The assessment of pain and plasma beta-endorphin immunoactivity in burned children

The need for better analgesia during burn dressing changes (BDCs) in acutely burned children led us to assess pain during BDC with a large 0-10 thermometer-like scale which was well accepted and appeared to reflect the varying degrees of pain that patients experienced. Pain scores were obtained at least once each minute throughout 33 BDCs in 15 patients of 8-17 years. Plasma levels of beta-endorphin immunoactivity (iB-EP) were measured at 5 intervals before and after BDC; mean values (+/- S.E.M.) ranged from 30.5 +/- 4.63 pg/ml (before BDC and analgesic) to 19.2 +/- 3.02 pg/ml (immediately following BDC). The mean pain score (MPS) for each BDC was inversely related to the iB-EP levels of that day (P less than 0.001 with 4 of the 5 iB-EP determinations). The MPS varied directly with the extent of burn injury and inversely with weight; the 2 variables together predicted MPS as well as the iB-EP alone (r2 = 43 and 36% respectively).     

Extraction of cyclic AMP for the determination in the competitive protein binding assay

The changes in free calcium, total calcium, albumin, protein, pH, lactate, sodium, magnesium, and potassium values during and following venous stasis (3 min at an external pressure of 100 mmHg) with and without forearm exercise have been measured. The pattern of changes observed with time were dependent on the presence or absence of forearm exercise. Without exercise significant changes are only observed at l min following stasis and then the increases are only moderate (free calcium 2.0%, total calcium 2.4%, albumin 6.9%, and protein 5.9%). However, when the forearm is exercised, larger increases (free calcium 8.6%, total calcium 8.4%, albumin and protein 12.4%) were observed for all parameters following stasis. These increases took 1 to 3 min to return to baseline for most parameters. Only potassium and magnesium went below baseline during the recovery period. It is recommended that when a tourniquet is used to aid in obtaining venous blood samples for these analytes, exercise of the forearm be avoided. If forearm exercise is unavoidable, then the sample should be obtained 1 to 3 min after release of the tourniquet.     

Acupuncture: an evaluation in the painful crises of sickle cell anaemia

An evaluation of acupuncture for pain relief was made in 10 patients with sickle cell anaemia during 16 pain crises. A model was developed in which the patient served as his own control and in which both patient and examiner were unaware of whether an acupuncture point or a sham site was treated. The results show (1) that pain relief was obtained in 15 of the 16 painful episodes regardless of whether an acupuncture point or a sham site was treated, demonstrating considerable overlap between the effects of needling acupuncture points and sham sites; (2) that needling at acupuncture points for pain relief is not significantly superior to treatment at sham sites; (3) that needling, per se, whether at acupuncture points of at sham sites can be useful for alleviating pain in sickle cell crises. The model could be useful for evaluation of pain relief by needling in other diseases.     

Ketamine analgesia is not related to an opiate action in the periaqueductal gray region of the rat brain

Ketamine is an injectable anesthetic agent that has been shown to interact as an agonist at opiate receptors. In addition, its antinociceptive action in rats is antagonized by the narcotic receptor antagonist naloxone. Thus it was assumed that the anesthetic may activate the pain inhibitory pathway, originating in the periaqueductal gray (PAG) and descending into the spinal cord, in a manner similar to that of narcotics like morphine. In the present study, it was verified that the systemic administration of naloxone (3 mg/kg i.p.) antagonized the elevation in tail-flick latency produced by an anesthetic dose of ketamine (160 mg/kg i.p.), but did not alter the duration of anesthesia (defined as duration of the loss of the righting reflex). However, when naloxone (3 micrograms/0.5 microliter/30 sec) was given by microinjection into the PAG it was found to be ineffective against the ketamine-induced elevation of the tail-flick latency. In contrast, the microinjection of the antagonist significantly attenuated (halved) the elevated latency in response to systemically administered morphine (4 mg/kg s.c.). It was also shown that ketamine was unable to elicit an increase in the latency of the tail-flick reflex when administered directly into the PAG over a wide range (0.10-100 micrograms) of doses. On the other hand, a local anesthetic-like effect of ketamine, known to occur when the drug is used in high concentration, was observed when doses exceeding 0.1 microgram were injected into the PAG. This action interfered with opiate actions in the PAG and made data from the microinjection studies difficult to interpret. The descending, pain inhibitory neuronal system originating in the PAG does not appear to participate in the antinociceptive action of ketamine measured by the tail-flick reflex. Perhaps the drug's effects are associated with alternative opiate mechanisms and/or opiate receptor subtypes not present on the cells of origin of the descending nerves within the PAG.     

Plasma vitamin D-binding globulin in vitamin D deficiency, pregnancy and chronic liver disease.

Plasma concentrations of vitamin D-binding globulin were measured by radial immunodiffusion in healthy subjects, pregnancy, and during oestrogen therapy. Subjects with disorders of vitamin D metabolism (dietary deficiency, malabsorption, anticonvulsant therapy, chronic liver disease) were also studied. Neither sex nor age influenced the plasma vitamin D-binding globulin concentration in healthy subjects, but there was a significant increase in concentration during pregnancy and oestrogen therapy. Elevated levels were found in vitamin D deficient elderly but not younger subjects, while levels in subjects with chronic liver disease were significantly reduced. Normal levels of vitamin D-binding globulin were present in hypervitaminosis D and no vitamin D-binding globulin was detected in human milk. No correlation was observed between plasma 25-hydroxycholecalciferol levels and plasma vitamin D-binding globulin concentrations.     

Plasma normetanephrine measurements for detection of pheochromocytoma in patients with hypertension

We describe a simple and specific radioenzymatic assay for measurement of total plasma normetanephrine (NMN), which is an extension of a previously developed procedure for measuring of urinary NMN. Plasma NMN is deconjugated by acid hydrolysis at pH 1.0 and boiled for 20 min. The assay is based on the conversion of NMN to its N-methylated, tritiated derivative metanephrine (3H-MN), utilizing phenylethanolamine N-methyltransferase and S-adenosyl-[3H]methionine. The assay is rapid, sensitive and results can be obtained in less than 4 h. Many antihypertensive drugs tested did not interfere with the assay. This assay could be used for detection of pheochromocytomas in patients with hypertension.     

Homocysteine and cysteine loads in patients with homocystinuria due to cystathionine synthase deficiency: Effects of vitamin B-6

The metabolic response of patients with homocystinuria due to cystathionine synthase deficiency to oral loads of homocysteine indicates: that even severely affected patients with homocystinuria have pools of cystine in their tissues; that control of sulfur amino acid metabolism favors increased concentrations of methionine rather than homocystine in the plasma; and that even patients who apparently are not B-6-responsive respond differently to the loads of homocysteine when challenged during B-6-treatment compared with their response before B-6 treatment. Loading tests with homocysteine indicate that B-6 treatment be of some benefit even in individuals who do not have an obvious biochemical response to such therapy.     

Hair chromium concentrations in adult insulin-treated diabetics.

Hair chromium concentrations have been measured in age- and sex-matched groups of insulin-treated diabetics and normal controls. Average concentration (+/- S.E.M.) was reduced in female (2.9 +/- 0.5 compared with 5.1 +/- 0.7 nmol/g) but not in male diabetics.     

A simple slide-rule method for the assessment of renal tubular reabsorption of phosphate in man

The activity of renal tubular reabsorption of phosphate in man is best expressed as the ratio of the maximum rate of reabsorption to the glomerular filtration rate (TmP/GFR). A slide-rule method based on existing data is described for the derivation of TmP/GFR from values of phosphate and creatinine concentrations in single samples of plasma and urine. This is a simple method which is suitable both for research and for clinical purposes.     

Direct observation of pain behavior in low back pain patients during physical examination

Trained observers measured the occurrence of 5 behaviors (guarding, bracing, rubbing, grimacing, and sighing) in a group of 80 low back pain patients undergoing physical examination. Bracing was frequently displayed, rubbing, guarding, and grimacing were moderately frequent and sighing was infrequent. Pain behaviors were much more likely to occur when patients were moving than when they were in a static position. The rate of guarding, bracing, and total pain behavior was predicted by physical examination findings and/or number of prior operations. Patients having longer pain histories were also more likely to show guarded movement. Topics for future research in this area are identified, and the utility of behavioral observation for clinicians is discussed.     

A comparison of phantom sensations among amputees whose amputations were of civilian and military origins

436 people experiencing phantom limb pain, whose amputations were unrelated to military service, filled out a survey concerning stump, phantom and other pain problems as well as demographic data. Their responses were compared with responses of American veterans, whose amputations were related to military service, who filled out an identical survey. The experiences of the two groups and the characteristics of the reported phantom sensations were remarkably similar. Treatment effectiveness was equally dismal for both groups with about 1% reporting effective relief.     

Hypercalcitoninemia in infancy.

Immunoreactive calcitonin (iCT) was measured in 19 infants with neonatal hypocalcemia. The infants had a variety of neonatal diseases and stresses. iCT levels were generally elevated to two to 20 times the adult values. Poor correlation existed between the infant age and the level of iCT or between iCT alone and the serum calcium. However, there was significant correlation between the serum calcium and the ratio of the iCT to infant age from conception, suggesting that both infant age and iCT levels in combination may be related to hypocalcemia. Also, it appears that a variety of neonatal stresses may be associated with increased sensitivity to the hypocalcemic effect of iCT, as well as increased levels of iCT.     

The sickness impact profile: a global measure of disability in chronic low back pain

This investigation examines the utility of the Sickness Impact Profile (SIP) for assessing disability associated with chronic pain and presents normative data on a sample of 107 patients experiencing chronic low back pain (CLBP). The results support the validity of the SIP as a measure of functional status with CLBP patients. Specifically, the psychosocial dimension was significantly correlated with the emotional distress categories of the MMPI and the physical dimension score was inversely associated with standing/walking and positively correlated with time spent lying down. In addition, the SIP appears to be a measure with sufficient sensitivity to detect pre-/post-treatment changes. Patients suffering from CLBP show significant impairment in physical, psychosocial, and work and recreational activities. The greatest impairment reported was in the area of work, but disability ratings for recreation, home management, social interaction, emotional behavior, and sleep and rest were also comparatively high. Based upon its reliability, validity, breadth of assessment, and ease of administration, the SIP appears to be well suited for the assessment of patients suffering from chronic pain and evaluating the efficacy of multidisciplinary pain units.