Pain detection

Hot and spicy foods contain molecules that stimulate pain-detecting nerve endings. Two such molecules are piperine and capsaicin ... 

Recurrent ST-segment elevation, especially with pain, detected with continuous multilead ST-segment monitoring (Akkerhuis et al., 2001). -According to the ST-segment elevation in the precordial or inferior leads and the presence of mirror patterns, the ECG allows for location of the coronary... 

Skin Photodynamic therapy causes selective destruction of abnormal cells by activating a photosensitizer in the presence of oxygen. Local phototoxic reactions and pain are the most common limiting adverse reactions. In a randomized comparison in healthy volimteers of the local phototoxic response to photodynamic therapy with 5-aminolevulinic acid 20% or methylaminolevulinate 160 mg/g cream, pain, detection of substance P, change in fluorescence intensity from before to 5 hours after cream application, and adverse reactions not related to local phototoxicity were studied [57 ]. Aminolevulinic acid and methylaminolevulinate caused equivalent frequencies of local adverse reactions, except for a higher frequency and extent of hyperpigmentation after exposure to aminolevulinic acid for 28 days. 

The pain appears to arise from the formation of melittin pores in the membranes of nociceptors, free nerve endings that detect harmful ( noxious —thus the name) stimuli of violent mechanical stress, high temperatures, and irritant chemicals. The creation of pores by melittin depends on the nociceptor membrane potential. Melittin in water solution is tetrameric. However, melittin interacting with membranes in the absence of a membrane potential is monomeric and shows no evidence of oligomer... 

For convenience, the usual measurement of sound is expressed in decibels (dB), and ratings go from threshold of hearing to threshold of pain (135 dB). Figure 34.11 illustrates the common noise criteria, which can be expressed in sound-pressure levels (SPL). The human ear can detect 1 dB but 6 dB represents a doubling of the SPL, although it would need a 10 dB increase to make it sound twice as loud. 

Thus, the presence of uric acid crystals in joints triggers a vicious cycle, resulting in an extremely painful inflammation. A typical localization of acute gouty arthritis is the first metatarsal joint of the foot (podagra). The diagnosis of acute gouty arthritis is confirmed by the detection of urate crystals in the joint or tophus. 

IM PA I RED ORAL M UCOUS M EM 0 RAN ES. The administration of oral penicillin may result in a fungal superinfection in tiie oral cavity. With impaired oral mucous membranes there will be varying degrees of inflamed oral mucous membranes, swollen and red tongue, swollen gums, and pain in tiie mouth and throat. To detect this problem early, tiie nurse inspects tiie patient s mouth... 

HYDANTOINS Fhenytoin is the most commonly prescribed anticonvulsant because of its effectiveness and relatively low toxicity. However, a genetically linked inability to metabolize phenytoin has been identified. For this reason, it is important to monitor serum concentrations of the drug on a regular basis to detect signs of toxicity Fhenytoin is administered orally and parenterally. If the drug is administered parenterally, the IV route is preferred over the intramuscular route because erratic absorption of phenytoin causes pain and muscle damage at the injection site... 

Lipoxygenases catalyse the regio-specific and stereoselective oxygenation of unsaturated fatty acids. The mammalian enzymes have been detected in human platelets, lung, kidney, testes and white blood cells. The leukotrienes, derived from the enzymatic action of the enzyme on arachidonic acid, have effects on neutrophil migration and aggregation, release of lysosomal enzymes, capillary permeability, induction of pain and smooth muscle contraction (Salmon, 1986). 

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. 

Not all diabetic foot ulcers are infected. However, infection is often difficult to detect when perfusion and the inflammatory response are limited in the diabetic patient. The common signs and symptoms (i.e., pain, erythema, and edema) of infection may be absent.32 Still, the diagnosis of diabetic foot infection depends mostly on clinical evaluation. 

Some forms of invasive candidiasis are dominated by deep organ infection and may never be detected by blood cultures. Chronic disseminated candidiasis or hepatosplenic candidiasis is a unique form of candidemia seen after recovery from neutropenia. Candidemia during the period of neutropenia may be initially localized to the portal circulation with dissemination to contiguous organs. After recovery of neutrophils, an inflammatory response is seen against areas of focal infection in the liver and spleen. This inflammatory response produces abdominal pain that is associated with... 

An evaluation of the rifaximin tolerability profile observed in almost 1,000 patients from 30 clinical trials was unable to identify a definite pattern of intolerance [33]. Very few adverse events have been reported during short-tem treatment with the drug, the most frequently reported being gastrointestinal in nature (e.g. flatulence, nausea, abdominal pain and vomiting). It is worthwhile to emphasize that the detection of GI adverse reactions could have been difficult in rifaximin trials since the symptoms of the underlying diseases were often similar to the GI complaints observed after drug treatment. 

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