gooseflesh or cold turkey), mydriasis, increased blood pressure and heart rate, and hyperpyrexia may be observed. Tremors, abdominal cramps, and muscle and joint pain may be present. Drug craving is an important feature of opioid withdrawal. In contrast to some other drugs of abuse, withdrawal is not life threatening. 

Initial treatment of gout and its associated hyperuricemia must involve therapy directed toward terminating the painful inflammatory process that is a prominent feature of acute gouty arthritis. A variety of nonsteroidal antiinflammatory compounds (e.g., in-... 

---