bluuebunny/crossref_metadata_2025 huggingface dataset:
Basic Science (31)
Authors: Boucher Timothy J. , Okuse Kenji , Bennett David L.H. , Munson John B. , Wood John N. , McMahon Stephen B.
Published: September 2010

Potent analgesic effects of GDNF in neuropathic pain states. (King's College London, London, United Kingdom) Science 2000;290:124–127.

Neuropathic pain arises as a debilitating consequence of nerve injury. The etiology of such pain is poorly understood, and existing treatment is largely ineffective. We demonstrate here that glial cell line‐derived neurotrophic factor (GDNF) both prevented and reversed sensory abnormalities that developed in neuropathic pain models, without affecting pain‐related behavior in normal animals. GDNF reduces ectopic discharges within sensory neurons after nerve injury. This may arise as a consequence of the reversal by GDNF of the injury‐induced plasticity of several sodium channel subunits. Together these findings provide a rational basis for the use of GDNF as a therapeutic treatment for neuropathic pain states.

Comment by Marshall Devor, PhD.

Nerve injury frequently causes sensory neurons to become electrically hyperexcitable. The resulting ectopic afferent firing is thought to be the immediate cause of ongoing pain, movement‐evoked pain, and allodynia in neuropathic pain states. But why do the neurons become hyperexcitable? A popular hypothesis has it that when the axon is cut, the sensory cell body in the dorsal root ganglion (DRG) is starved of essential neurotrophic molecules that are normally produced in the periphery and transported to the DRG via axoplasmic transport. If so, then providing an exogenous source of the critical neurotrophin should prevent, or even reverse, the hyperexcitability and the pain. Boucher et al tried this, administering 1 of 3 candidate neurotrophins (NGF, NT‐3, or GDNF) by the intrathecal (i.t.) route. One of them, GDNF, worked dramatically. The authors believe that i.t. GDNF acts by diffusing into the DRG (rather than the spinal cord) where it alters the expression of the channel proteins that are responsible for electrical hyperexcitability.
Clinical Science (36)
Authors: Greipp Mary E.
Published: September 2010

A follow‐up study of 14 young adults with complex regional pain syndrome type I. (Hospital Morvan, Brest, France) J Neurosci Nurs. 2000;32:83–88.

This study evaluated the symptom experience and functional status of 27 young adults with reflex sympathetic dystrophy syndrome, now known as complex regional pain syndrome (CRPS) type I. All were originally diagnosed and studied 12 years ago. Only 15 subjects could be located; 14 participated in the research. A descriptive exploratory design was utilized. A tool was designed to gather data about daily living variables, psychological variables, and symptom variables. Although many questions required the use of Likert scales, there were some open‐ended questions to capture the qualitative descriptions of the participant's symptom experiences. Findings contribute to the clinical literature about CRPS and its effect on clients over time.

Comment by Mauricio Orbegozo, MD.

This paper is a follow‐up interview on 14 patients diagnosed with complex regional pain syndrome (CRPS) type I more than a decade ago. The author created a tool with the purpose of gathering data in 3 different aspects such as: current activity levels, psychosocial assessment, and symptom experiences. This data were gathered in a questionnaire form. The first 2 sections (current acting levels and psychosocial assessment) are questions to be answered on a 4‐point Likert scale and the last part (symptom experiences) is an open‐ended question section where the subject can answer in a more descriptive manner. What is particular about the population of patients in this study is the fact that all were diagnosed at an early age (childhood or as young adults). This yielded an interesting set of results. As far as current activity levels, more that two‐thirds of the patients were able to perform basic daily living activities and at least 50% of them can perform more strenuous activities such as running, climbing stairs, and driving a car. The results above extrapolate well into the psychosocial assessment where greater than 90% considered themselves self‐sufficient. Of interest was the fact that there was no depression or overwhelming psychiatric morbidity reported. This could be because at a younger age of onset for CRPS type I, more effective coping skills can be developed that would aid these patients in adaptation to daily life. It is not surprising that in symptom experience the most common was continuing pain, followed by limitations in range of motion. In summation, this study sheds light into an aspect that has not been researched in an extensive manner, which is a long‐term follow‐up of patients suffering from CRPS type I and how they adapted to daily life. Although conclusions reflect valid facts, the sample size is small and larger population including patients who develop CRPS type I at later stages in life may provide us with crucial information in a general set of patients.
Clinical Science (37)
Authors: Kemler Marius A. , Barendse Gerard A.M. , Van Kleef Maarten , Egbrink Mirjam G.A. Oude
Published: September 2010

Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation. (Maastricht University Hospital, Maastricht, The Netherlands) Anesthesiology 2000;92:1653–1660.

This study aimed to assess whether pain relief in complex regional pain syndrome (CRPS after spinal cord stimulation (SCS) is, in fact, dependent on vasodilation. In addition, the study attempted to determine which of the potential mechanisms may cause the vasodilatory effect that is generally found after SCS. Twenty‐four of 36 patients with unilateral CRPS responded to the test of SCS. Twenty‐two of the 24 responders (hand, n = 14; foot, n = 8) who had undergone previous sympathectomy were enrolled in the study. In addition, 20 control subjects (10 controls for each extremity) were studied. By means of laser Doppler flowmetry, the skin microcirculation of the patients was measured bilaterally while the SCS system was switched off and while it was activated. Control subjects were tested only once. The ratio of the rest flow at heart level and the dependent position was defined as the vasoconstricted index. Both in affected hands and feet, patients were found to have lower vasoconstriction indices (P < 0.01) as compared with controls, indicating a decreased sympathetic tone. Applying SCS did not result in any microcirculatory change as compared with the baseline or the contralateral clinically unaffected side. Conclude that the study failed to show that SCS influences skin microcirculation in patients with CRPS and a low sympathetic tone. Therefore, it was also concluded that pain relief in CRPS due to SCS is possible without vasodilation. Because sympathetic activity was greatly decreased in the patients, these results support the hypothesis that the vasodilation that is normally found with SCS is due to an inhibitory effect on sympathetically maintained vasoconstriction.

Comment by Hemmo A. Bosscher, MD.

SCS probably provides pain relief independent of increases in blood flow to the affected area. There may be several weaknesses in this study. All patients underwent prior sympathectomy. As every pain management specialist knows, the results of these procedures are variable. That leaves a group of pain patients with CRPS I that is either predominantly sympathetically mediated or sympathetically independent, with variable degrees of sympathetic blockade. In addition, only part of the peripheral circulation is measured with a device which accuracy has not yet been confirmed. Many variables are introduced in this study making a statement that there are no differences between the treatment group and the control somewhat strong. In my opinion: pain relief in complex regional pain syndrome due to spinal cord stimulation may not depend on vasodilatation.
Clinical Science (38)
Authors: Lillesø J. , Hammer N.A. , Pedersen J.L. , Kehlet H.
Published: September 2010

Effect of peripheral morphine in a human model of acute inflammatory pain. (Hvidovre University Hospital, Hvidovre, Denmark) BR J Anaesth 2000;85:228–232.

This study used a randomized, double‐blinded, placebo‐controlled, three‐way crossover design in a human model of acute inflammatory pain (heat injury). Eighteen healthy volunteers were studied who each received morphine locally (2 mg), morphine systemically (2 mg), or placebo on three separate study days. The subjects received morphine infiltration subcutaneously (s.c.) 1 h before heat injury (47°C, 7 min) and naloxone infiltration s.c. (0.2 mg) 2.5 h after the heat injury. Hyperalgesia to mechanical and heat stimuli were examined using von Frey hairs and thermodes, and pain was rated using a visual analogue scale. The burns produced significant hyperalgesia, but local morphine infiltration neither reduced pain during the burn, nor primary or secondary hyperalgesia to mechanical and heat stimuli after the burn. Conclude peripherally applied morphine had no acute antinociceptive effects in this human model of acute inflammatory pain.

Comment by Hemmo A. Bosscher, MD.

This study is well controlled for placebo effect and the systemic effect of subcutanuously injected morphine. One of the few criticisms that can be made is the amount of narcotic injected. This may not be enough to bind to a sufficient number of receptors. One would expect some role for peripheral opioid receptors. The other comment would be that this type of injury (mainly small fiber involvement in this case) does not represent all types of nociception and, therefore, the peripheral action of morphine can not be excluded for different types of nociception. But overall this is a convincing study, consistent with the literature.
Clinical Science (39)
Authors: Lewis M.C. , Lafferty J.P. , Sacks M.S. , Pallares V.S. , TerRiet M.
Published: September 2010

How much work is required to puncture dura with Tuohy needles? (Veterans Affairs Medical Center/Jackson Memorial Medical Center, University of Miami, Miami, FL) BR J Anaesth 2000;85:238–241.

This study was designed to evaluate whether bevel orientation or patient position alters the force necessary to produce dural puncture. A constant hydrostatic pressure was applied to the subdural surface, either high or low, simulating the sitting and lateral positions. A 17‐gauge Tuohy needle was advanced through the dura with the bevel oriented parallel or perpendicular to dural fibres. Travel distance and peak force at which dural penetration occurred was measured under both pressure conditions. The work required to produce dural penetration was calculated. Greater force and work were required to penetrate dura in the perpendicular orientation (P < 0.05), regardless of the subdural pressure exterted. Dural displacement was similar under both pressure conditions.

Comment by Hemmo A. Bosscher, MD.

Work is the product of displacement and force (the area under the curve). The same amount of work is required whether the dura is under pressure (sitting position) or not (lying down). This is surprising. Absolute force is, therefore, not the most important factor. Penetration of the dura probably depends more on local pressure, the area of contact between needle and dura, and the structure of the dura (eg, fiber direction). A sharp needle will obviously penetrate much easier than a blunt one. Considering the shape of a Tuohy needle you would expect that the area of contact not only depends on orientation of the needle, but also strongly on the angle at which the dura is approached. Since dural puncture with a Tuohy needle in a young person almost invariably results in a “spinal headache” most benefit will be obtained from reducing the change of dural puncture. This study supports the concept of putting the bevel of the needle perpendicular to the fiber direction to reduce this change.
Clinical Science (40)
Authors: Ferguson Sue A. , Marras William S. , Gupta Purnendu
Published: September 2010

Longitudinal quantitative measures of the natural course of low back pain. (Ohio State University, Columbus, OH) Spine 2000;25:1950–1956.

This prospective study compared traditional self‐report measures of low back pain recovery with quantitative measure of recovery. Sixteen occupational and 16 non‐occupational patients with low back pain were recruited. Recovery was monitored prospectively every 2 weeks for 3 to 6 months, using subjective work status, pain symptoms, activities of daily living, and objective functional performance probability (trunk kinematics). Return to work underestimated the percentage of subjects impaired, as compared with all other outcome measures. Symptoms, activities of daily living, and functional performance probability all showed similar patterns of recovery for 0 to 12 weeks. At 14 weeks, there was a lag in functional performance recovery. Both symptoms and activities of daily living indicated that 80% of the population was recovered, whereas functional performance indicated the figure to be 68%. Conclude that the objective kinematic functional performance measure of recovery quantifies a different aspect of impairment not evaluated by traditional subjective measures. Use of several outcome measures may lead to a better understanding of low back pain recovery or residual impairment, which may minimize the risk of recurrent injury.

Comment by Hemmo A. Bosscher, MD.

This study evaluates several traditional and not so traditional quantitative measures in the recovery of low back pain. The authors hypothesize that a better understanding of the natural course of low back pain (LBP) recovery may provide the knowledge necessary to prevent high cost recurrent low back injuries. But the relationship between acute low back pain, its recovery, and the subsequent recurrence of LBP is not studied here at all. However the study offers some other interesting information. The traditional outcome measure “back to work” is a very insensitive one. It depends on the job rather than the severity of the LBP. A relatively new functional outcome measure was introduced: the lumbar motion monitor, a device that evaluates trunk kinematics. This measure seems more important in later stages of recovery.
Medicine (46)
Authors: Watson Peter N.
Published: September 2010

The treatment of neuropathic pain: antidepressants and opioids. (University of Toronto, Ontario, Canada) Clin J Pain 2000;16:S49–S55.

This article reviewed the scientific data on antidepressants and opioids, which are largely confined to randomized controlled trials in two neuropathic pain conditions that have proved to be good models for clinical investigation. A review of literature was conducted using MEDLINE, CINAHL, and the Cochrane Database regarding postherpetic neuralgia and painful diabetic neuropathy. The use of the older antidepressants such as amitriptyline in neuropathic pain was extensively supported by the literature. However, newer randomized controlled trials supported the use of opioids. Conclude that first‐line therapy for neuropathic pain may be either an older generation antidepressant such as amitriptyline or nortriptyline or the anticonvulsant gabapentin. For refractory cases, chronic opioid therapy may be the only avenue of relief, and evidence is accumulating that this approach is safe if proper guidelines are observed.
Neurology (48)
Authors: Kooijman Carolien M. , Dijkstra Pieter U. , Geertzen Jan H.B. , Elzinga Albert , Van der Schans Cees P.
Published: September 2010

Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. (University Hospital Groningen, Groningen, The Netherlands) Pain 2000;87:33–41.

This study determined the prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Additionally, the relationship between phantom pain, phantom sensations, and prosthesis use in upper limb amputees was investigated. One hundred twenty‐four upper limb amputees participated in the study. Subjects were asked to fill out a self‐developed questionnaire scoring the following items: date, side, level, and reason of amputation, duration of experienced pain before amputation, frequencies with which phantom sensations, phantom pain, and stump pain are experienced, amount of trouble and suffering experienced, respectively, related to these sensations, type of phantom sensations, medical treatment received for phantom pain and/or stump pain, and the effects of the treatment, self medication, and prosthesis use. The response rate was 80%. The prevalence of phantom pain was 51%, of phantom sensations 76%, and of stump pain 49%; 48% of the subjects experienced phantom pain a few times per day or more. Moderate to severe suffering from phantom pain was experienced by 64% of the respondents. A significant association was found between phantom pain and phantom sensations (relative risk 11.3) and between phantom pain and stump pain (relative risk 1.9). No other factors associated with phantom pain or phantom sensations could be determined. Only 4 patients received medical treatment for their phantom pain. Phantom pain is a common problem in upper limb amputees that causes considerable suffering for the subjects involved. Only a small number of subjects are treated for phantom pain. Conclude that further research is needed to determine factors associated with phantom pain.
Neurology (49)
Authors: Khattab Jihad , Terebelo Howard R. , Dabas Basel
Published: September 2010

Phantom limb pain as a manifestation of paclitaxel neurotoxicity. (Providence Hospital, Southfield, MI) Mayo Clin Proc 2000;75:740–742.

This case report described 2 patients with prior amputation who experienced phantom limb pain (PLP) after receiving paclitaxel therapy. A third patient experienced disabling neurotoxicity in the extremity of a prior ulnar nerve and tendon transposition after receiving paclitaxel. This unique syndrome should be identified as a direct causal effect of paclitaxel. The pathophysiology of PLP and the treatment options are reviewed. Conclude that physicians should be aware that PLP can occur after initiation of paclitaxel.
Neurology (50)
Authors: Yaszay Burt , Jablecki Charles K. , Safran Marc R.
Published: September 2010

Zoster paresis of the shoulder. (Stanford University School of Medicine, Stanford, CA) Clinical Orthopaedics and Related Research 2000;377:112–118.

A case of unilateral left C5‐C6 segmental paresis attributable to herpes zoster in an otherwise healthy individual and a current review of literature are presented. A case of zoster paresis of the shoulder muscles is presented to remind the orthopedic community that this diagnosis may be confused with other diagnoses, including rotator cuff tear, and should be considered in the differential diagnosis of shoulder pain and shoulder girdle muscle weakness.
Neurology (52)
Authors: Brookman C.A. , Rutledge M.L.c
Published: September 2010

Epidural abscess: case report and literature review. (Western General Hospital, Edinburgh, Scotland) Reg Anesth Pain Med 2000;25:428–431.

A case of a 72‐year‐old woman who underwent adrenalectomy and groin dissection for recurrent malignant melanoma under combined general and epidural anesthesia was presented. On the fourth postoperative day, she developed signs of localized infection at the epidural site and a band of reduced sensation. Further neurological signs developed before the diagnosis was made by magnetic resonance imaging scans. She subsequently underwent emergency laminectomy and drainage of the epidural abscess. Conclude that delayed diagnosis allowed the development of significant morbidity before neurosurgical intervention and antibiotics were instituted.
Neurology (54)
Authors: Stanton‐Hicks: Michael
Published: September 2010

Complex regional pain syndrome (type I, RSD; type II, causalgia): controversies. (The Cleveland Clinic Foundation, Cleveland, OH) Clin J Pain 2000;16:S33–S40.

In this review, the relationship of sympathetically maintained pain and sympatholysis is examined, particularly as a neuropathic process that is found in many conditions including complex regional pain syndromes. This review also focused on recent observations proposing a pathologic basis in support of diagnosis and treatment of these disorders.
Neurology (59)
Authors: Phelps Ribert G. , Wilentz: Seth
Published: September 2010

Reflex sympathetic dystrophy. (Mount Sinai School of Medicine, New York, NY) Int J Dermatol 2000;39:481–486.

This review aimed to familiarize the dermatologist with the essential features of reflex sympathetic dystrophy. It highlights areas that are most likely to be of interest to the dermatologist. Information regarding diagnosis, pathogenesis theories, and treatment are included.

Comment by Enrique Reig, MD.

This paper analyses RSD from the point of view of a specialist in dermatology. It addresses in depth the definition of RSD (or the new name, CRPS type I), the symptoms required for adequate diagnosis, some theories to explain this syndrome, and some of the treatments available. It highlights the clinical pictures, which can cause RSD (trauma, ischemia, tumors, infection, neurological and iatrogenic causes), and particularly dermatological syndromes (minor surgery, postherpetic neuralgia, Dupuytren, vasculitis …).

The treatment has a bipolar objective: to relieve pain in order to be able to apply appropriate physical therapy, which will allow recovery of the involved limb. There are more than 60 treatments reported in the literature, suggesting that there is no universal protocol. However, prevention of RSD, and particularly the early onset of treatment are essential for achieving functional and pain relief. To suppress sympathetic hyperactivity, nerve blocks (somatic and sympathetic), intravenous regional blockade with guanethidine or reserpine, alpha blockers (phentolamine), beta blockers (propranolol), and calcitonine can be used.

No reference is made to anticonvulsants (gabapentine, topiramate), antidepressants (ie, amitriptyline), intravenous lidocaine, or spinal cord stimulation.
Neurology (60)
Authors: I Marí J. M. Puig , Martinez‐Miralles E. , Perich X.
Published: September 2010

Reflex sympathetic dystropy syndrome of the lower limbs in a renal transplant patient treated with tacrolimus. (Hospital de Mar, Barcelona, Spain) Transplantation 2000;70:210–211.

This study describes the treatment of a 49‐year‐old woman who received a kidney transplant from a cadaver donor and was treated with tacrolimus. Three months later, the patient complained of severe pain in her lower limbs that affected both knees and ankles. Bone scintigraphy and magnetic resonance were consistent with reflex sympathetic dystrophy syndrome. Laboratory tests that included creatinine, glomerular filtration rate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 μg/mL. Clinical improvement appeared slowly and spontaneously during the following 3 months, without appreciable changes in the tacrolimus level. Conclude that in kidney transplant patients, tacrolimus could be a risk factor for the development of a reflex sympathetic dystrophy syndrome.
Neurology (61)
Authors: Kanazi Ghassan E. , Johnson Ribert W. , Dworkin Ribert H.
Published: September 2010

Treatment of postherpetic neuralgia: an update. (University of Rochester School of Medicine and Dentistry, Rochester, NY) Drugs 2000;59:1113–1126.

This article provided an update on recent developments in the treatment of postherpetic neuralgia (PHN). In clinical trials, the topical lidocaine patch, gabapentin, and controlled release oxycodone have been shown to provide superior pain relief in patients with PHN when compared with placebo. It has also been demonstrated that the tricyclic antidepressant nortriptyline provides equivalent analgesic benefit when compared with amitriptyline, but is better tolerated. Based on these results, nortriptyline can now be considered the preferred antidepressant for treatment of PHN. The topical lidocaine patch, gabapentin, and controlled release oxycodone all appear to be as effective as tricycline antidepressants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early in the course of treatment. Additional controlled trials are needed to compare the efficacy and tolerability of these 4 treatments for patients with PHN.
Neurology (63)
Authors: Hanai Fumihiko
Published: September 2010

Effect of electrical stimulation of peripheral nerves on neuropathic pain. (Inabe Orthopedic Clinic, Inabe, Japan) Spine 2000;25:1886–1892.

Responses of wide dynamic range neurons in the lumbosacral dorsal horn to input from C fibers were studied in urethane chloralose‐anesthetized cats. The posterior tibial nerve and sciatic nerve were stimulated simultaneously to examine the effect on the C fiber responses elicited by superficial peroneal nerve stimulation. Simultaneous stimulation of the posterior tibial nerve and sciatic nerve was performed with superficial peroneal nerve C fiber stimulation. This study demonstrated that electrical stimulation of peripheral nerves leads to inhibitory input to the pain pathways at the spinal cord level.
Neurology (64)
Authors: Schmader Kenneth
Published: September 2010

Herpes zoster in the elderly: issues related to geriatrics. (Durham Veterans Affairs medical Center, Durham, NC) Clin Infect Dis 1999;28:736–739.

This article reviews specific clinical and research issues of herpes zoster related to geriatric medicine. Salient epidemiological and clinical issues include the increasing probability of zoster and postherpetic neuralgia with aging, age‐related decline in immunity to varicella‐zoster virus, the functional and psychosocial impact of zoster on the quality of life of the elderly, illness behavior in elderly patients with zoster, and varicella‐zoster virus transmission and control in the nursing home. The role of antiviral therapy, corticosteroids, and analgesics; the measurement and analysis of pain, health‐related quality of life, and functional status; and the development of varicella vaccine in the management of zoster in the elderly are also emphasized. Fertile research opportunities exist within these areas for investigators interested in infectious diseases, geriatrics, and other zoster‐related disciplines.
Neurosurgery (67)
Authors: Kemler Marius A. , Barendse Gerard A.M. , Van Kleef: Maarten
Published: September 2010

Recurrent rejection of a spinal cord stimulation system. (Maastricht University Hospital, Maastricht, The Netherlands) Contact Dermatitis 2000;42:304–305.

This case report involved a 52‐year old male reflex sympathetic dystrophy patient. This brief report describes a patient who responded to spinal cord stimulation positively, but who could not continue to undergo this treatment because of inflammatory‐type reactions of unknown pathophysiology.

Comment by R. Ruiz‐López, MD.

This is a case report communication describing a patient who responded to spinal cord stimulation (SCS) positively, but who could not continue to undergo this modality because of inflammatory‐type reactions of unknown pathophysiology. Once signs and symptoms of infection with negative bacteriological cultures had occurred for 2 consecutive times, the authors suspected contact hypersensitivity to materials of the SCS system to be the cause of rejection. Although a very rare condition, allergic reactions to cardiac pacemakers have previously been reported. In this case, a striking feature was the lack of any visible skin reaction such as rash, erythema, local swelling, or pruritus.
Neurosurgery (68)
Authors: Wahlig John B. , Welch William C. , Weigel Tracey L. , Luketich: James D.
Published: September 2010

Microinvasive transaxillary thoracoscopic sympathectomy: technical note. (Presbyterian University Hospital, Pittsburgh, PA) Neurosurgery 2000;46:1254–1258.

This report describes a two‐port transaxillary thoracoscopic approach for thoracic sympathectomy that maximizes working space, improves manipulative ability, and enhances visualization of the surgical field. Positioning of the patients was optimized to displace the scapula posteriorly, widen the avenue of approach to the sympathetic ganglia, and create a more direct route to the target. The semi‐Fowler position permitted the lung apex to fall away from mediastinal structures, obviating a separate retraction port. A 30‐degree endoscope allowed an unobstructed view of surgical progress, and anatomic relationships were manipulated in a temporal sequence to facilitate dissection. Microinvasive transaxillary sympathectomy was performed successfully in 13 patients, all of whom had a good outcome without complications. Conclude the modifications implemented increase the speed and safety of thoracoscopic sympathectomy while minimizing complications.

Comment by R. Ruiz‐López, MD.

Thoracic sympathectomy is an accepted means of treating hyperhidrosis, Raynaud's disease, causalgia major and other autonomically mediated syndromes. The authors describe a two‐port transaxillary thoracoscopic approach that maximizes working space, improves manipulative ability, and enhances visualization of the surgical field, advocating a lateral decubitus semi‐Fowler position. A total of 13 patients were treated, 11 with reflex sympathetic dystrophy (complex regional pain syndrome type I (CRPS I)) and 2 with palmar hyperhidrosis. Interestingly, the authors excellent outcomes for CRPS I, not reflecting the experience of most practitioners. Thoracoscopic sympathectomy is evolving quickly since first described by Klux in 1951. From a technical standpoint, the authors describe a useful procedure of endoscopic thoracic sympathectomy that is worthy of further investigation as the series is limited to only 13 patients and in a larger series come complications would be encountered.
Neurosurgery (69)
Authors: Kohno Michihiro , Takakashi Hiroshi , Segawa Hiromu , Sano: Keiji
Published: September 2010

Neurovascular decompression for idiopathic tarsal tunnel syndrome: technical note. (Fuji Brain Institute and Hospital, Fujinomiya City, Shizuoka Prefecture, Japan) J Neurol Neurosurg Psychiatry 2000;69:87–90.

This study evaluates the efficacy of neurovascular decompression for patients with tarsal tunnel syndrome (TTS). Twelve feet from 9 patients with idiopathic TTS were treated. The patients were aged 52–78 years (mean 64.6 years), and all of them complained of pain or dysaesthesia of the sole of the foot. The posterior tibial nerve was freed from the attached arteriovenous complex (posterior tibial artery and veins). The dissected nerve had a flattened appearance in all of the patients, suggesting nerve compression by the adjacent arteriovenous complex and superficially by the flexor retinaculum. A graft of fat was inserted as both a cushion and an antiadhesive between the vessels and the nerve to achieve neurovascular decompression. Patients on whom neurovascular decompression was performed had resolution or lessening of symptoms in their feet. Neither wound infection nor recurrence of symptoms was found during the follow‐up period (mean 26.8 months). Conclude neurovascular compression syndrome plays a part in idiopathic TTS, and adding neurovascular decompression to resection of the flexor retinaculum is effective.

Comment by R. Ruiz‐López, MD.

The surgical outcome of idiopathic tarsal tunnel syndrome (TTS) has been reported less than ideal and worse than that attributable to tarsal coalition tumor or ganglion. The authors considered necessary the development of a new technique in the surgical treatment of this syndrome assuming that neurovascular compression plays a part in idiopathic TTS. They treated 12 feet from 9 patients on whom neurovascular depression with a graft of fat adding resection to the flexor retinaculum was effective for the resolution or lessening of pain and paresthesia in all cases during a mean follow‐up period of 26.8 months without complications.
Orthopedics (72)
Authors: Dolan Patricia , Greenfield Keith , Nelson Richard J. , Nelson: Ian W.
Published: September 2010

Can exercise therapy improve the outcome of microdiscectomy? (University of Bristol, Bristol, United Kingdom) Spine 2000;25:1523–1532.

This study determined the effects of a postoperative exercise program on pain, disability, psychological status, and spinal function. Twenty patients who underwent lumbar microdiscectomy were randomized into EXERCISE and CONTROL groups. After surgery, all patients received normal postoperative care that included advice from a physiotherapist about exercise and a return to normal activities. Six weeks after surgery, patients in the EXERCISE group undertook a 4‐week exercise program that concentrated on strength and endurance of the back and abdominal muscles and mobility of the spine and hips. Assessments of spinal function were performed in all patients during the week before the surgery and at 6, 10, 26, and 52 weeks after. On each occasion, patients completed questionnaires that asked about pain, disability, and psychological status. Surgery improved pain, disability, back muscle endurance capacity and hip and lumbar mobility in both groups of patients. After the exercise program, the EXERCISE group showed further improvements. The only further improvement showed by the CONTROL group was an increase in back muscle endurance capacity. Conclude that a 4‐week postoperative exercise program can improve pain, disability and spinal function in patients who undergo microdiscectomy.
Orthopedics (74)
Authors: Keskimäki Llmo , Seitsalo Seppo , Österman Jeikki , Rissanen: Pekka
Published: September 2010

Reoperations after lumbar disc surgery: a population‐based study of regional and interspecialty variations. (National Research and Development Center for Welfare and Health (STAKES), Helsinki, Finland) Spine 2000;25:1500–1507.

This study aimed to explore rates of reoperation after lumbar disc surgery and their regional and interspecialty variations. Patients who underwent lumbar spine surgery from 1987 to 1995 were identified in the Finnish Hospital Discharge Register. Data on the patient's initial disc operations, subsequent operations, and cause‐of‐death records were linked using personal identification codes. The Kaplan‐Meier method and proportional hazard model were used to analyze risks of reoperation after initial surgery and for neurosurgical and orthopedic patients of university hospitals. Out of 25,359 surgical patients with herniated lumbar discs, 12.3% underwent subsequent lumbar operations corresponding to the cumulative risk of 18.9% in the 9‐year follow‐up. Reoperation rates increased during the study period with the recent patient cohorts exhibiting risks. The reoperation risk showed a systematic geographic variation: the higher the regional disc surgery rate, the higher the reoperation risk. Overall, neurosurgical patients had a higher reoperation risk than orthopedic patients, but it was not a uniform finding. Conclude that the reoperation risk after disc surgery increased during the study period and was higher in hospital catchment areas with higher overall discectomy rates. The reoperation rates varied among the university hospitals, but tended to be higher for neurosurgical rather than for orthopedic patients.
Orthopedics (75)
Authors: BenDebba Mohammed , Torgerson Warren S. , Long: Donlin M.
Published: September 2010

A validated, practical classification procedure for many persistent low back pain patients. (Johns Hopkins School of Medicine, Baltimore, MD) Pain 2000;87:89–97.

This article discussed the development of a simple procedure for assigning persistent low back pain (LBP) patients to 1 of 4 mutually exclusive, hierarchically organized classes. This procedure relies on the spatial distribution of a patient's pain and the results of straight leg raise tests to make the assignment. The procedure was applied to a large group of patients who sought treatment for persistent LBP at several university affiliated tertiary care clinics, and found that the resulting 4 classes of patients were significantly different from one another in their presentation, and in the way they were evaluated and treated by physicians. Conclude that the procedure may have practical research and clinical applications.
Orthopedics (76)
Authors: Kang James D. , Bohlman: Henry H.
Published: September 2010

Cervical disc herniation in a patient with congenital insensitivity to pain: a case report. (University of Pittsburg Medical center, Pittsburg, PA) Spine 2000;25:1726–1728.

This report discussed the clinical manifestations and the treatment outcome of a patient with a known diagnosis of congenital insensitivity to pain who developed a herniated cervical disc. The patient had neurologic motor weakness with “neck and shoulder pain.” A clear radicular pattern could not be elicited. The patient underwent a successful anterior discectomy and fusion with long‐term clinical and radiographic results. Conclude that patients with congenital insensitivity to pain who develop a cervical disc herniation may present with atypical symptoms not manifesting in the classic radicular pattern. Higher index of suspicion by the clinician must be practiced to make the appropriate diagnosis. Successful surgical outcome may be achieved in these patients.
Pediatrics (78)
Authors: Aromaa Minna , Sillanpää Matti , Rautava Päivi , Helenius: Hans
Published: September 2010

Pain experience of children with headache and their families: a controlled study. (University of Turku, Turku, Finland) Pediatrics 2000;106:270–275.

This study reported the pain sensitivity of children with headache and their family members as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age. A representative population‐based sample of 1443 families expecting their first child was followed over 7 years. A screening questionnaire relating to the child's headache was sent to parents of a representative sample of 1132 6‐year‐old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety‐six children (58 migraine and 38 tension‐type headache children) with primary headache and matched controls were included in further examinations. Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. More mothers of tension‐type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension‐type headache children had a poorer family environment; the family atmosphere was more often unhappy and the relationship between parents was more often distant than in families of children with migraines. Conclude that in addition to somatic factors, it is important to consider the child's pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The child's coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management
Pediatrics (79)
Authors: Perquin Christel W. , Hazebroek‐Kampschreur Alice A.J.M. , Hunfeld Joke A.M.
Published: September 2010

Pain children: a common experience. (Erasmus University Rotterdam, Rotterdam, The Netherlands) Pain 2000;87:51–57.

This study analyzed the prevalence of pain in Dutch children from 0 to 18 years of age. A random sample of 1300 children 0–3 years of age was taken from the register of population in Rotterdam, The Netherlands. In the Rotterdam area, 27 primary schools and 14 secondary schools were selected to obtain a representative sample of 5336 children from 4–18 years of age. Depending on the age of the child, a questionnaire was either mailed to the parents (0–3 years) or distributed at school (4–18 years). Of 6636 children surveyed, 5424 (82%) responded; response rates ranged from 64% to 92%, depending on the subject age and who completed the questionnaire. Of the respondents, 54% had experienced pain within the previous 3 months. Overall, a quarter of the respondents reported chronic pain (recurrent or continuous pain for more than 3 months). The prevalence of chronic pain increased with age, and was significantly higher in girls (P < 0.001). In girls, a marked increase occurred in reporting chronic pain between 12 and 14 years of age. The most common types of pain in children were limb pain, headache, and abdominal pain. Half of the respondents who had reported pain reported to have multiple pain, and one‐third of the chronic pain sufferers experienced frequent and intense pain. These multiple pains and severe pains were more often reported by girls (P < 0.001). The intensity of pain was higher in the case of chronic pain (P < 0.001) and multiple pains (P < 0.001), and for chronic pain the intensity was higher for girls (P < 0.001). These findings indicate that chronic pain is a common complaint in childhood and adolescence. In particular, the high prevalence of severe chronic pain and multiple pain in girls aged 12 years and over calls for follow‐up investigations documenting the various bio‐psycho‐social factors related to this pain.
Anesthesia (8)
Authors: Casati Andrea , Fanelli Guido , Beccaria Paolo
Published: September 2010

The effects of the single or multiple injection technique on the onset time of femoral nerve blocks with 0.75% ropivacaine. (University of Milan and IRCCS San Raffaele Hospital, Milan, Italy) Anesth Analg 2000;91:181–184.

This study evaluated the effect of the injection technique on the onset time and efficacy of femoral nerve block performed with 0.75% ropivacaine. A total of 30 patients undergoing arthroscopic knee surgery were randomly allocated to receive femoral nerve blocakade with 0.75% ropivacaine by using either a single injection (Single group, n = 15) or multiple injection (Multiple group, n = 15). Nerve blocks were placed by using a short‐beveled, Teflon‐coated, stimulating needle. The stimulation frequency was set at 2 Hz, and the intensity of the stimulating current, initially set at 1 mA, was gradually decreased to <0.5 mA after each muscular twitch was observed. In the Single group, 12 mL of 0.75% ropivacaine was slowly injected, as soon as the first muscular twitch was observed. In the Multiple group, the stimulating needle was inserted and redirected, eliciting each of the following muscular twitches: contraction of vastus medialis, vastus intermedius, and vastus lateralis. At each muscular twitch, 4 mL of the study solution was injected. Placing the block required 4.2 ± 1.7 min in the Multiple group and 3.4 ± 2.2 min in the Single group (P = 0.02). Onset of nerve block required 10 ± 3.7 min in the Multiple group and 30 ± 11 min in the Single group (P < 0.0005). Propofol sedation was never required to complete surgery; although 0.1 mg fentanyl at trocar insertion was required in 2 patients of the Multiple group (13%) and 9 patients of the Single group (60%) (P = 0.02). Conclude that searching for multiple muscular twitches shortened the onset time and improved the quality of femoral nerve block performed with small volumes of 0.75% ropivacaine.

Comment by Octavio Calvillo, MD, PhD.

This study is concerned with the onset of femoral nerve block utilizing 0.75% ropivacaine in 2 groups of 15 patients undergoing arthroscopic knee surgery. The optimal site for injection was identified by the electrically evoked muscular twitch at the quadriceps. In 1 group, 12 mL of 0.75% ropivacaine was injected as soon as a muscle twitch was evoked. In the second group, 4 mL of local anesthetic was injected only after a specific response was elicited at the vastus medialis, vastus intermedius, and vastus laterallis. Onset of the nerve block required 10 ± 3.7 min. in the multiple injection group, whereas in the single group, onset of the nerve block took 30 ± 11 min. The authors concluded that searching for multiple twitches shortened the surgical anesthesia and improved the quality of neural blockade.
Physical Medicine and Rehabilitation (84)
Authors: Kang Yoon‐Kyoo , Lee Eun‐Ha , Hwang: Miriam
Published: September 2010

Pure trigeminal motor neuropathy: a case report. (Korea University Medical Center, Guro‐gu, Korea) Arch Phys Med Rehabil 2000;81:995–998.

A 38‐year‐old man complaining of progressive weakness and wasting of the right masticatory muscles after a bout of mild cold symptoms is presented in this case report. No sensory symptoms were present. History, neurologic examination, electrophysiologic studies, and magnetic resonance imaging of the brain led to the diagnosis of pure trigeminal motor neuropathy. The cause may have been an autoimmune reaction to a viral infection.

Comment by Miles Day, MD.

This article is a case report of pure trigeminal motor neuropathy. Trigeminal motor neuropathy is defined as a trigeminal motor paralysis accompanied by no trigeminal sensory signs or other cranial nerve involvement. The author described the history of the patient and their work up including examination, laboratory tests, and electro diagnostic examinations, which all pointed to the pure trigeminal motor neuropathy. The strength of this case report is the detailed description of the anatomy of the trigeminal nerve and the muscular innervations of the mandubular branch. The authors attributed the motor neuropathy to a possible post viral infection autoimmune response that predominantly affected the motor division of the trigeminal nerve. They have stressed that all other potential causes of motor neuropathy should be ruled out including malignancy in mass lesions.