Joint Pain - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

OINT AIN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Joint Pain: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84589-1 1. Joint Pain-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on joint pain. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON JOINT PAIN ................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Joint Pain ...................................................................................... 8 The National Library of Medicine: PubMed ................................................................................ 20 CHAPTER 2. ALTERNATIVE MEDICINE AND JOINT PAIN................................................................ 59 Overview...................................................................................................................................... 59 National Center for Complementary and Alternative Medicine.................................................. 59 Additional Web Resources ........................................................................................................... 63 General References ....................................................................................................................... 70 CHAPTER 3. DISSERTATIONS ON JOINT PAIN.................................................................................. 71 Overview...................................................................................................................................... 71 Dissertations on Joint Pain .......................................................................................................... 71 Keeping Current .......................................................................................................................... 71 CHAPTER 4. PATENTS ON JOINT PAIN ............................................................................................ 73 Overview...................................................................................................................................... 73 Patents on Joint Pain ................................................................................................................... 73 Patent Applications on Joint Pain ............................................................................................... 80 Keeping Current .......................................................................................................................... 88 CHAPTER 5. BOOKS ON JOINT PAIN ................................................................................................ 89 Overview...................................................................................................................................... 89 Book Summaries: Federal Agencies.............................................................................................. 89 Book Summaries: Online Booksellers........................................................................................... 91 Chapters on Joint Pain ................................................................................................................. 92 CHAPTER 6. MULTIMEDIA ON JOINT PAIN ..................................................................................... 95 Overview...................................................................................................................................... 95 Video Recordings ......................................................................................................................... 95 CHAPTER 7. PERIODICALS AND NEWS ON JOINT PAIN .................................................................. 97 Overview...................................................................................................................................... 97 News Services and Press Releases................................................................................................ 97 Newsletter Articles ...................................................................................................................... 99 Academic Periodicals covering Joint Pain.................................................................................... 99 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................. 101 Overview.................................................................................................................................... 101 U.S. Pharmacopeia..................................................................................................................... 101 Commercial Databases ............................................................................................................... 102 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 107 Overview.................................................................................................................................... 107 NIH Guidelines.......................................................................................................................... 107 NIH Databases........................................................................................................................... 109 Other Commercial Databases..................................................................................................... 111 APPENDIX B. PATIENT RESOURCES ............................................................................................... 113 Overview.................................................................................................................................... 113 Patient Guideline Sources.......................................................................................................... 113 Finding Associations.................................................................................................................. 115 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 117 Overview.................................................................................................................................... 117 Preparation................................................................................................................................. 117 Finding a Local Medical Library................................................................................................ 117 Medical Libraries in the U.S. and Canada ................................................................................. 117

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ONLINE GLOSSARIES................................................................................................................ 123 Online Dictionary Directories ................................................................................................... 124 JOINT PAIN DICTIONARY........................................................................................................ 125 INDEX .............................................................................................................................................. 177

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with joint pain is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about joint pain, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to joint pain, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on joint pain. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to joint pain, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on joint pain. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON JOINT PAIN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on joint pain.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and joint pain, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “joint pain” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Symptom Patterns and Comorbidity in the Early Stages of Alzheimer's Disease Source: Journal of the American Geriatrics Society. 42(5): 517-521. May 1994. Summary: This case control study assessed whether patients with early Alzheimer's disease (AD) under-report or over-report symptoms, and compared their comorbidity with patients without dementia. Three groups of patients (mean age 76 years) enrolled in the University of Washington, Seattle, Alzheimer's Disease Patient Registry between April 1987 and July 1991 participated. They included 154 patients clinically diagnosed with AD; 92 patients without dementia, yet complaining of some cognitive impairment; and 129 healthy controls, matched for age and sex. Subjects' medical records for the 2 years prior to registry enrollment were examined. Symptoms suggesting cognitive impairment were evident 7.8 months prior to registry enrollment in 95 percent of the AD cases, in 77 percent of those without dementia, and in 6 percent of the controls. After

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correction for multiple comparisons, only symptoms of cognitive impairment were more frequent in AD cases. However, several common symptoms not suggesting cognitive impairment (e.g., gastrointestinal discomfort, joint pain, vision problems) occurred more often in controls and those without dementia, even though comorbidity was similar among all three groups. Overall, the study shows that persons with AD complain of symptoms clearly related to cognitive impairment early in the course of illness. However, they may under-report common symptoms not suggestive of cognitive impairment, even though their comorbidity is similar to patients without dementia. 4 tables, 25 references. •

Early DMARD Therapy for RA Source: Journal of Musculoskeletal Medicine. 19(10): 395-398, 401-403. October 2002. Summary: This journal article discusses the disease progression of rheumatoid arthritis (RA), the use of medications to control symptoms and stop the disease progression of RA, and the role that primary care physicians can play in diagnosing early RA and managing the symptoms. Disease progression in patients with RA frequently leads to joint destruction, physical dysfunction, and disability. Achieving the best outcomes in patients with RA requires early diagnosis and appropriate initiation of diseasemodifying anti-rheumatic drug (DMARD)therapy. Patients with new onset of inflammatory arthritis are usually treated with NSAIDs. If inflammatory arthritis symptoms do not resolve within 1 to 2 months of onset, most rheumatologists initiate the use of DMARDs to prevent joint damage. Recently introduced DMARDs including leflunomide, etanercept, and infliximib have shown increased short-term effectiveness and long-term improvement. Primary care physicians play an important role in diagnosing early RA and managing its symptoms by detecting new-onset joint pain in patients, determining the likely prognosis of the disease, obtaining rheumatological consultations for patients, and assisting rheumatologists in ongoing assessment of the response to DMARD therapy and possible toxicity. 21 references and 3 tables. (AAM).

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Osteoarthritis of the Hand: Clinical Features and Management Source: Journal of Musculoskeletal Medicine. 14(5):66-68,71-74,77; May 1997. Summary: This journal article for health professionals reviews the epidemiology of and risk factors for osteoarthritis (OA) of the hand, the pathologic and roentgenographic features, and the general and specific characteristics of the various osteoarthritic syndromes affecting the hand. OA is the most common cause of hand joint pain in the elderly. Initial signs and symptoms include joint disfigurement and transient morning stiffness. The distal interphalangeal (DIP) joints and thumb base are affected most often. Joint appearance can change considerably as disease activity increases, changes, and stabilizes. Radiologic hallmarks include joint margin osteophytes, periarticular ossicles, joint-space narrowing, subchondral cysts, and attrition. Specific syndromes include nodal generalized OA, perimenopausal OA, thumb base OA, erosive OA, acutely painful gelatinous DIP joint swelling, and calcium pyrophosphate dihydrate-associated arthropathies. Management ranges from reassurance, heat, exercise, and simple analgesics to splints, nonsteroidal anti-inflammatory drugs, and intra-articular corticosteroid injections. Surgery is rarely needed. 15 references, 4 figures, and 2 tables. (AA-M).

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Arthritis Source: Hippocrates. 10(8):39-40; September 1996.

Studies

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Summary: This journal article for patients with arthritis responds to common questions about the disease and its treatment. It discusses risk factors for arthritis, its warning signs, and what can be done by the physician and the patient to slow the damage. It is explained that excessive body weight, age, heredity, and injury or overuse are contributing factors to arthritis. Joint pain and stiffness, swelling, and a general sickness are all signs of the onset of arthritis. Treatment depends on the type of arthritis. Options involve use of medications to reduce the aching, stiffness, and swelling; physical therapy; splints and braces; and joint replacement surgery. The patient can often help by exercising, practicing good body mechanics, and properly applying heat and cold to relax joint tissues. •

Trigger Points: Diagnosis and Management Source: American Family Physician. 65(4): 653-660. February 15, 2002. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the diagnosis and management of trigger points. Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area or cause radiation of pain toward a zone of reference and a local twitch response. Predisposing and perpetuating factors in chronic overuse or stress injury on muscles must be eliminated if possible. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy, and injection, are used to inactivate trigger points. Trigger point injection has been shown to be one of the most effective treatment modalities to inactive trigger points and provide prompt relief of symptoms. The article discusses trigger point injection in terms of preinjection considerations, needle selection, injection solutions, injection technique, and post injection management. 3 figures, 4 tables, and 20 references. (AA-M).

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Treating Pain With COX-2 Inhibitors Source: Nurse Practitioner, The. 24(11): 95-96,99-100,102. November 1999. Summary: This journal article provides nurses with information on treating pain with cyclooxygenase-2 (COX-2) inhibitors, a new class of nonsteroidal anti-inflammatory drugs (NSAIDs) that have been associated with low rates of gastrointestinal bleeding. The article discusses COX-2 inhibitors in terms of their clinical pharmacology, pharmacokinetics, clinical studies, clinical indications, contraindications, drug interactions, adverse reactions, dosing and administration, and cost. Celecoxib and rofecoxib, two COX-2 inhibitors approved by the Food and Drug Administration, inhibit prostaglandin E2 synthesis, mainly by inhibiting COX-2. For celecoxib, steady state conditions are reached on or before day 5 with multiple dosing, whereas for rofecoxib,

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steady state conditions are reached by day 4 with multiple dosing. Both drugs are eliminated by hepatic metabolism. Clinical studies have shown that compared with placebo, both drugs significantly reduced joint pain in patients with osteoarthritis (OA). Celecoxib is used for treating OA and rheumatoid arthritis (RA), and rofecoxib is used to treat OA and primary dysmenorrhea. Both drugs are contraindicated in patients who have known hypersensitivity to them. Celecoxib should be used in low doses in patients who are taking fluconazole. Rofecoxib in a daily dose of 25 milligrams (mg) should be considered in patients who are taking rifampin. Patients who are taking COX-2 inhibitors should avoid aspirin if possible. The most common adverse reactions to rofecoxib have been upper respiratory infection, diarrhea, nausea, and headache. Adverse reactions to celecoxib include gastrointestinal symptoms. The recommended oral dose of celecoxib for OA is 200 mg or 100 mg twice daily. For RA, the recommended daily oral dose of celecoxib is 100 mg to 200 mg twice daily for adults. The recommended starting dose for rofecoxib is 12.5 mg orally once daily for treatment of OA and 50 mg once daily for the management of acute pain and treatment of primary dysmenorrhea. COX-2 inhibitors are more expensive than other NSAIDs, so they are not considered frontline drugs for patients with newly diagnosed OA. In addition, the article comments on the use of the COX-2 inhibitors during pregnancy. 17 references. •

Your Heritage, Your Health Source: Arthritis Today. 13(1): 41-45. January-February 1999. Summary: This journal article provides people who have arthritis with information on the role of race or culture in the development of musculoskeletal and rheumatic diseases. Researchers have established links between racial groups and several arthritisrelated conditions. The discovery of the familial Mediterranean fever (FMF) gene in 1998 is giving researchers a clue as to the cause of this disease. However, the genetic links are not likely to be as direct in other forms of arthritis and related conditions. For most forms of arthritis, there may be many genes involved and not all people with the disease have all of the genes. Despite the complexity and unpredictability of genetics in arthritis, researchers are making some progress. During the mid-1970s, researchers first discovered that rheumatoid arthritis is associated with a genetic marker called human leukocyte antigen DR4. Researchers are finding links between race and conditions such as lupus, scleroderma, and ankylosing spondylitis. Although genetics are involved in many musculoskeletal and rheumatic diseases, researchers believe that environmental or lifestyle factors also have an important role. For example, Kashin-Beck disease (KBD), which stunts growth in children and causes chronic joint pain and swelling in adults, affects about one in 10 people living in farming communities in the Tibetan plateau across China to Siberia. The article discusses the challenges facing researchers who study disease risk by population and identifies the benefits of understanding why certain populations get certain diseases.

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Clinical Features and Differential Diagnosis of RA Source: Journal of Musculoskeletal Medicine. 18(11): 529-531,534-537. November 2001. Summary: This journal article, the second in a series of articles on the diagnosis and management of rheumatoid arthritis (RA), provides health professionals with information on the clinical features and differential diagnosis of RA. This chronic, usually progressive, systemic inflammatory disease is characterized by joint pain, swelling, and myriad extraarticular manifestations. The mode of onset of RA is quite variable. In most cases, joint involvement develops gradually over several weeks to months. Early in the disease process, the course is typically one of fluctuating disease

Studies

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activity. The clinical manifestations of RA vary with the joints involved and the aggressiveness and duration of the disease. For most patients, symptoms are most pronounced in the morning. Morning stiffness in and around the joints, lasting at least an hour before maximal improvement, is a typical symptom of RA. RA can affect any synovial joint. In addition to the small joints of the hands, wrists, knees, and feet, the disease may affect the elbows, shoulders, sternoclavicular joints, hips, and ankles. Although the course of RA is somewhat individualized, RA is associated with significant loss of function in most patients because of pain, loss of motion, and systemic symptoms. RA has been associated with a range of systemic features, most of them suggestive of a poor prognosis. Subcutaneous nodules are a classic feature of RA. Other extra-articular manifestations may be vascular, ocular, cardiac, pulmonary, renal, or neurologic. Correct diagnosis of RA early in the disease is believed to be the key to effective treatment. An improved understanding of the clinical features can facilitate its diagnosis. Elements of a thorough patient evaluation include the history, a physical examination that emphasizes the musculoskeletal system, and laboratory and radiographic assessments. The differential diagnosis of RA includes systemic lupus erythematosus, psoriatic arthritis, and viral syndromes. 9 figures, 3 tables, and 8 references. (AA-M). •

Carpometacarpal pain: Is It Osteoarthritis? Source: Journal of Musculoskeletal Medicine. 17(12): 744-747,751-753. December 2000. Summary: This journal article, the sixth in a special series on the diagnosis and management of musculoskeletal problems in women, provides health professionals with information on the diagnosis and management of carpometacarpal (CMC) pain. Osteoarthritis (OA) of the CMC joint of the thumb targets postmenopausal women. Generalized ligamentous laxity appears to be a predisposing factor. This may be related to the presence of estrogen receptors on the ligaments. Patients present with tenderness over the CMC joint, pain, and limited mobility. Some people may have CMC joint pain without radiographic changes, whereas others may have severe deformity and radiographic changes with minimal symptoms. With advanced disease, the metacarpal flexes and adducts, the joint subluxates, and the metacarpal base becomes prominent. Axial loading and rotation characteristically reproduces symptoms and causes crepitus. Grip strength may be compromised. Early radiographic evidence of OA includes joint space widening. This is followed by subchondral sclerosis, cysts, and joint space narrowing. Most patients can be treated conservatively with rest, avoidance of aggravating activities, and splinting. Injections of corticosteroid mixed with anesthetic may provide some respite from acute symptoms. No more than three injections should be given, and they should be spaced 3 to 4 months apart. More advanced disease may require surgery. 5 figures, 2 tables, and 15 references. (AA-M).

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Osteoarthritis Source: Rheumatic Disease Clinics of North America. 25(2): i-xiii, 257-488. May 1999. Summary: This journal provides health professionals with information on osteoarthritis (OA). The articles can be grouped into the broad categories of the etiopathogenesis of OA, new approaches to treatment, and evaluation of outcome measures proposed for assessing the efficacy of disease-modifying OA drugs. (DMOADs). The first article in the etiopathogenesis category focuses on the role that crystals may have in articular cartilage damage in OA. The next reviews the possible role of nitric oxide (NO) in articular cartilage damage in OA by describing current understanding of the role of NO in cartilage biology and pathophysiology and summarizing the results of various lines

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of research. Other contributions in this category deal with the role of muscle weakness and proprioceptive defects in the pathogenesis of OA and the possible effects of dietary deficiencies, including deficiencies of vitamins C and D, as possible originating factors. Articles devoted to treatment begin with an overview of gene therapy for OA. Another article that reviews the evidence supporting the contention that intra-articular hyaluronan therapy may relieve joint pain is followed by an article devoted to the design of new nonsteroidal anti-inflammatory drugs with very high selectivity against the inducible isoform of cyclooxygenase, Cox-2, relative to their activity against the constitutive cyclooxygenase isoform, Cox-1. Another contribution reviews the controversial use of glucosamine and chondroitin sulfate to relieve OA symptoms. The final article in the treatment category focuses on the importance and effectiveness of exercise regimens in the managing patients with OA. Articles in the category concerned with the evaluation of outcome measures in studies of DMOADs focus on serum markers of articular cartilage damage and repair, synovial fluid markers in OA, magnetic resonance imaging, and plain radiography as an outcome measure in clinical trails involving patients with OA of the knee. 29 figures, 15 tables, and numerous references.

Federally Funded Research on Joint Pain The U.S. Government supports a variety of research studies relating to joint pain. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to joint pain. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore joint pain. The following is typical of the type of information found when searching the CRISP database for joint pain: •

Project Title: AEROBIC OSTEOARTHRITIS

EXERCISE

INTERVENTION

FOR

KNEE

Principal Investigator & Institution: Kaufman, Kenton R.; Professor of Bioengineering; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-MAR-2006 Summary: (provided by applicant): Arthritis is one of the most common causes of functional limitation and dependency in the United States. Individuals with osteoarthritis restrict joint motion and limit activity in order to decrease their symptoms. Traditional, conservative medical treatment of osteoarthritis has been directed at improving functional status through reducing joint pain and inflammation and 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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maintaining or restoring joint function. Exercise as an adjunct therapy in the clinical management of patients with osteoarthritis of the knee, however, is not uniformly accepted. In contrast, exercise has been shown to be effective for prevention and treatment of cardiovascular and metabolic disorders. Standard guidelines exist for aerobic exercise prescriptions. The focus of this study is to determine if these guidelines can also be applied to individuals with knee osteoarthritis. Patients with knee osteoarthritis will be randomized into a control group, a walking exercise group, and a stationary cycling exercise group. The individuals in the exercise groups will be required to exercise three times per week for one year using emerging public health recommendations for aerobic exercise in the adult and aging population. Patient outcome will be assessed using objective gait analysis measurements, knee radiographs to quantify joint space narrowing, magnetic resonance imaging, a general health status questionnaire (SF-36), a disease/site specific questionnaire (WOMAC), and a visualanalog pain scale. All subjects will be studied at 0 and 52 weeks. The central hypothesis of this work is that aerobic exercise can be successfully implemented as an effective nonsurgical option for treatment of patients with early stages of knee osteoarthritis. In order to evaluate this hypothesis, the following specific aims are proposed: Specific Aim 1: Determine the effect of aerobic exercise on patients with knee osteoarthritis. Hypothesis A: Clinical Outcome measures will be better in patients enrolled in exercise programs that in control patients. Hypothesis B: Quantitative measures of lower extremity function will not decline over time in an effective aerobic exercise program. Specific Aim 2: Determine prognostic factors that effect outcome in patients with knee osteoarthritis. Hypothesis: A effective exercise prescription for adults with degenerative joint disease is dependent on knee compartment involvement, CIA stage, BMI, and type of exercise prescribed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ARTHRITIS

BLOOD-TO-CNS

DRUG

UPTAKE

IN

PAIN/RHEUMATOID

Principal Investigator & Institution: Davis, Thomas P.; Professor; Pharmacology; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2004; Project Start 05-AUG-1997; Project End 28-FEB-2009 Summary: (provided by applicant): RHEUMATOID ARTHRITIS (RA) is a chronic disease that affects two to three million Americans and is three times more prevalent in women than in men. While RA typically occurs in people twenty to fifty years old, children and the elderly can also develop RA. Every year, $65 billion is spent on medical costs, lost income, and lost productivity for patients suffering from musculoskeletal conditions such as RA. ARTHRITIC PAIN (AP) is a dominant symptom of RA. To date, studies of CNS drug uptake across the blood-brain barrier (BBB) have been carried out in naive (i.e., nondiseased) animals, despite the fact that studies have shown that central and peripheral inflammation modulates BBB function (i.e., permeability) and endothelial cell cytoarchitecture. The proposed studies will meld two areas of expertise already present in our laboratory: drug delivery to the CNS and assessment of biochemical and molecular alterations of the blood-brain barrier. The goal of this proposal is to investigate the effects of AP (using an acute arthritis pain rat model) versus RA (using a chronic RA rat model) on CNS drug uptake (i.e., BBB permeability) and endothelial cell structure and to ultimately differentiate between the effects of AP and RA on CNS delivery of opioid analgesics. Additionally, the influence of RA (a chronic disease state involving the joints) on CNS uptake of drugs used to treat RA itself will be assessed. These studies are clinically relevant since disease-associated BBB

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permeability increases could be a factor in the CNS toxicity sometimes observed following administration of opioids and RA drugs to patients. Our hypothesis is that functional changes in the transport of substances (including opioid analgesics and RA drugs) into the brain will occur due to alterations in the biochemical and molecular structure of the BBB caused by the release of pain/disease mediators during AP and RA. This study will allow us to differentiate between acute joint pain (AP) effects on the BBB and chronic disease (RA) effects on the BBB in terms of drug delivery and the mechanisms by which delivery is altered. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRAIN STEM MECHANISMS MEDIATING THE NOCICEPTIVE PRESSOR RESPONSE Principal Investigator & Institution: Felder, Robert B.; Professor; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2002 Summary: The goal of this proposal is to determine the role of the lateral parabrachial nucleus (LPBN) in mediating the cardiovascular responses to pain. Noxious stimulation typically elicits increases in arterial blood pressure and heart rate. These responses are mediated by nociceptive and cardiovascular centers in the brain stem. Recent anatomical and electrophysiological studies point to the LPBN as the major projection site for nociceptive inputs from lamina I and lamina II neurons in the spinal cord and the spinal trigeminal sensory nucleus in medulla. Moreover calcitonin gene-related peptide (CGRP) and substance P (SP), neuropeptides prominently involved in sensory afferent and nociceptive pathways, are present in LPBN and have been implicated in ascending pain pathways. These studies will use single cell electrophysiological recording techniques, recordings of arterial pressure, heart rate and sympathetic nerve activity, and functional neuroanatomy (c-fos) to determine the role of the LPBN in mediating the nociceptive pressor response by stimulating the trigeminal afferent system which has a discrete termination site in caudal medulla and well defined projection pathways to LPBN. The influence of the solitary tract nucleus (NTS) will also be examined, though existing data suggest a secondary role for NTS in this process. Finally, the interactions of baroreceptor afferent signals with noxious inputs will be determined at LPBN and at the rostral ventrolateral medulla (RVLM), the medullary sympathetic outflow site for the pressor response. The trigeminal afferent system mediates a number of important clinical pain syndromes, including migraine headache, the headache of arachnoid hemorrhage, trigeminal neuralgia, temporal mandibular joint pain and corneal and oral cavity pain. Thus, a better understanding of the central neural mechanisms mediating cardiovascular responses to noxious trigeminal stimulation may ultimately lead to new management strategies for patients with these clinical syndromes. In addition, these findings will contribute to the basic understanding of the central link between nociceptive afferent signals and cardiovascular regulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHANGE: MAINTENANCE

AN

INTERVENTION

TO

INCREASE

EXERCISE

Principal Investigator & Institution: Moore, Shirley M.; Associate Professor and Associate Dean; None; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-MAR-2000; Project End 29-FEB-2004

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Summary: Cardiac rehabilitation (CR) following an acute cardiac event has been shown to increase cardiovascular functional capacity, decrease myocardial demand, and improve blood pressure control, weight control, and lipid levels. However, continued exercise is required to sustain these effects. Yet only 30 to 60% of individuals are still exercising at 6 months after the completion of the CR program. Using a randomized clinical trial, this study will test an intervention to increase individuals' exercise maintenance following a CR program. Titled "Change Habits by Applying New Goals and Experiences" (CHANGE), the intervention consists of five small- group counseling and behavior modification sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies. The study questions are: 1. Does the CHANGE intervention improve exercise maintenance of women and men during the year following completion of a cardiac rehabilitation program? 2. Do the effects of the intervention on exercise maintenance during the first year following completion of a CR program differ by gender? 3. Does the CHANGE intervention extend the time individuals continue an exercise maintenance regimen during the year following completion of a CR program for women and for men? 4. Do the effects of the intervention hold when controlling for the effects of covariates: age, body fat, heart failure, co-morbidity, angina, muscle or joint pain, depression, and social support? 5. Do problem-solving skills, motivation, health beliefs, and self-efficacy mediate the effects of the intervention on exercise maintenance? 6.What are the acceptability and resource requirements of the CHANGE intervention? Two hundred and eighty individuals (140 men and 140 women) who are recovering from a myocardial infarction, coronary artery bypass graft surgery or angioplasty will be randomly assigned to the CHANGE intervention or the usual CR program. Measures of exercise maintenance (number of minutes exercised over the study period, number of minutes exercised within the target heart rate zone, mean number o~ exercise sessions per week, and metabolic equivalents (METS) expended) will be taken for 1 year following completion of a CR program and compared. Exercise will be measured using heart rate wristwatch monitors, exercise diaries, & a 7-Day Recall Survey. The effect of the covariates age, body fat, heart failure, co-morbidity, angina, muscle or joint pain, depression, adherence to other cardiac risk factor modification behaviors and social support will be assessed. Problem-solving skills, motivation, health beliefs about exercise, and exercise self-efficacy also will be measured before and after the intervention is applied. Analyses will examine the effects of the CHANGE intervention over time in both men and women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL EVALUATION OF BOTANICAL DIETARY SUPPLEMENT Principal Investigator & Institution: Derman, Richard J.; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: The overall objectives of this project are to conduct Phase I and II clinical trials of black cohosh (Cimicifuga racemosa) and red clover (Trifolium pratense), to be used for women's health problems-for menopausal hot flashes (primarily) and other somatic symptoms. Observational and epidemiological studies demonstrated that black cohosh is effective for menopausal women, and safe (at least in short-term). Phase I: The aims of this study is to determine safe doses (acute toxicity) of extracts of both botanicals, to be used in the subsequent Phase II clinical trial. Three doses will be tested over a one-week period in an attempt to determine symptoms of acute toxicity. There will be 5 subjects for each of 3 dosages (1X, 2X, 3X) of the 2 botanicals. (N=30) The goal is

12

Joint Pain

a sample size large enough to estimate unknown parameters Also studied will be pharmacokinetics (hourly bloods) absorption, distribution, metabolism, elimination, and pharmacological mode of action and side effects in healthy menopausal women. Phase II: This is a one year, randomized, controlled, double-blind efficacy study, the primary aim of which is to evaluate the efficacy of black cohosh and red clover, over a "safe dose range," for menopausal hot flashes. Additional goals are to assess these botanicals for other menopausal symptoms such as insomnia, joint pain, vaginal dryness, and dyspareunia (using Kupperman Index, bleeding scales and index of sexual function). They will also assess longer-term risks and safety issues and to determine changes in biomarkers (such as bone turnover and lipids) associated with use of these botanicals. Most previous studies of black cohosh lasted at most 6 months. Longer-term (1-year) safety data will be evaluated. In particular, incidence of endometrial hyperplasia, breakthrough bleeding, and other side effects will be determined. Subjects (n=112) will be randomized into one of 4 treatment groups (28/gr): placebo, Prempro 0.625/2.5, black cohosh and red clover. Also they will take blood samples to measure DNA oxidation products for measurements of DNA strand breaks using the comet assay to determine if DNA in peripheral blood leukocytes is being protected from damage through the antioxidant properties of the 'active' compounds or whether DNA damage is being produced (indicator of toxicity). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE INTERVENTION FOR CFS

BEHAVIORAL

STRESS

MANAGEMENT

Principal Investigator & Institution: Antoni, Michael H.; University of Miami-Medical Box 248293 Coral Gables, Fl 33124 Timing: Fiscal Year 2002 Summary: The proposed 5-year study examines the effects of a cognitive behavioral stress management (CBSM) intervention (including relaxation training and cognitive restructuring) on physical health status and illness burden in 150 (after attrition) patients diagnosed with Chronic Fatigue Syndrome (CFS). The study tests the efficacy of a conceptual model which holds that the interaction of psychological factors (distress and depression associated with either CFS related symptoms or other stressful life events) and immunologic dysfunction (elevations in cytokines such as tumor necrosis factor [TNF]-alpha and the macrophage activation marker, neopterin) contribute to: (a) the exacerbation of physical symptoms associated with CFS (e.g., fatigue, joint pain, fever) and subsequent increases in illness burden (operationalized as disruptions in daily activities due to fatigue and related physical symptoms); and (b) further dysfunction in the immune system (e.g., impaired lymphocyte proliferative responses to phytohemagglutinin [PHA] and natural killer cell cytotoxicity [NKCC]). The proposed revised study tests this model experimentally by first evaluating the effects of a 10 week group CBSM intervention upon the primary health outcome variables: physical health status (CFS symptoms), fatigue severity, CFS-related illness burden and functional quality of life. Secondly, this study examines the role of two sets of hypothesized mediator variables: (l) reductions in psychological distress and depression levels; and (2) immune system modulation (less impaired NKCC and PHA responsivity, lowered TNFalpha peptides and TNF-type II receptors in serum, reduced neopterin levels, reduced numbers of lymphocyte subsets expressing activation markers). To bring about these effects the intervention is hypothesized to directly modulate a set of psychosocial intervention targets that we hypothesize will influence the mediator variables. These intervention targets include reductions in distorted cognitive appraisals, greater use of

Studies

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active and engaging coping strategies, increased coping self-efficacy and increased perceptions of social support provisions. This is a randomized experiment with a 12week CBSM (plus education and standard care) condition vs. an Education plus standard care (ED/SC) control condition, At the end of the 12-week CBSM intervention, the experimental group will continue on a standard of care regimen and will be monitored for their adherence to the techniques learned in the CBSM intervention and for intercurrent medical treatment. At the end of the 12-week ED/SC period the control group will be subsequently monitored as they continue on their standard of care. We will follow subjects at 6 and 12 months post-CBSM to assess treatment carryover and to correlate prospectively pre-post CBSM changes in mediator and health outcome variables measured at these follow-up points. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORTICAL PATHOPHYSIOLOGY OF PAIN Principal Investigator & Institution: Apkarian, Apkar Vania.; Associate Professor; Physiology; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2003; Project Start 01-MAY-1996; Project End 31-MAY-2007 Summary: (provided by applicant): This is a competitive renewal application where we propose to study cortical network differences between neuropathic and inflammatory chronic pain conditions, and determine the re-organizational properties of these networks as a function of time and of therapy. In the last funding cycle we developed noninvasive brain imaging techniques tailored specifically to study clinical pain conditions. With these tools we studied two populations of chronic neuropathic pain conditions, and showed that the brain network underlying chronic pain is distinct from that of acute pain, that it may be reorganizing in time and also undergoing a neurodegenerative process. In this cycle 3 groups of chronic pain patients are studied, compared and contrasted to matched normal volunteers: chronic inflammatory or neuropathic back pain (CLBP), chronic post herpetic neuropathy (PHN), and chronic osteoarthritic knee joint pain (OAP). In Aim 1 we determine the cortical network underlying ongoing, spontaneously fluctuating, pain perception in chronic neuropathic and inflammatory conditions, by comparing fMRI results between CLBP, PHN, & OAP. In Aim 2 we determine the cortical network underlying stimulus-evoked chronic neuropathic and inflammatory conditions, by comparing fMRI results for tactile allodynia in PHN to joint stimulation-evoked pain in OAP. In Aim 3 we attempt to find a causal link between brain gray and white matter density decreases and gray and white matter chemical decreases, mainly of N-acetylaspartate (NAA), as a result of chronic pain, differentiating between neuropathic and inflammatory conditions. These entail MRI-based morphometric studies, MRI spectroscopic measures of brain gray matter and white matter chemistry, and water diffusion based studies of white matter tracks. These studies are done in a cross-sectional and longitudinal design. In Aim 4 we study the reversibility of cognitive deficits, chemical concentration decreases and gray matter density decreases in OAP and PHN patients before and after pain therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ESTROGEN AND INFLAMMATION IN TMD PAIN Principal Investigator & Institution: Bereiter, David A.; Research Professor; Rhode Island Hospital (Providence, Ri) Providence, Ri 029034923 Timing: Fiscal Year 2002; Project Start 01-SEP-1998; Project End 30-JUN-2007

14

Joint Pain

Summary: (provided by applicant): Arthritis and musculoskeletal disorders, including temporomandibular joint disorders (TMD), are chronic pain conditions that occur more frequently in women of reproductive age than men. Current status of the neural mechanisms of articular pain has relied mainly on experimental models of the knee or ankle joint. However, organizational differences between trigeminal and spinal systems suggest the mechanisms that mediate deep craniofacial pain cannot be fully understood from results obtained by other models of joint pain. The proposed experiments use an animal model to study nociceptive signaling from the temporomandibular joint (TMJ) by neurons in the lower trigeminal brainstem under naive conditions and during chronic inflammation. The overall goal of this study is to test the hypothesis that sex steroid hormones influence central neural processing of sensory signals arising from TMJ region. Aim 1 determines if sex steroid replacement therapy (estrogen and progesterone) modifies neural activity evoked by stimulating the TMJ. Aim 2 determines if sex steroids act through glutamate receptors to modify processing of nociceptive signals from the TMJ. Aim 3 determines if mitogen-activated protein (MAP) kinase, a transduction pathway shared by estrogen and nerve growth factor, contributes to processing of nociceptive signals from the TMJ. Three approaches are used to provide converging lines of evidence: c-fos immunocytochemistry determines neural population responses at single cell resolution, microdialysis determines amino acid transmitter release and electrophysiological recording determines the properties of individual trigeminal neurons that encode sensory input from the TMJ region. This information may lead to a better understanding of how the brain integrates pain-like signals relevant for TMD in women Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GLUCOSAMINE, ATHEROSCLEROSIS

PROTEOGLYCAN

SYNTHESIS

AND

Principal Investigator & Institution: Tannock, Lisa R.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 18-JUN-2001; Project End 31-DEC-2003 Summary: (APPLICANT'S ABSTRACT): Glucosamine is a nutritional supplement commonly used for the relief of joint pain. However, it is not subject to FDA regulation and its long-term safety is unknown. Glucosamine is used in the synthesis of glycosaminoglycan chains on proteoglycans. Vascular proteoglycans play a key role in atherogenesis due to their retention of atherogenic lipoproteins in the arterial wall. Thus, glucosamine use could potentially be atherogenic. Previous studies have yielded conflicting results with respect to the atherogenic potential of glucosamine. Some studies have suggested that glucosamine may have pro=atherogenic effects, while others suggest an anti-atherogenic effect. This grant proposes to investigate the role of glucosamine in vascular. proteoglycan biosynthesis and lipoprotein retention in vitro, andin vivo. The major hypothesis of this grant is that glucosamine supplementation will result in altered proteoglycan synthesis by vascular-smooth muscle cells, which will in turn result in an altered propensity to atherosclerosis. Depending on the nature of these altered vascular proteoglycans, glucosamine supplementation could either enhance susceptibility to, or protect against, atherosclerosis. This grant proposes to study the effect of glucosamine supplementation on the structure and function of proteoglycans synthesized by monkey aortic smooth muscle cells in vitro. Studies will be performed to determine the effect on-degree of sulfation, size, and ratio of classes of proteoglycans synthesized by vascular smooth muscle cells, and the retention of atherogenic lipoproteins by these altered proteoglycans. In addition, this grant proposes to address

Studies

15

the effect of glucosamine supplementation in vivo. LDL receptor deficient mice, a mouse model of atherosclerosis that has a human-like lipoprotein profile, will be supplemented with oral glucosamine, and the extent of atherosclerotic lesions will be determined. The findings from the proposed study should provide important insights into the potential effects of glucosamine supplementation on atherosclerotic cardiovascular disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERVENTIONS WHEELCHAIRS

FOR

SCI

SHOULDER

FUNCTION

IN

Principal Investigator & Institution: Mulroy, Sara J.; Director; Los Amigos Research/Education Institute Education Institute, Inc. Downey, Ca 90242 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: (verbatim from the application) Today, the increased longevity and mobility of individuals with spinal cord injury (SCI) has led to disabling shoulder pain becoming a significant clinical problem which has been related to the demands of wheelchair propulsion (WCP). The goal of this project will be to develop guidelines for the reduction of the demands on the shoulder during WCP for persons with SCI. Specifically, the aims are to determine the effects of changes in the horizontal wheelchair seat position and a muscle strengthening exercise intervention on the shoulder joint forces and muscle activity during WCP in persons with paraplegia and tetraplegia from complete SCI. Subjects with SCI who are asymptomatic for shoulder joint pain and those who report shoulder pain during WCP will be tested. Participants will be grouped according to SCI level of injury (paraplegia, C7 tetraplegia and C6 tetraplegia). Subjects will wheel their chairs, on a wheelchair ergometer in three horizontal seat positions at free and fast velocities and on a simulated 8 percent incline. Subjects will maintain fixed velocities in the three seat positions for each propulsion condition. Function of the supraspinatus, infraspinatus, sbscapularis, anterior and middle deltoid, serratus anterior, sternal pectoralis major, middle and lower rapezius and rhomboid major will be recorded with dynamic EMG using intramuscular fine wire electrodes. Motion of the shoulder, elbow and wrist joints will be measured with the Vicon Motion Analysis System. WCP forces will be recorded with a strain gauge instrumented wheel. Maximal isometric shoulder elevation in the sagittal and scapular planes (scaption), shoulder adduction and internal and external rotation torques will be measured with a LIDO dynamometer. A sub‑group of the subjects will participate in a 12 week shoulder muscle strengthening and flexibility exercise program. Those subjects who do not participate in the exercise program will serve as a control group. Both exercise and control subjects will return every three weeks for strength assessment. The strength and propulsion tests will be repeated for all subjects at the end of the 12 week period. The data will be analyzed to compare the shoulder joint forces, moments, patterns of muscle activity and reports of shoulder pain during WCP in the three seat positions and before and after the exercise program. Statistical significance of the findings will be determined by repeated measures MANOVA analyses with grouping factors for SCI level and exercise/control groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENSTRUAL CYCLE EFFECTS ON TMD PAIN AND OTHER SYMPTOMS Principal Investigator & Institution: Leresche, Linda A.; Research Professor; Oral Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105

16

Joint Pain

Timing: Fiscal Year 2002; Project Start 20-SEP-1998; Project End 19-SEP-2004 Summary: Temporomandibular disorders (TMD's) are musculoskeletal pain conditions characterized by pain in the muscles of mastication and/or the temporomandibular joint. These pain problems are about twice as common in women as in men in the community, and prevalence peaks during the reproductive years. About 80 percent of patients treated in tertiary care settings are women. The investigators propose a 5-year program of clinical epidemiologic and experimental research to examine the possible interactive influences of hormonal status, other gender factors in pain sensitivity, the presence of non-TMD somatic symptoms and psychological distress on TMD pain in women. Study 1 will assess variations in self report of clinical TMD pain, other physical symptoms and psychosocial state in relation to hormonal status across three consecutive ovulatory menstrual cycles for normally cycling female TMD patients, as well as appropriate comparison groups (male TMD patients, female TMD patients who use oral contraceptives and normally cycling pain-free females controls). Studies 2 and 3 will assess variability in responses to standardized experimental pain stimuli at critical points (menses, ovulatory, mid-luteal and late luteal/premenstrual phases) across three consecutive ovulatory cycles in female TMD cases and appropriate controls, to ascertain the extent to which variability and level of pain experience may be attributable to female gender, hormonal status, experience of pain during the menstrual period (i.e., dysmenorrhea) and/or presence of clinical TMD pain. Study 4 assesses clinical pain, pain in response to palpation of muscles of mastication and the temporomandibular joint, psychosocial variables and hormonal status during each trimester of pregnancy, as well as postpartum in TMD cases and age-matched controls. Finally, Study 5 compares hormone levels, pain report and psychological factors over the menstrual cycle in women diagnosed with joint pain only and women diagnosed only with muscle pain. Thus, the proposed studies will: 1) provide important descriptive information concerning the course of clinical pain across the menstrual cycle and during pregnancy; 2) illuminate relationships between clinical pain, generalized pain sensitivity, psychological state, gender and hormonal status; and 3) explore whether central or peripheral mechanisms may be involved in pain-hormone relationships. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MUSIC AND CHRONIC PAIN: A CLINICAL TRIAL Principal Investigator & Institution: Siedlecki, Sandra L.; None; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 28-AUG-2002 Summary: Chronic non-malignant pain (CNMP) affects millions of individuals and results in powerlesssness, depression, and disability. Pharmacological interventions have unpleasant side effects and provide only partial relief. The purpose of this experimental study is to examine and compare the effects of two music interventions on power, pain, functional disability, and depression in individuals with CNMP. Ninety adults who have experienced back, neck, and/or joint pain for more than six months will be randomly assigned to one of three groups. The pattern-healing music (PMH) group will use self-selected music and music-listening techniques based on selfevaluation of comfort and mood. The standard music (SM) group will use relaxing instrumental music provided by the researcher, and the control group will receive no music. It is posited that perceived pain, depression, and functional disability will decrease in both music groups, that it will decrease more in the PHM group, and that this effect will be mediated by power. The McGill Pain Questionnaire Short-form, the Pain Disability Index, the Center for Epidemiological Studies Depression Scale, and the

Studies

17

Power as Knowing Participation in Change Tool will used to examine the effect of the music interventions. One-hour music interventions will be self-administered once a day, for seven consecutive days and data will be recorded at baseline, day 7, and day 21. Analysis of covariance will be used to test the hypotheses. If providing a music intervention decreases pain, depression, and the functional disability associated with CNMP this will result in improved quality of life for a large population who currently have limited treatment choices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GANGLIA

RECOMBINANT

HERPES

INJECTION

INTO

TRIGEMINAL

Principal Investigator & Institution: Yeomans, David C.; Assistant Professor; Anesthesia; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Head cancer pain, trigeminal neuralgia, migraine headache, dental pain and temporomandibular joint pain are all examples of pain syndromes that are unique to the trigeminal system. In many instances, these pain types are hard to treat clinically, with last-line opiates working only marginally well in some instances, and not at all in others. In addition, the tolerance and addiction potential of strong, systemic opioids sometimes limit the duration over which they can be used effectively. Thus, there is a need for novel approaches to the treatment of trigeminal pain. We have previously demonstrated the potential of using replication-defective herpes viral constructs to alter the function of pain-sensing nerve cells, such that we have been able to produce robust, highly localized analgesia for months after a single application. In doing this we have applied the virus locally to targeted tissues, such as skin. Doing so, we have observed a very long-lasting (> 20 weeks) attenuation of pain responses limited to those areas treated with the virus. In many trigeminal syndromes however, pain is relatively diffuse or multicentered. Applications of vectors to peripheral tissues may be of limited utility in these cases, as a more widely distributed analgesic effect is desirable. One method that has not yet been investigated would be to inject vectors directly into the trigeminal ganglia, the grouping of neurons that make up the cell bodies of the sensory nerves of the trigeminal. In doing this, we would expect to introduce recombinant vectors over a wide distribution of trigeminal neurons, and thus, potentially, producing a widespread analgesic effect. The experiments described here will provide evidence as to whether direct trigeminal injection of recombinant herpes vectors, encoding genes for analgesic peptides, will alter the sensitivity to nociceptive stimulation of tissue innervated by the trigeminal. In so doing, we hope to provide initial support for what may be a new long-lasting treatment for trigeminal nerverelated pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SENSATE SCAFFOLDS FOR ORTHOPAEDIC TISSUE REPAIR Principal Investigator & Institution: Szivek, John A.; Orthopaedic Surgery; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Arthritis is the most widespread debilitating disease in the United States affecting over 13% of the population. As the population ages the prevalence which is currently nearly 50% for people 55 and older will increase. Lower extremity impairments (in particular arthritis) represent over 50% of reported

18

Joint Pain

impairments and accounts for the placement of more than 50% of all implants. In addition, arthritis related complaints account for over 3% of all hospital stays. Although orthopaedic implants, particularly artificial joints, improve patient function and reduce pain, they often involve radical procedures mandating a hospital stay and reduce proprioception and stability which can lead to an increased incidence of falls. The overall goal of this research program is the development of a sensate scaffold with a functional cartilage layer on one surface that can easily be implanted into a joint to replace damaged tissue and precluding the need for artificial joint placement. Since nearly half of the US population over 25 years of age experiences knee pain, and the knee is the most common joint for which joint pain and arthritis like symptoms are reported, a knee model will be used to study scaffold development. First, direct measurements will be collected proximal to, distal to and from within joints utilizing a novel in vivo sensing technique in conjunction with radio telemetry to better understand loading of tissues in joints and the way in which scaffolds (designed to carry engineered tissues into joints) affect loading patterns. This strain data will be used to engineer tissue covered scaffolds for cartilage repair. The in vivo measurements will be compared in animals with and without cartilage coated scaffolds. Measurements from the joint will be correlated with surface pressure to better understand cartilage loading and viability. Bone strain patterns during ingrowth into the scaffolds will be correlated with quantitative histomorphometry and radiography to define relationships between loading and tissue structure. Finally, this information will be used to develop cell culture loading systems to produce functional engineered tissues. Within the framework of the overall goal, the specific aims of this research are: 1. Prepare and calibrate a series of scaffolds with wired sensors in them for placement in a dog model and collect strain information from the distal femur of a dog using an existing measurement system prior to and following scaffold placement. 2. Test combinations of osteoconductive coatings and osteoinductive proteins and loading to establish conditions which provide rapid segregated cell growth and appropriate tissue formation in call culture. 3. Place sensate scaffolds with layers of functionally loaded cells into dogs and monitor loading of the scaffold during healing and for several months following healing. Compare the loading pattern changes to the tissue response using histomorphometry. An understanding of loads acting on cartilage will allow development of functional tissues for implantation and an in vivo monitoring system which could eventually be used in patients. A system of this type will provide a means of monitoring healing and rehabilitation in patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENRICHMENT

SHAPING

HEALTH

BEHAVIORS

THROUGH

SCIENCE

Principal Investigator & Institution: Campfield, L A.; Department Head and Professor; Food Science & Human Nutrition; Colorado State University-Fort Collins Fort Collins, Co 80523 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: (Adapted from the applicants abstract): The epidemic of obesity in children and adolescents is a major challenge in the prevention and medical management of obesity. It is serious and alarming because being overweight or obese as a child or adolescent greatly increases the risks for chronic diseases such as type 2 diabetes, heart disease, sleep apnea, stroke, joint pain and some cancers. The increasing number of obese children and adolescents will lead to a large increase in the number of adult obese Americans. Obesity affects at least 25 percent of all adolescents in the United States with young Hispanic Americans and African Americans at higher risk. A strong relationship

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has been shown between childhood and adult obesity: One third of obese preschoolers and more than one half of obese grade school kids become obese adults. A Science Education Partnership is proposed to promote obesity prevention in Colorado. The Program on Obesity of the Center for Human Nutrition will partner with the Department of Preventive Medicine in the School of Medicine and the School of Nursing at UCHSC, Det of Food Science and Human Nutrition at Colorado State University, the Culinary Arts Program of Johnson & Wales University in Denver. These university groups will also work collaboratively with the major science museums in Denver: the Museum of Natural History, the Children's Museum, and Botanic Garden. The Partnership will aim to reduce the rate of childhood and adolescent obesity in Colorado by introducing science and math enrichment programs in elementary schools as well as science museum-based and school-based programs directed at middle and high school students and the community. These programs will provide interactive, "hands-on", fun, and challenging educational science enrichment using examples and exercises from food, nutrition, healthy eating, physical activity and the biology of body weight regulation. Internet-based technology will be used for many lessons, activities and data collection on health behaviors and knowledge of students. All programs will include elements on obesity-its causes, health impacts, and prevention. These model programs will be evaluated by: a) determining the rate of weight and body mass index (BMI) gain of individual students; b) improvement in science-based health knowledge; and c) improvement in health behaviors in individual elementary school students. In addition, we propose to establish and provide leadership for a partnership of interested organizations within Colorado to plan, develop, implement and support a public health campaign. The goal of the campaign will be to prevent obesity and enhance health through the promotion of active lifestyles and healthy eating with a special focus on changing the behavior of children and their families. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TEMPOROMANDIBULAR JOINT SYNDROME IN FEMALES Principal Investigator & Institution: Berman, Nancy E.; Professor; Anatomy and Cell Biology; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2004; Project Start 05-MAR-2004; Project End 28-FEB-2006 Summary: Temporomandibular joint pain is two to three times more common in women than in men, and symptoms are often associated with natural changes in levels of ovarian steroids. Preliminary experiments have demonstrated that galanin, neuropeptide Y and tryptophan hydroxylase are regulated by ovarian steroids in trigeminal ganglia. The overall hypothesis of this application is that ovarian steroids regulate the phenotype of trigeminal neurons by acting upon estrogen receptors during the natural estrous cycle, following ovariectomy and during pregnancy. We will examine 3 stages of the natural cycle, proestrus, when estrogen levels are highest, estrus, when estrogen levels are falling, and diestrus, when estrogen levels are low. We will study pregnant mice, when estrogen levels are stable and high, and ovariectomy, when estrogen levels are stable and low. We will use hormone replacement to determine if the changes are due to estrogen. Responses of the estrogen receptor in regulating gene expression during the natural estrous cycle will be assessed in a transgenic mouse that expresses a luciferase reporter gene under the control of activated estrogen receptors (ERE-luc mice). In Specific Aim 1, we will determine whether trigeminal neurons innervating the TMJ express estrogen receptors, and whether trigeminal neurons increase expression of genes with estrogen response elements in phase with the natural estrous cycle. In Specific Aim 2, we will determine whether the cyclical hormonal

20

Joint Pain

changes of the natural estrous cycle and the constant high levels during pregnancy or low levels following ovariectomy alter expression of trigeminal genes involved in nociception and inflammation. In Specific Aim 3, we will examine the effects of ovarian steroids on TMJ and trigeminal responses to TMJ inflammation. These experiments will provide an innovative approach to the mechanism of hormonal regulation of facial pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with joint pain, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “joint pain” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for joint pain (hyperlinks lead to article summaries): •

23-year-old woman with diffuse muscle and joint pain. Author(s): Larochelle A, Phillips MB. Source: Mayo Clinic Proceedings. 2003 August; 78(8): 1041-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12911052

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35 years of joint pain, diarrhea, skin eruptions. Author(s): Strum WB. Source: Hosp Pract (Off Ed). 1983 September; 18(9): 265, 268. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6411596

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66-year-old woman with joint pain and urinary frequency. Author(s): Harrington JL, Farley DR. Source: Mayo Clinic Proceedings. 1997 March; 72(3): 281-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9070206

3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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99Tc(m) nanocolloid scintigraphy: a reliable way to detect active joint disease in patients with peripheral joint pain. Author(s): Adams BK, Al Attia HM, Khadim RA, Al Haider ZY. Source: Nuclear Medicine Communications. 2001 March; 22(3): 315-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11314764

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A 4-year-old girl with a rash and joint pain. Author(s): Usatine RP. Source: The Western Journal of Medicine. 1999 August; 171(2): 116-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10510658

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A 57-year-old man with bruising and joint pain. Author(s): Blanchard K, Campbell L, Abreo F, Massingill R, Abreo K. Source: J La State Med Soc. 1994 December; 146(12): 515-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7844462

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A 66-year-old man with limited jaw opening and temporomandibular joint pain, clicking and crepitation. Author(s): Eriksson L, Westesson PL, Henrikson H. Source: Cranio. 1985 March-May; 3(2): 184-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3855941

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A biopsychological approach to temporomandibular joint pain and other chronic facial pain. Part II: Broadening of spectrum of treatments. Author(s): Hampf G. Source: Proc Finn Dent Soc. 1993; 89(1-2): 15-28. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8284299

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A diabetic man with persistent joint pain and infection. Author(s): Cadle R, Lidsky MD, Rodriguez-Barradas MC. Source: Hosp Pract (Off Ed). 1997 July 15; 32(7): 177, 182-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9227667

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A few observations on the features of temporomandibular joint pain dysfunction syndrome. Author(s): Solomon EG. Source: J Indian Dent Assoc. 1982 August; 54(8): 305-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6962250

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A rationale for the treatment of back pain and joint pain by manual therapy. Author(s): Twomey LT. Source: Physical Therapy. 1992 December; 72(12): 885-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1454864

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Acute joint pain. Author(s): Samuelson CO Jr, Ward JR. Source: The Journal of Family Practice. 1974 November-December; 1(3-4): 52-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4452876

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Acute temporomandibular joint pain-dysfunction syndrome: neuro-otologic and electromyographic study. Author(s): Adour KK. Source: American Journal of Otolaryngology. 1981 May; 2(2): 114-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7270801

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Afferent and spinal mechanisms of joint pain. Author(s): Schaible HG, Grubb BD. Source: Pain. 1993 October; 55(1): 5-54. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8278210

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Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. Author(s): O'Sullivan PB, Beales DJ, Beetham JA, Cripps J, Graf F, Lin IB, Tucker B, Avery A. Source: Spine. 2002 January 1; 27(1): E1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805650

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An alternative view of the temporomandibular joint pain-dysfunction syndrome. Author(s): Reade PC. Source: Aust Orthod J. 1984 March; 8(3): 77-81. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6599264

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An analysis of self-reported joint pain among New York farmers. Author(s): Gomez MI, Hwang S, Stark AD, May JJ, Hallman EM, Pantea CI. Source: J Agric Saf Health. 2003 May; 9(2): 143-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12827860

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An approach to the management of temporomandibular joint pain-dysfunction syndrome. Author(s): Reade PC. Source: The Journal of Prosthetic Dentistry. 1984 January; 51(1): 91-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6583393

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An asymptomatic lung nodule in an elderly woman with joint pain. Author(s): Adlakha A, Ryu JH, Adlakha K. Source: Hosp Pract (Off Ed). 1995 April 15; 30(4): 70, 73-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7714024

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An investigation of pain distribution in patients with temporomandibular joint pain dysfunction syndrome. Author(s): Gray RJ, Rothwell PS, Wastell DG. Source: Journal of Dentistry. 1986 June; 14(3): 114-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3470334

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Analysis of patients with temporomandibular joint pain. Author(s): Carraro JJ, Quirch JS, Albano E. Source: The Journal of Prosthetic Dentistry. 1969 June; 21(6): 639-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5254503

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Are there psychologic predictors of treatment outcome in temporomandibular joint pain and dysfunction? Author(s): Schnurr RF, Rollman GB, Brooke RI. Source: Oral Surg Oral Med Oral Pathol. 1991 November; 72(5): 550-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1745513

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Aromatherapy massage for joint pain and constipation in a patient with Guillian Barre. Author(s): Shirreffs CM. Source: Complementary Therapies in Nursing & Midwifery. 2001 May; 7(2): 78-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11855776

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Aspects of the periodontal condition of temporomandibular joint pain dysfunction patients. Author(s): Grossman E, Rothwell PS. Source: Journal of Dentistry. 1982 June; 10(2): 107-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6955319

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Assessing joint pain complaints and locomotor disability in the Rotterdam study: effect of population selection and assessment mode. Author(s): Odding E, Valkenburg HA, Stam HJ, Hofman A. Source: Archives of Physical Medicine and Rehabilitation. 2000 February; 81(2): 189-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10668773

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Association of body mass index with joint pain among community-dwelling women in Japan. Author(s): Aoyagi K, Ross PD, Okano K, Hayashi T, Moji K, Kusano Y, Takemoto T. Source: Aging Clin Exp Res. 2002 October; 14(5): 378-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12602572

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Atlanto-occipital and lateral atlanto-axial joint pain patterns. Author(s): Dreyfuss P, Michaelsen M, Fletcher D. Source: Spine. 1994 May 15; 19(10): 1125-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8059267

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Atlanto-occipital joint pain. A report of three cases and description of an intraarticular joint block technique. Author(s): Dreyfuss P, Rogers J, Dreyer S, Fletcher D. Source: Reg Anesth. 1994 September-October; 19(5): 344-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7848935

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Back pain and peripheral joint pain in an industrial setting. Author(s): Jefferson JR, McGrath PJ. Source: Archives of Physical Medicine and Rehabilitation. 1996 April; 77(4): 385-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8607764

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Bilateral arthrographic evaluation of unilateral temporomandibular joint pain and dysfunction. Author(s): Kozeniauskas JJ, Ralph WJ. Source: The Journal of Prosthetic Dentistry. 1988 July; 60(1): 98-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3165463

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Biofeedback and relaxation therapy for chronic temporomandibular joint pain: predicting successful outcomes. Author(s): Funch DP, Gale EN. Source: Journal of Consulting and Clinical Psychology. 1984 December; 52(6): 928-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6394632

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Biofeedback in the treatment of long-term temporomandibular joint pain: an outcome study. Author(s): Carlsson SG, Gale EN. Source: Biofeedback Self Regul. 1977 June; 2(2): 161-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=901853

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Blood serotonin and joint pain in seropositive versus seronegative rheumatoid arthritis. Author(s): Kopp S, Alstergren P. Source: Mediators of Inflammation. 2002 August; 11(4): 211-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12396472

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Boy with peripheral joint pain. Author(s): Baum J. Source: Bulletin on the Rheumatic Diseases. 1997 April; 46(2): 1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9104041

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Case management study: boy with peripheral joint pain. Author(s): Kredich D. Source: Bulletin on the Rheumatic Diseases. 1996 August; 45(5): 1-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8768497

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Case report. Carcinoma of maxillary sinus manifested by temporomandibular joint pain dysfunction syndrome. Author(s): Orlean SL, Robinson NR, Ahern JP, Mallon CF, Blewitt G. Source: J Oral Med. 1966 July; 21(3): 127-31. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5222646

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Causes and signs of temporomandibular joint pain and dysfunction: an electromyographical investigation. Author(s): Schroeder H, Siegmund H, Santibanez G, Kluge A. Source: Journal of Oral Rehabilitation. 1991 July; 18(4): 301-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1890531

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Central neurophysiological processing of joint pain on the basis of studies performed in normal animals and in models of experimental arthritis. Author(s): Guilbaud G. Source: Canadian Journal of Physiology and Pharmacology. 1991 May; 69(5): 637-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1650651

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Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Author(s): Dwyer A, Aprill C, Bogduk N. Source: Spine. 1990 June; 15(6): 453-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2402682

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Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Author(s): Aprill C, Dwyer A, Bogduk N. Source: Spine. 1990 June; 15(6): 458-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2402683

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Changes in temporomandibular joint pain-dysfunction after surgical correction of dentofacial anomalies. Author(s): Magnusson T, Ahlborg G, Finne K, Nethander G, Svartz K. Source: International Journal of Oral and Maxillofacial Surgery. 1986 December; 15(6): 707-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3100672

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Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Author(s): Lord SM, Barnsley L, Wallis BJ, Bogduk N. Source: Spine. 1996 August 1; 21(15): 1737-44; Discussion 1744-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8855458

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Chronic cervical zygapophysial joint pain after whiplash--a placebo-controlled prevalence study. Author(s): Maigne JY. Source: Spine. 1997 June 15; 22(12): 1420-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9201850

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Chronic joint pain. Arthritis or osteitis? Author(s): Wallach S. Source: Hosp Pract (Off Ed). 1985 November 30; 20(11A): 29-39. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3934188

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Chronic temporomandibular joint pain and litigation. Author(s): Lapeer GL. Source: Gen Dent. 1986 July-August; 34(4): 275-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3462086

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Clinical and arthrographic evaluation of the location of temporomandibular joint pain. Author(s): Roberts CA, Tallents RH, Katzberg RW, Sanchez-Woodworth RE, Espeland MA, Handelman SL. Source: Oral Surg Oral Med Oral Pathol. 1987 July; 64(1): 6-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3475659

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Clinical evaluation of intra-articular injections for lumbar facet joint pain. Author(s): Lau LS, Littlejohn GO, Miller MH. Source: The Medical Journal of Australia. 1985 December 9-23; 143(12-13): 563-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2937992

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Coccygectomy for severe refractory sacrococcygeal joint pain. Author(s): Perkins R, Schofferman J, Reynolds J. Source: Journal of Spinal Disorders & Techniques. 2003 February; 16(1): 100-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12571492

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Comments on 'psychosocial correlates of temporomandibular joint pain and dysfunction' by R.F. Schnurr, R.I. Brooke and G.B. Rollman. Author(s): Owen JE. Source: Pain. 1991 July; 46(1): 113-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1896202

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Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Author(s): Barnsley L, Lord S, Bogduk N. Source: Pain. 1993 October; 55(1): 99-106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8278215

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Comparison of three different populations with temporomandibular joint paindysfunction syndrome. Author(s): Gelb H, Bernstein IM. Source: Dent Clin North Am. 1983 July; 27(3): 495-503. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6578962

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Complete oral examination with a view to eliciting occlusion related temporomandibular joint pain dysfunction. Author(s): Egan NJ. Source: Aust Soc Prosthodontists Bull. 1982 June; 12(1): 7-12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6964059

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Conservative treatment for temporomandibular joint pain dysfunction. Author(s): Bradley PF. Source: The British Journal of Oral & Maxillofacial Surgery. 1987 April; 25(2): 125-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3472594

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Correlation of psychological findings and treatment results in temporomandibular joint pain-dysfunction syndrome. Author(s): Small EW. Source: J Oral Surg. 1974 August; 32(8): 589-92. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4526312

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Cryoneurotomy for intractable temporomandibular joint pain. Author(s): Goss AN. Source: The British Journal of Oral & Maxillofacial Surgery. 1988 February; 26(1): 26-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3422820

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Decrease in knee joint pain and increase in function in patients with medial compartment arthrosis: a prospective analysis of valgus bracing. Author(s): Hewett TE, Noyes FR, Barber-Westin SD, Heckmann TP. Source: Orthopedics. 1998 February; 21(2): 131-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9507265

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Depressive symptoms associated with symptoms of the temporomandibular joint pain and dysfunction syndrome. Author(s): Vimpari SS, Knuuttila ML, Sakki TK, Kivela SL. Source: Psychosomatic Medicine. 1995 September-October; 57(5): 439-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8552734

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Descriptions of joint pain by American Indians: comparison of inflammatory and noninflammatory arthritis. Author(s): Kramer BJ, Harker JO, Wong AL. Source: Arthritis and Rheumatism. 2002 April 15; 47(2): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11954008

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Diagnosing patients with longstanding shoulder joint pain. Author(s): Norregaard J, Krogsgaard MR, Lorenzen T, Jensen EM. Source: Annals of the Rheumatic Diseases. 2002 July; 61(7): 646-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12079911

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Diagnosis of temporomandibular joint pain in patients seen at a pain clinic. Author(s): Goss AN, Speculand B, Hallet E. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1985 February; 43(2): 110-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3855447

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Diagnostic approach to polyarticular joint pain. Author(s): Mies Richie A, Francis ML. Source: American Family Physician. 2003 September 15; 68(6): 1151-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14524403

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Diclofenac sodium as an alternative treatment of temporomandibular joint pain. Author(s): Ekberg EC, Kopp S, Akerman S. Source: Acta Odontologica Scandinavica. 1996 June; 54(3): 154-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8811136

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Discriminant function analysis of clinical and psychological variables in temporomandibular joint pain dysfunction. Author(s): Gerke DC, Richards LC, Goss AN. Source: Aust Dent J. 1989 February; 34(1): 44-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2705939

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Does glucosamine relieve arthritis joint pain? Author(s): Miller DC, Richardson J. Source: The Journal of Family Practice. 2003 August; 52(8): 645-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12899824

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Dorsal wrist joint pain in tetraplegic patients during and after rehabilitation. Author(s): Hara Y. Source: Journal of Rehabilitation Medicine : Official Journal of the Uems European Board of Physical and Rehabilitation Medicine. 2003 March; 35(2): 57-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12691334

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Dynamic MR imaging of the temporomandibular joint in patients with arthrosis: relationship between contrast enhancement of the posterior disk attachment and joint pain. Author(s): Suenaga S, Hamamoto S, Kawano K, Higashida Y, Noikura T. Source: Ajr. American Journal of Roentgenology. 1996 June; 166(6): 1475-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8633468

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Effect of bracing on patellar kinematics in patients with patellofemoral joint pain. Author(s): Powers CM, Shellock FG, Beering TV, Garrido DE, Goldbach RM, Molnar T. Source: Medicine and Science in Sports and Exercise. 1999 December; 31(12): 1714-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10613420

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Effect of indomethacin phonophoresis on the relief of temporomandibular joint pain. Author(s): Shin SM, Choi JK. Source: Cranio. 1997 October; 15(4): 345-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9481998

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Effect of monetary gain on the treatment of zygapophysial joint pain in cervical whiplash. Author(s): Ferrari R. Source: Spine. 2002 February 1; 27(3): 327. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805701

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Effectiveness of push/pull hemodiafiltration using large-pore membrane for shoulder joint pain in long-term dialysis patients. Author(s): Maeda K, Kobayakawa H, Fujita Y, Takai I, Morita H, Emoto Y, Miyazaki T, Shinzato T. Source: Artificial Organs. 1990 October; 14(5): 321-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2241598

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Effects of occlusal treatment and intraarticular injections on temporomandibular joint pain and dysfunction. Author(s): Kopp S, Wenneberg B. Source: Acta Odontologica Scandinavica. 1981; 39(2): 87-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6948488

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Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Author(s): Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Source: Spine. 2000 May 15; 25(10): 1270-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10806505

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Efficacy of disodium-clodronate in the management of joint pain in rheumatoid arthritis. Six months open study. Author(s): Rovetta G, Monteforte P. Source: Minerva Med. 2003 October; 94(5): 353-857. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14973430

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Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction. Author(s): Al-Badawi EA, Mehta N, Forgione AG, Lobo SL, Zawawi KH. Source: Cranio. 2004 January; 22(1): 10-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14964334

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Electronic thermography for the assessment of acute temporomandibular joint pain. Author(s): Kalili TK, Gratt BM. Source: Compend Contin Educ Dent. 1996 October; 17(10): 979-83; Quiz 984. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9533317

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Emotional factors in non-organic temporomandibular joint pain. Author(s): Moulton RE. Source: Dent Clin North Am. 1966 November; : 609-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5227800

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Evaluating occlusal relationships, mandibular dysfunction, and temporomandibular joint pain by palpation. Author(s): Bohl CF, Knap FJ. Source: The Journal of Prosthetic Dentistry. 1974 July; 32(1): 80-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4525511

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Evaluation of a proprietary analgesic/antihistamine in the management of pain associated with temporomandibular joint pain dysfunction syndrome. Author(s): Gerschman JA, Reade PD, Burrows GD. Source: Aust Dent J. 1984 October; 29(5): 300-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6398047

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Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Author(s): Albert H, Godskesen M, Westergaard J. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2000 April; 9(2): 161-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10823434

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Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Author(s): Hungerford B, Gilleard W, Hodges P. Source: Spine. 2003 July 15; 28(14): 1593-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865851

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Facet joint pain. Author(s): Bogduk N, Schwarzer A. Source: Aust Fam Physician. 1995 May; 24(5): 924. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7794159

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Factors associated with joint pain among postmenopausal women. Author(s): Huang C, Ross PD, Lydick E, Wasnich RD. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 1997 May; 21(5): 349-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9152735

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Fall of skin impedance and bone and joint pain. Author(s): Fujita T, Fujii Y, Okada SF, Miyauchi A, Takagi Y. Source: Journal of Bone and Mineral Metabolism. 2001; 19(3): 175-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11368303

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Frustration and temporomandibular joint pain. Author(s): Gale EN, Carlsson SG. Source: Oral Surg Oral Med Oral Pathol. 1978 January; 45(1): 39-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=271287

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Genetic and behavioral risk factors for self-reported joint pain among a populationbased sample of Swedish twins. Author(s): Charles ST, Gatz M, Pedersen NL, Dahlberg L. Source: Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 1999 November; 18(6): 644-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10619538

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Glucosamine therapy compared to ibuprofen for joint pain. Author(s): Ruane R, Griffiths P. Source: British Journal of Community Nursing. 2002 March; 7(3): 148-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11904551

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Glucose intolerance associated with temporomandibular joint pain-dysfunction syndrome. Author(s): Oles RD. Source: Oral Surg Oral Med Oral Pathol. 1977 April; 43(4): 546-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=265482

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Hearing aids as an etiologic factor in temporomandibular joint pain. Report of a case. Author(s): Feder MJ, Stratigos GT. Source: Oral Surg Oral Med Oral Pathol. 1971 August; 32(2): 193-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5284104

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Hemifacial atrophy and temporomandibular joint pain-dysfunction syndrome. Author(s): Talacko AA, Reade PC. Source: International Journal of Oral and Maxillofacial Surgery. 1988 August; 17(4): 2246. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3139790

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Herpes simplex virus and acute temporomandibular joint pain-dysfunction syndrome. Author(s): Adour KK, Hilsinger RL Jr. Source: Dent Clin North Am. 1983 July; 27(3): 631-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6578969

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Histoplasmosis presenting with joint pain and hilar adenopathy. “Pseudosarcoidosis”. Author(s): Thornberry DK, Wheat LJ, Brandt KD, Rosenthal J. Source: Arthritis and Rheumatism. 1982 December; 25(12): 1396-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7150375

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Immediate effects of the serotonin antagonist granisetron on temporomandibular joint pain in patients with systemic inflammatory disorders. Author(s): Voog O, Alstergren P, Leibur E, Kallikorm R, Kopp S. Source: Life Sciences. 2000 December 22; 68(5): 591-602. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11197756

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Impact of temporomandibular joint pain on activities of daily living in patients with rheumatoid arthritis. Author(s): Voog U, Alstergren P, Leibur E, Kallikorm R, Kopp S. Source: Acta Odontologica Scandinavica. 2003 October; 61(5): 278-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763779

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Incidence of four syndromes of pregnancy-related pelvic joint pain. Author(s): Albert HB, Godskesen M, Westergaard JG. Source: Spine. 2002 December 15; 27(24): 2831-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12486356

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Incidence of tempero-mandibular joint pain dysfunction syndrome in rural population. Author(s): Rao MB, Rao CB. Source: Int J Oral Surg. 1981 August; 10(4): 261-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6809656

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Index of suspicion. Case 3. Campylobacter gastroenteritis with joint pain. Author(s): Policastro AM. Source: Pediatrics in Review / American Academy of Pediatrics. 1994 March; 15(3): 117, 119. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8041674

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Instinctive sleeping and resting postures: an anthropological and zoological approach to treatment of low back and joint pain. Author(s): Tetley M. Source: Bmj (Clinical Research Ed.). 2000 December 23-30; 321(7276): 1616-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11124203

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Intra-articular injection of hyaluronate (SI-6601D) improves joint pain and synovial fluid prostaglandin E2 levels in rheumatoid arthritis: a multicenter clinical trial. Author(s): Goto M, Hanyu T, Yoshio T, Matsuno H, Shimizu M, Murata N, Shiozawa S, Matsubara T, Yamana S, Matsuda T. Source: Clin Exp Rheumatol. 2001 July-August; 19(4): 377-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11491492

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Intraarticular opioid-local anesthetic combinations for chronic joint pain. Author(s): Khoury GF, Garland DE, Stein C. Source: Middle East J Anesthesiol. 1994 October; 12(6): 579-85. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7838073

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Is the concept of temporomandibular joint pain-dysfunction syndrome valid? Author(s): Reynolds MD. Source: Cranio. 1988 October; 6(4): 299-307. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3076527

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Joint pain and arthritis in renal transplant recipients and correlation with cyclosporine therapy. Author(s): Kart-Koseoglu H, Yucel AE, Isiklar I, Turker I, Akcali Z, Haberal M. Source: Rheumatology International. 2003 July; 23(4): 159-62. Epub 2003 February 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856139

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Joint pain and paralysis in two middle-aged men. Author(s): Bluestone R. Source: Hosp Pract (Off Ed). 1983 November; 18(11): 78-9, 83. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6195079

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Joint pain and quality of life; results of a randomised trial. Author(s): Parr G, Darekar B, Fletcher A, Bulpitt CJ. Source: British Journal of Clinical Pharmacology. 1989 February; 27(2): 235-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2653395

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Joint pain and weather. A critical review of the literature. Author(s): Quick DC. Source: Minn Med. 1997 March; 80(3): 25-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9090247

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Joint pain in children. When is it serious? Author(s): Nelson AM. Source: Postgraduate Medicine. 1989 April; 85(5): 141-2, 147-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2928285

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Joint pain in children: an algorithmic approach. Author(s): Gedalia A. Source: Isr Med Assoc J. 2002 October; 4(10): 837-42. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12389359

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Joint pain of recent onset. Author(s): Samuelson CO Jr, Ward JR. Source: The Journal of Family Practice. 1977 September; 5(3): 437-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=903755

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Joint pain or arthritis. Author(s): Fries JF, Mitchell DM. Source: Jama : the Journal of the American Medical Association. 1976 January 12; 235(2): 199-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=946031

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Joint pain. Author(s): Sorokin R, Ward SB. Source: The Medical Clinics of North America. 1995 March; 79(2): 247-60. Review. Erratum In: Med Clin North Am 1995 July; 79(4): Xi. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7877389

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Joint pain. It isn't always arthritis. Author(s): Baum J. Source: Postgraduate Medicine. 1989 January; 85(1): 311-3, 316, 321. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2911545

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Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain. Author(s): Tsuji T, Matsuyama Y, Goto M, Yimin Y, Sato K, Hasegawa Y, Ishiguro N. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2002; 7(5): 519-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12355123

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Lateral branch blocks as a treatment for sacroiliac joint pain: A pilot study. Author(s): Cohen SP, Abdi S. Source: Regional Anesthesia and Pain Medicine. 2003 March-April; 28(2): 113-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12677621

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Life study of a patient with temporomandibular joint pain. Seven year clinical treatment and observation. Author(s): Woytowitz JV, Mitcherling JJ, Mitcherling WW, Johnson RK. Source: J Md State Dent Assoc. 1983 April; 26(1): 13-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6586945

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Long-term results of treatment for temporomandibular joint pain-dysfunction. Author(s): Mejersjo C, Carlsson GE. Source: The Journal of Prosthetic Dentistry. 1983 June; 49(6): 809-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6576135

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Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. Author(s): Rudisch A, Innerhofer K, Bertram S, Emshoff R. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2001 November; 92(5): 566-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11709695

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Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain. Author(s): Emshoff R, Brandimaier I, Bertram S, Rudisch A. Source: International Journal of Oral and Maxillofacial Surgery. 2002 December; 31(6): 598-602. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12521314

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Magnetic resonance imaging predictors of temporomandibular joint pain. Author(s): Emshoff R, Brandlmaier I, Gerhard S, Strobl H, Bertram S, Rudisch A. Source: The Journal of the American Dental Association. 2003 June; 134(6): 705-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12839406

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Major maxillomandibular malrelations and temporomandibular joint paindysfunction. Author(s): Upton LG, Scott RF, Hayward JR. Source: The Journal of Prosthetic Dentistry. 1984 May; 51(5): 686-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6587092

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Management of temporomandibular joint pain dysfunction syndrome. Author(s): Bell WH, Ware WH. Source: Dent Clin North Am. 1971 April; 15(2): 487-506. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5278931

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Mandibular joint pain symptoms, signs and diagnosis. Author(s): Thomson H. Source: Rev Belge Med Dent. 1966; 21(1): 79-85. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5222005

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Maxillary sinusitis as a differential diagnosis in temporomandibular joint paindysfunction syndrome. Author(s): Rihani A. Source: The Journal of Prosthetic Dentistry. 1985 January; 53(1): 97-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3856028

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Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Author(s): Barnsley L, Bogduk N. Source: Reg Anesth. 1993 November-December; 18(6): 343-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8117629

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Medical and physical management of facial muscle and joint pain. Author(s): Berry DC. Source: British Dental Journal. 1985 September 21; 159(6): 172. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3863650

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Medical or physical management of facial muscle and joint pain? A dialogue. Author(s): Berry DC, Harris M. Source: British Dental Journal. 1985 March 23; 158(6): 227-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3859309

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Medical versus surgical management of temporomandibular joint pain and dysfunction. Author(s): Harris M. Source: The British Journal of Oral & Maxillofacial Surgery. 1987 April; 25(2): 113-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3555612

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Modern approaches to temporomandibular joint pain. Author(s): Papa F, Lavorgna G. Source: Arch Stomatol (Napoli). 1979 July-September; 20(3): 373-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=299271

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Morphine in nonmalignant joint pain. Physiological rationale, value, and limitations. Author(s): Perrot S. Source: Rev Rhum Engl Ed. 1999 May; 66(5): 271-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10380259

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Morphological changes in the mandibular joint disk in temporomandibular joint pain dysfunction syndrome. Author(s): Carlsson GE, Oberg T, Bergman F, Fajers CM. Source: Acta Odontologica Scandinavica. 1967 August; 25(2): 163-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5233923

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Multiple joint pain following steroid therapy. Author(s): McClelland D, Morgan-Jones RL, Wynn-Jones C. Source: Postgraduate Medical Journal. 1998 October; 74(876): 629-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10211369

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Muscle and joint pain: design and evaluation of courses for general practitioners. Author(s): Griffin GA, Barry SM. Source: J R Coll Gen Pract. 1981 November; 31(232): 661-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6977027

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Muscle endurance, muscle tension and personality traits in patients with muscle or joint pain--a pilot study. Author(s): Elert J, Dahlqvist SR, Almay B, Eisemann M. Source: The Journal of Rheumatology. 1993 September; 20(9): 1550-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8164213

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Muscle weakness, fatigue, and joint pain in a 52-year-old woman. Author(s): Hearth-Holmes M, Campbell GD Jr. Source: Chest. 1995 August; 108(2): 563-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7634900

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Musculoskeletal pain and quality of life in patients with noninflammatory joint pain compared to rheumatoid arthritis: a population survey. Author(s): Hagen KB, Kvien TK, Bjorndal A. Source: The Journal of Rheumatology. 1997 September; 24(9): 1703-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9292791

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Myofascial pain syndrome masquerading as temporomandibular joint pain. Author(s): Domnitz JM, Swintak EF, Schriver WR, Shereff RH. Source: Oral Surg Oral Med Oral Pathol. 1977 January; 43(1): 11-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=264334

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Nettle sting of Urtica dioica for joint pain--an exploratory study of this complementary therapy. Author(s): Randall C, Meethan K, Randall H, Dobbs F. Source: Complementary Therapies in Medicine. 1999 September; 7(3): 126-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10581821

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Neural mechanisms of joint pain. Author(s): Wong HY. Source: Ann Acad Med Singapore. 1993 July; 22(4): 646-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7504903

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Neuroaugmentation in the management of sacroiliac joint pain. Report of two cases. Author(s): Calvillo O, Esses SI, Ponder C, D'Agostino C, Tanhui E. Source: Spine. 1998 May 1; 23(9): 1069-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9589549

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Neurophysiology of joint pain. Author(s): Fantini F. Source: Rays. 1989 July-September; 14(3): 213-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2636717

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Nondiscogenic causes of temporomandibular joint pain. Author(s): Tom BM, Rao VM, Farole A. Source: Cranio. 1991 July; 9(3): 220-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1810668

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Opioid rotation in the treatment of joint pain. A review of 67 cases. Author(s): Grilo RM, Bertin P, Scotto di Fazano C, Coyral D, Bonnet C, Vergne P, Treves R. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 October; 69(5): 491-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12477234

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Orthognathic treatment in patients with temporomandibular joint pain-dysfunction. Author(s): Ware WH, Roth RH. Source: Alpha Omegan. 1978 December; 71(2): 52-63. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=294821

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Osteoarthritis involving the metatarsophalangeal joints and management of metatarsophalangeal joint pain via injection therapy. Author(s): Boxer MC. Source: Clin Podiatr Med Surg. 1994 January; 11(1): 125-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8124651

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Osteoid osteoma in the differential diagnosis of persistent joint pain. Author(s): Georgoulis AD, Soucacos PN, Beris AE, Xenakis TA. Source: Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the Esska. 1995; 3(2): 125-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7553009

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Osteoid osteoma: a cause of monoarticular joint pain. Three case reports. Author(s): Belding RH, Thompson JD Jr, Hay EL. Source: J S C Med Assoc. 1976 September; 72(9): 343-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1071775

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Osteophyte impingement of the popliteus tendon as a cause of lateral knee joint pain. Author(s): Gaine WJ, Mohammed A. Source: The Knee. 2002 September; 9(3): 249-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12126688

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Parotid gland malignancy presenting as temporomandibular joint pain or dysfunction. Author(s): Telfer MR, Thomas SJ, Sleeman DJ, Jones GM, Irvine GH. Source: British Dental Journal. 1990 October 20; 169(8): 248-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2173941

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Pathophysiology of joint pain. Author(s): Perrot S, Guilbaud G. Source: Rev Rhum Engl Ed. 1996 July-September; 63(7-8): 485-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8896062

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Pathophysiology of joint pain. Author(s): Kidd BL, Morris VH, Urban L. Source: Annals of the Rheumatic Diseases. 1996 May; 55(5): 276-83. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8660099

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Patient with neurologic deficits and joint pain. Author(s): Sherman JA. Source: Lippincott's Primary Care Practice. 1998 January-February; 2(1): 105-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9451207

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Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of hip joint pain. Author(s): Kawaguchi M, Hashizume K, Iwata T, Furuya H. Source: Regional Anesthesia and Pain Medicine. 2001 November-December; 26(6): 57681. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11707799

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Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution. Author(s): Lord SM, Barnsley L, Bogduk N. Source: Neurosurgery. 1995 April; 36(4): 732-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7596504

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Personality and psychopathology in patients with temporomandibular joint paindysfunction syndrome. A controlled investigation. Author(s): Meldolesi G, Picardi A, Accivile E, Toraldo di Francia R, Biondi M. Source: Psychotherapy and Psychosomatics. 2000 November-December; 69(6): 322-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11070445

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Personality and response to treatment of the temporomandibular joint pain dysfunction syndrome. Author(s): Rothwell PS. Source: Oral Surg Oral Med Oral Pathol. 1973 September; 36(3): 331-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4516462

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Personality disorders and regulative styles of patients with temporo-mandibular joint pain dysfunction syndrome. Author(s): Baggi L, Rubino IA, Zanna V, Martignoni M. Source: Percept Mot Skills. 1995 February; 80(1): 267-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7624203

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Possible association of temporomandibular joint pain and dysfunction with a polymorphism in the serotonin transporter gene. Author(s): Herken H, Erdal E, Mutlu N, Barlas O, Cataloluk O, Oz F, Guray E. Source: American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics. 2001 September; 120(3): 308-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11552131

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Post-renal transplant syndrome of transient lower limb joint pain: description under a tacrolimus-based immunosuppression. Author(s): Goffin E, Vande Berg B, Devogelaer JP, Pochet JM, De Meyer M, Squifflet JP, Pirson Y. Source: Clinical Nephrology. 2003 February; 59(2): 98-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12608552

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Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Author(s): Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R. Source: Annals of the Rheumatic Diseases. 1995 February; 54(2): 100-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7702395

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Prevalence of joint pain is higher among women in rural Japan than urban JapaneseAmerican women in Hawaii. Author(s): Aoyagi K, Ross PD, Huang C, Wasnich RD, Hayashi T, Takemoto T. Source: Annals of the Rheumatic Diseases. 1999 May; 58(5): 315-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10225818

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Prevalence of self-reported peripheral joint pain and swelling in an Italian population: the Chiavari study. Author(s): Cimmino MA, Parisi M, Moggiana GL, Maio T, Mela GS. Source: Clin Exp Rheumatol. 2001 January-February; 19(1): 35-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11247322

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Prevalence of temporomandibular joint pain in a population seeking orthodontic treatment. Author(s): Goddard G. Source: Funct Orthod. 1995 May-July; 12(3): 18-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9563317

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Prognostic features of value in the management of temporomandibular joint paindysfunction syndrome by occlusal splint therapy. Author(s): Suvinen T, Reade P. Source: The Journal of Prosthetic Dentistry. 1989 March; 61(3): 355-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2921753

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Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Author(s): Drawer S, Fuller CW. Source: British Journal of Sports Medicine. 2001 December; 35(6): 402-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11726474

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Prospective application of an expert system for the medical history of joint pain. Author(s): Schewe S, Herzer P, Kruger K. Source: Klin Wochenschr. 1990 May 4; 68(9): 466-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2192195

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Psychogenic, diagnostic and therapeutic aspects of temporomandibular joint pain: an analysis of 232 patients with discusssion. Author(s): Nally FF, Moore DS. Source: Journal (Canadian Dental Association). 1975 July; 41(7): 403-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1055722

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Psychological characteristics of long-term female temporomandibular joint pain patients. Author(s): Gale EN. Source: Journal of Dental Research. 1978 March; 57(3): 481-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=277554

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Psychological factors associated with non-organic temporomandibular joint pain dysfunction syndrome. Author(s): Fine EW. Source: British Dental Journal. 1971 November 2; 131(9): 402-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5289501

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Psychosocial correlates of temporomandibular joint pain and dysfunction. Author(s): Schnurr RF, Brooke RI, Rollman GB. Source: Pain. 1990 August; 42(2): 153-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2247314

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Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Author(s): Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D. Source: The Spine Journal : Official Journal of the North American Spine Society. 2003 September-October; 3(5): 360-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14588947

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Quantitative assessment of joint pain following treatment of rheumatoid arthritis with ibuprofen cream. Author(s): Arendt-Nielsen L, Drewes AM, Svendsen L, Brennum J. Source: Scandinavian Journal of Rheumatology. 1994; 23(6): 334-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7801058

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Radio-frequency lesioning to treat chronic lumbar facet joint pain. Author(s): Curtis S. Source: Aorn Journal. 1997 October; 66(4): 684-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9337470

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Radiographic assessment of temporomandibular joint pain and dysfunction in the pediatric age-group. Author(s): Sanchez-Woodworth RE, Katzberg RW, Tallents RH, Guay JA. Source: Asdc J Dent Child. 1988 July-August; 55(4): 278-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3165986

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Re: Efficacy and validity of radiofrequency neurotomy for chroniclumbar zygapophysial joint pain (Spine 2000;25:1270-7). Author(s): van Kleef M, Weber WE, Kessels A, Dreyfuss P, Pauza K, Bogduk N. Source: Spine. 2001 April 1; 26(7): E163-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11295918

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Recurrent headaches in relation to temporomandibular joint pain-dysfunction. Author(s): Magnusson T, Carlsson GE. Source: Acta Odontologica Scandinavica. 1978; 36(6): 333-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=281857

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Reduction of clinical temporomandibular joint pain is associated with a reduction of the jaw-stretch reflex. Author(s): Wang K, Arendt-Nielsen L, Jensen T, Svensson P. Source: J Orofac Pain. 2004 Winter; 18(1): 33-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15022534

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Reduction of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable. Author(s): Rene J, Weinberger M, Mazzuca SA, Brandt KD, Katz BP. Source: Arthritis and Rheumatism. 1992 May; 35(5): 511-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1575787

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Relationship between joint effusion, joint pain, and protein levels in joint lavage fluid of patients with internal derangement and osteoarthritis of the temporomandibular joint. Author(s): Takahashi T, Nagai H, Seki H, Fukuda M. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1999 October; 57(10): 1187-93; Discussion 1193-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10513864

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Relationship between lower limb dynamics and knee joint pain. Author(s): Radin EL, Yang KH, Riegger C, Kish VL, O'Connor JJ. Source: Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society. 1991 May; 9(3): 398-405. Erratum In: J Orthop Res 1991 September; 9(5): 776. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2010844

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Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement. Author(s): Emshoff R, Innerhofer K, Rudisch A, Bertram S. Source: International Journal of Oral and Maxillofacial Surgery. 2001 April; 30(2): 118-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11405446

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Relationships between pain-related mediators and both synovitis and joint pain in patients with internal derangements and osteoarthritis of the temporomandibular joint. Author(s): Nishimura M, Segami N, Kaneyama K, Suzuki T, Miyamaru M. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2002 September; 94(3): 328-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12324788

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Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema. Author(s): Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2003 April; 95(4): 437-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686927

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Repeated assessment of temporomandibular joint pain: reasoned decision-making with use of unidimensional and multidimensional pain scales. Author(s): Kropmans TJ, Dijkstra PU, Stegenga B, Stewart R, de Bont LG. Source: The Clinical Journal of Pain. 2002 March-April; 18(2): 107-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11882774

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation. Author(s): Yokoyama K, Oku T. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1999 July; 46(7): 683-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10442966

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Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study. Author(s): Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Source: Journal of Oral Rehabilitation. 2003 May; 30(5): 537-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12752937

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Role of depressive illness in the outcome of treatment of temporomandibular joint pain-dysfunction syndrome. Author(s): Tversky J, Reade PC, Gerschman JA, Holwill BJ, Wright J. Source: Oral Surg Oral Med Oral Pathol. 1991 June; 71(6): 696-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2062523

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Role of the sympathetic nervous system in chronic joint pain and inflammation. Author(s): Kidd BL, Cruwys S, Mapp PI, Blake DR. Source: Annals of the Rheumatic Diseases. 1992 November; 51(11): 1188-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1466593

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Sacroiliac joint pain referral zones. Author(s): Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Source: Archives of Physical Medicine and Rehabilitation. 2000 March; 81(3): 334-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10724079

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Sacroiliac joint pain. Author(s): Tanner J. Source: Spine. 1997 July 15; 22(14): 1673-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9253105

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Sacro-iliac joint pain: etiology and conservative treatment. Author(s): Yong-Hing K. Source: Chir Organi Mov. 1994 January-March; 79(1): 35-45. Review. English, Italian. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8076476

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Sacroiliac joint pain: practical management. Author(s): Prather H. Source: Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2003 July; 13(4): 252-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855929

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Sacroiliac joint pain: should physicians be blocking lateral branches, medial branches, dorsal rami, or ventral rami? Author(s): Manchikanti L, Boswell MV, Singh V, Hansen HC. Source: Regional Anesthesia and Pain Medicine. 2003 September-October; 28(5): 488-90; Author Reply 490-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14556149

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Sarcoidosis presenting with large vessel vasculitis and osteosclerosis-related bone and joint pain. Author(s): Kirou KA, Bateman HE, Bansal M, Schneider R, Fantini GA, Paget SA. Source: Clin Exp Rheumatol. 2000 May-June; 18(3): 401-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10895383

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Self-arthrocentesis in a man with joint pain. Author(s): Cohen PL. Source: Arthritis and Rheumatism. 2004 February; 50(2): 680. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14872521

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Short term effect of intra-articular injections of a corticosteroid on temporomandibular joint pain and dysfunction. Author(s): Wenneberg B, Kopp S. Source: Swed Dent J. 1978; 2(6): 189-96. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=282678

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Sleepiness does not modulate experimental joint pain in healthy volunteers. Author(s): Drewes AM, Rossel P, Arendt-Nielsen L, Nielsen KD, Hansen LM, BirketSmith L, Stengaard-Pedersen K. Source: Scandinavian Journal of Rheumatology. 1997; 26(5): 399-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9385357

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Socioeconomic variation in back and joint pain in Finland. Author(s): Leino-Arjas P, Hanninen K, Puska P. Source: European Journal of Epidemiology. 1998 January; 14(1): 79-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9517877

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'Strange nodules' and joint pain in an alcoholic. Case presentation. Author(s): Waytz PH. Source: Hosp Pract (Off Ed). 1981 November; 16(11): 53, 56. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6797925

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Stress as a factor in muscle and temporomandibular joint pain. Author(s): Lundeen TF, Sturdevant JR, George JM. Source: Journal of Oral Rehabilitation. 1987 September; 14(5): 447-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3478453

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Stress distribution in cervical traction: prevention of temporomandibular joint pain syndrome: a case report. Author(s): Frankel VH, Shore NA, Hoppenfeld S. Source: Clinical Orthopaedics and Related Research. 1964 January-February; 32: 114-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5889048

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Structural influences in temporomandibular joint pain and dysfunction. Author(s): Royder JO. Source: J Am Osteopath Assoc. 1981 March; 80(7): 460-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7239973

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Surgery for temporomandibular joint pain. Author(s): Poker ID, Hopper C. Source: Dent Update. 1990 September; 17(7): 291-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2079167

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Sympathetic nervous system in chronic joint pain. Author(s): Veale DJ, Fitzgerald O. Source: Annals of the Rheumatic Diseases. 1993 July; 52(7): 552. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7688501

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Symphyseal and sacroiliac joint pain associated with pubic symphysis instability. Author(s): LaBan MM, Meerschaert JR, Taylor RS, Tabor HD. Source: Archives of Physical Medicine and Rehabilitation. 1978 October; 59(10): 470-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=152619

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Synovectomy-arthroplasty as an alternative to triple arthrodesis in the management of subtalar joint pain. Author(s): Jacobs AM, Hodson BS, Albrecht HM. Source: Clin Podiatr Med Surg. 1991 July; 8(3): 485-500. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1893331

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Temporalis haemangioma presenting as temporomandibular joint pain dysfunction syndrome. Author(s): Hughes C, Hutchison I. Source: The British Journal of Oral & Maxillofacial Surgery. 1993 February; 31(1): 21-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8431408

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Temporomandibular disorders: relationship between joint pain and effusion and nitric oxide concentration in the joint fluid. Author(s): Suenaga S, Abeyama K, Hamasaki A, Mimura T, Noikura T. Source: Dento Maxillo Facial Radiology. 2001 July; 30(4): 214-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11681483

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Temporomandibular joint pain analgesia by linearly polarized near-infrared irradiation. Author(s): Yokoyama K, Sugiyama K. Source: The Clinical Journal of Pain. 2001 March; 17(1): 47-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11289088

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Temporomandibular joint pain and dysfunction: a clinical study of emotional and occlusal components. Author(s): Solberg WK, Flint RT, Brantner JP. Source: The Journal of Prosthetic Dentistry. 1972 October; 28(4): 412-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4403492

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Temporomandibular joint pain and myofascial pain dysfunction syndromes: a viewpoint. Author(s): Atterbury R. Source: Oral Health. 1980 May; 70(5): 31-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6942352

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Temporomandibular joint pain as a manifestation of temporal arteritis. Author(s): Selsky EJ, Nirankari VS. Source: Southern Medical Journal. 1985 October; 78(10): 1249-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4049048

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Temporomandibular joint pain as a neuropathy. Author(s): Zapp JJ, Short S. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1995 December; 80(6): 621. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8680964

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Temporomandibular joint pain assessment. Author(s): Stegenga B, de Bont LG, Boering G. Source: J Orofac Pain. 1993 Winter; 7(1): 23-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8467295

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Temporomandibular joint pain by dysfunction and pseudo Class III malocclusions. Author(s): Moore DS. Source: Journal (Canadian Dental Association). 1975 July; 41(7): 407-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1055723

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Temporomandibular joint pain dysfunction and mandibular asymmetry. Author(s): Zwemer JD, Williamson EH, Brown SR, Morse PK. Source: Facial Orthop Temporomandibular Arthrol. 1986 May; 3(5): 12-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3458593

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Temporo-mandibular joint pain dysfunction syndrome: report of two cases and review of literature. Author(s): Iyogun CA. Source: Afr Dent J. 1995; 9: 38-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9590900

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Temporo-mandibular joint pain dysfunction syndrome--value of occlusal rehabilitation. Author(s): Reddy MB, Bhat KS, Rao MB, Rao R, Rao CB. Source: J Indian Dent Assoc. 1979 August; 51(8): 239-43. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=298311

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Temporomandibular joint pain in a renal dialysis patient. Author(s): Churton MC, Luyk NH. Source: N Z Dent J. 1981 July; 77(349): 105-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6944626

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Temporomandibular joint pain. Author(s): Hiatt SW. Source: J Mo Dent Assoc. 1981 November-December; 61(6): 22-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6947094

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Temporomandibular joint pain/dysfunction overlying more insidious diseases: report of two cases. Author(s): Christiansen EL, Thompson JR, Appleton SS. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1987 April; 45(4): 335-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3470454

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Temporomandibular joint pain: a review of 8 cases and their etiology. Author(s): Ahing SI. Source: J Dent Que. 1979 February; 16: 23-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=296172

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Temporomandibular joint pain: relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha. Author(s): Emshoff R, Puffer P, Rudisch A, Gassner R. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2000 October; 90(4): 442-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11027380

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Temporomandibular joint pain-dysfunction in patients suffering from atypical facial pain. Author(s): Yusuf H, Rothwell PS. Source: British Dental Journal. 1986 September 20; 161(6): 208-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3463338

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Temporomandibular joint pain-dysfunction problems can be solved. Author(s): Dawson PE. Source: The Journal of Prosthetic Dentistry. 1973 January; 29(1): 100-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4508618

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Temporomandibular joint pain-dysfunction syndrome and bruxism: etiopathogenesis and treatment from a psychosomatic integrative viewpoint. Author(s): Biondi M, Picardi A. Source: Psychotherapy and Psychosomatics. 1993; 59(2): 84-98. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8332706

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Temporomandibular joint pain-dysfunction syndrome. Author(s): Uthman AA, Mohl ND, McCall WD. Source: The New York State Dental Journal. 1978 October; 44(8): 326-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=280813

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Temporomandibular joint pain-dysfunction syndrome: a rare cause of headaches in adolescents. Author(s): Holmes GL, Zimmerman AW. Source: Developmental Medicine and Child Neurology. 1983 October; 25(5): 601-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6354798

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The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes. Author(s): Jull G, Bogduk N, Marsland A. Source: The Medical Journal of Australia. 1988 March 7; 148(5): 233-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3343953

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The association of obesity with joint pain and osteoarthritis in the HANES data. Author(s): Hartz AJ, Fischer ME, Bril G, Kelber S, Rupley D Jr, Oken B, Rimm AA. Source: J Chronic Dis. 1986; 39(4): 311-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3958117

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The association of temporomandibular joint pain with abnormal bone marrow in the mandibular condyle. Author(s): Sano T, Westesson PL, Larheim TA, Takagi R. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2000 March; 58(3): 254-7; Discussion 258-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10716105

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The basal joint pain syndrome. Author(s): Melone CP Jr, Beavers B, Isani A. Source: Clinical Orthopaedics and Related Research. 1987 July; (220): 58-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3595011

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The biological concept of “internal derangement and osteoarthrosis”: a diagnostic approach in patients with temporomandibular joint pain? Author(s): Emshoff R, Innerhofer K, Rudisch A, Bertram S. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2002 January; 93(1): 39-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805776

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The bite in the temporomandibular joint pain dysfunction syndrome. Author(s): Speck JE, Ellis DA, Awde JD. Source: The Journal of Otolaryngology. 1979 June; 8(3): 232-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=458919

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The conservative treatment of temporomandibular joint pain dysfunction syndrome. Author(s): Fournier DF. Source: Ariz Dent J. 1977; 23(1): 30-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=270308

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The design of maxillary occlusal guards in the treatment of acute temporomandibular joint pain dysfunction (T.M.J.) patients. Author(s): Schuller PD. Source: Quintessence Int. 1981 December; 12(12): 1295-301. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6952294

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The discriminating value of serum lactate dehydrogenase levels in children with malignant neoplasms presenting as joint pain. Author(s): Wallendal M, Stork L, Hollister JR. Source: Archives of Pediatrics & Adolescent Medicine. 1996 January; 150(1): 70-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8542010

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The effect of active absorbable algal calcium (AAA Ca) with collagen and other matrix components on back and joint pain and skin impedance. Author(s): Fujita T, Ohue M, Fujii Y, Miyauchi A, Takagi Y. Source: Journal of Bone and Mineral Metabolism. 2002; 20(5): 298-302. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12203036

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The effect of public or private management on patients with temporomandibular joint pain dysfunction. Author(s): Gerke DC, Sambrook P, Smales RJ, Goss AN. Source: Aust Dent J. 1989 August; 34(4): 310-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2775017

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The effect of transcutaneous electrical nerve stimulation (TNS) on joint pain in patients with rheumatoid arthritis. Author(s): Mannheimer C, Lund S, Carlsson CA. Source: Scandinavian Journal of Rheumatology. 1978; 7(1): 13-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=307810

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The effects of collagen hydrolysat on symptoms of chronic fibromyalgia and temporomandibular joint pain. Author(s): Olson GB, Savage S, Olson J. Source: Cranio. 2000 April; 18(2): 135-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11202824

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The influence of neuropeptides, serotonin, and interleukin 1beta on temporomandibular joint pain and inflammation. Author(s): Kopp S. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1998 February; 56(2): 189-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9461143

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The prevalence of cervical zygapophyseal joint pain. A first approximation. Author(s): Aprill C, Bogduk N. Source: Spine. 1992 July; 17(7): 744-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1502636

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The prevalence of chronic cervical zygapophysial joint pain after whiplash. Author(s): Barnsley L, Lord SM, Wallis BJ, Bogduk N. Source: Spine. 1995 January 1; 20(1): 20-5; Discussion 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7709275

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The recording of brain evoked potentials resulting from intra-articular focused ultrasonic stimulation: a new experimental model for investigating joint pain in humans. Author(s): Wright A, Davies II. Source: Neuroscience Letters. 1989 February 13; 97(1-2): 145-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2918998

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The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. Author(s): Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. Source: The Journal of the American Dental Association. 2001 April; 132(4): 476-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11315378

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The role of scintigraphy with technetium-99m nanocolloid in patients with peripheral joint pain. Author(s): Al Attia HM, Al Haider ZY, Khadim RA, El Higrisy M, Adams BK. Source: Clinical Rheumatology. 2001; 20(4): 255-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11529631

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The short-term effect of intra-articular injections of sodium hyaluronate and corticosteroid on temporomandibular joint pain and dysfunction. Author(s): Kopp S, Wenneberg B, Haraldson T, Carlsson GE. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1985 June; 43(6): 429-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3858479

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The temporomandibular joint pain dysfunction syndrome. Author(s): Henning FR. Source: Aust Fam Physician. 1977 October; 6(10): 1250-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=588140

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The temporomandibular joint pain dysfunction syndrome. Author(s): Alpert RL. Source: J S C Med Assoc. 1972 October; 68(10): 379-82. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4507434

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The temporomandibular joint pain-dysfunction syndrome: a frequent cause of headache. Author(s): Reik L Jr, Hale M. Source: Headache. 1981 July; 21(4): 151-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7263226

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The treatment of patients with temporomandibular joint pain dysfunction syndrome. Author(s): Zarb GA, Thompson GW. Source: Journal (Canadian Dental Association). 1975 July; 41(7): 410-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1094024

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The use of hypnosis in treating the temporomandibular joint pain dysfunction syndrome. Report of two cases. Author(s): Cohen ES, Hillis RE. Source: Oral Surg Oral Med Oral Pathol. 1979 September; 48(3): 193-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=289922

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The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Author(s): Lord SM, Barnsley L, Bogduk N. Source: The Clinical Journal of Pain. 1995 September; 11(3): 208-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8535040

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The value of medical history and physical examination in diagnosing sacroiliac joint pain. Author(s): Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. Source: Spine. 1996 November 15; 21(22): 2594-602. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8961447

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Thoracic zygapophyseal joint pain patterns. A study in normal volunteers. Author(s): Dreyfuss P, Tibiletti C, Dreyer SJ. Source: Spine. 1994 April 1; 19(7): 807-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8202799

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Thoughts on temporomandibular joint pain. Author(s): Hargitai IA. Source: The Journal of the American Dental Association. 2003 December; 134(12): 1566, 1568; Author Reply 1568. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719752

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Treatment of joint pain in Crohn's patients with budesonide controlled ileal release. Author(s): Florin TH, Graffner H, Nilsson LG, Persson T. Source: Clinical and Experimental Pharmacology & Physiology. 2000 April; 27(4): 295-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10779128

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Treatment of the temporomandibular joint pain-dysfunction syndrome. Author(s): Cobin HP. Source: The New York State Dental Journal. 1969 November; 35(9): 552-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5259382

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Tumor necrosis factor-alpha in synovial fluid and plasma from patients with chronic connective tissue disease and its relation to temporomandibular joint pain. Author(s): Nordahl S, Alstergren P, Kopp S. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2000 May; 58(5): 525-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10800908

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Underbite and temporomandibular joint pain. Author(s): Cameron BM. Source: Am J Orthop. 1967 January; 9(1): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6037919

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Unstable angina in a man with joint pain. Author(s): Frierson JH, May CM. Source: Hosp Pract (Off Ed). 1993 January 15; 28(1): 40-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8419414

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Use and misuse of intra-articular corticosteroids in treatment of temporomandibular joint pain. Author(s): Toller PA. Source: Proc R Soc Med. 1977 July; 70(7): 461-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=896783

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Use of morphine in nonmalignant joint pain: the Limoges recommendations. The French Society for Rheumatology. Author(s): Perrot S, Bannwarth B, Bertin P, Javier RM, Glowinski J, Le Bars M, Treves R. Source: Rev Rhum Engl Ed. 1999 November; 66(11): 571-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10591118

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CHAPTER 2. ALTERNATIVE MEDICINE AND JOINT PAIN Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to joint pain. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to joint pain and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “joint pain” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to joint pain: •

A biopsychological approach to temporomandibular joint pain and other chronic facial pain. Part II: Broadening of spectrum of treatments. Author(s): Hampf G. Source: Proc Finn Dent Soc. 1993; 89(1-2): 15-28. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8284299

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A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation. Author(s): Neblett R, Gatchel RJ, Mayer TG. Source: Applied Psychophysiology and Biofeedback. 2003 June; 28(2): 147-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12827993

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A combination of systematic review and clinicians' beliefs in interventions for subacromial pain. Author(s): Johansson K, Oberg B, Adolfsson L, Foldevi M.

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Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2002 February; 52(475): 145-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11885825 •

A critical look at the subluxation hypothesis. Author(s): Brantingham JW. Source: Journal of Manipulative and Physiological Therapeutics. 1988 April; 11(2): 130-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3290374

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A critical review of neuromuscular electrical stimulation for treatment of motor dysfunction in hemiplegia. Author(s): Chae J, Yu D. Source: Assist Technol. 2000; 12(1): 33-49. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11067576

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A double blind randomized controlled trial of Maharishi Vedic vibration technology in subjects with arthritis. Author(s): Nader TA, Smith DE, Dillbeck MC, Schanbacher V, Dillbeck SL, Gallois P, Beall-Rougerie S, Schneider RH, Nidich SI, Kaplan GP, Belok S. Source: Frontiers in Bioscience : a Journal and Virtual Library. 2001 April 1; 6: H7-H17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11282569

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A dual pathway model of daily stressor effects on rheumatoid arthritis. Author(s): Affleck G, Urrows S, Tennen H, Higgins P, Pav D, Aloisi R. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 1997 Spring; 19(2): 161-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9603691

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A long-term study on the efficacy of a herbal plant, Orthosiphon grandiflorus, and sodium potassium citrate in renal calculi treatment. Author(s): Premgamone A, Sriboonlue P, Disatapornjaroen W, Maskasem S, Sinsupan N, Apinives C. Source: Southeast Asian J Trop Med Public Health. 2001 September; 32(3): 654-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11944733

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A patient with severe palindromic rheumatism and frequent episodes of pain. Author(s): Takata S, Harada S, Mitsunobu F, Mifune T, Hosaki Y, Asida K, Tsugeno H, Okamoto M, Iwahashi M, Kawashima M, Yamamura M, Makino H, Tanizaki Y. Source: Intern Med. 2001 February; 40(2): 140-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11300148

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A phase I/II study of paclitaxel plus cisplatin as first-line therapy for head and neck cancers: preliminary results. Author(s): Hitt R, Hornedo J, Colomer R, Mendiola C, Brandariz A, Sevilla E, AlvarezVicent J, Cortes-Funes H. Source: Seminars in Oncology. 1995 December; 22(6 Suppl 15): 50-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8643971

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A phase I/II study of sequential doxorubicin and paclitaxel in the treatment of advanced breast cancer. Author(s): Amadori D, Frassineti GL, Zoli W, Milandri C, Tienghi A, Ravaioli A, Gentile A, Salzano E. Source: Seminars in Oncology. 1996 October; 23(5 Suppl 11): 16-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8893894

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A phase I/II trial of combination paclitaxel and carboplatin in advanced or metastatic non-small cell lung cancer: preliminary results of an ongoing study. Author(s): Natale RB. Source: Seminars in Oncology. 1995 December; 22(6 Suppl 15): 34-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8643968

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A pilot study to evaluate the effectiveness of Bowen technique in the management of clients with frozen shoulder. Author(s): Carter B. Source: Complementary Therapies in Medicine. 2001 December; 9(4): 208-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12184347

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A systematic review of physical interventions for patellofemoral pain syndrome. Author(s): Crossley K, Bennell K, Green S, McConnell J. Source: Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2001 April; 11(2): 103-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11403109

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Aromatherapy massage for joint pain and constipation in a patient with Guillian Barre. Author(s): Shirreffs CM. Source: Complementary Therapies in Nursing & Midwifery. 2001 May; 7(2): 78-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11855776

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Biofeedback and relaxation therapy for chronic temporomandibular joint pain: predicting successful outcomes. Author(s): Funch DP, Gale EN.

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Source: Journal of Consulting and Clinical Psychology. 1984 December; 52(6): 928-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6394632 •

Biofeedback in the treatment of long-term temporomandibular joint pain: an outcome study. Author(s): Carlsson SG, Gale EN. Source: Biofeedback Self Regul. 1977 June; 2(2): 161-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=901853

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Characterization and opioid modulation of inflammatory temporomandibular joint pain in the rat. Author(s): Hartwig AC, Mathias SI, Law AS, Gebhart GF. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 November; 61(11): 1302-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14613087

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Effect of indomethacin phonophoresis on the relief of temporomandibular joint pain. Author(s): Shin SM, Choi JK. Source: Cranio. 1997 October; 15(4): 345-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9481998

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Emotional factors in non-organic temporomandibular joint pain. Author(s): Moulton RE. Source: Dent Clin North Am. 1966 November; : 609-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5227800

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Nettle sting of Urtica dioica for joint pain--an exploratory study of this complementary therapy. Author(s): Randall C, Meethan K, Randall H, Dobbs F. Source: Complementary Therapies in Medicine. 1999 September; 7(3): 126-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10581821

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Psychological characteristics of long-term female temporomandibular joint pain patients. Author(s): Gale EN. Source: Journal of Dental Research. 1978 March; 57(3): 481-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=277554

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Sacro-iliac joint pain: etiology and conservative treatment. Author(s): Yong-Hing K.

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Source: Chir Organi Mov. 1994 January-March; 79(1): 35-45. Review. English, Italian. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8076476 •

Temporomandibular joint pain-dysfunction syndrome and bruxism: etiopathogenesis and treatment from a psychosomatic integrative viewpoint. Author(s): Biondi M, Picardi A. Source: Psychotherapy and Psychosomatics. 1993; 59(2): 84-98. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8332706

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The effect of transcutaneous electrical nerve stimulation (TNS) on joint pain in patients with rheumatoid arthritis. Author(s): Mannheimer C, Lund S, Carlsson CA. Source: Scandinavian Journal of Rheumatology. 1978; 7(1): 13-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=307810

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The effects of collagen hydrolysat on symptoms of chronic fibromyalgia and temporomandibular joint pain. Author(s): Olson GB, Savage S, Olson J. Source: Cranio. 2000 April; 18(2): 135-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11202824

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The use of hypnosis in treating the temporomandibular joint pain dysfunction syndrome. Report of two cases. Author(s): Cohen ES, Hillis RE. Source: Oral Surg Oral Med Oral Pathol. 1979 September; 48(3): 193-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=289922

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Transcutaneous electric nerve stimulation in joint pain in patients with rheumatoid arthritis [proceedings] Author(s): Mannheimer C, Lund S. Source: Aktuelle Gerontol. 1978 October; 8(10): 554-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=81618

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to joint pain; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview AIDS and HIV Source: Integrative Medicine Communications; www.drkoop.com Amyloidosis Source: Integrative Medicine Communications; www.drkoop.com Bone Marrow Disorders Source: Integrative Medicine Communications; www.drkoop.com Celiac Disease Source: Healthnotes, Inc.; www.healthnotes.com Chronic Fatigue Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Chronic Myelogenous Leukemia Source: Integrative Medicine Communications; www.drkoop.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Erythema Source: Integrative Medicine Communications; www.drkoop.com Fibromyalgia Source: Integrative Medicine Communications; www.drkoop.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com

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Hemophilia Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com HIV and AIDS Source: Integrative Medicine Communications; www.drkoop.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Joint Pain Source: Integrative Medicine Communications; www.drkoop.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com Malabsorption Source: Healthnotes, Inc.; www.healthnotes.com Myelofibrosis Source: Integrative Medicine Communications; www.drkoop.com Myeloproliferative Disorders Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Osteoarthritis Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Prima Communications, Inc.www.personalhealthzone.com Polycythemia Vera Source: Integrative Medicine Communications; www.drkoop.com Psoriasis Source: Integrative Medicine Communications; www.drkoop.com

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Rheumatoid Arthritis Source: Healthnotes, Inc.; www.healthnotes.com Rubella Source: Integrative Medicine Communications; www.drkoop.com Sarcoidosis Source: Integrative Medicine Communications; www.drkoop.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com Serum Sickness Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Healthnotes, Inc.; www.healthnotes.com Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Temporomandibular Joint Dysfunction Source: Integrative Medicine Communications; www.drkoop.com Thrombocytosis Source: Integrative Medicine Communications; www.drkoop.com TMJ Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com Wilson's Disease Source: Healthnotes, Inc.; www.healthnotes.com •

Alternative Therapy Chelation Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,679,00.html Chiropractic Source: Healthnotes, Inc.; www.healthnotes.com Hypnotherapy Source: Integrative Medicine Communications; www.drkoop.com Macrobiotics Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,714,00.html Rolfing Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,732,00.html •

Chinese Medicine Chuanwu Alternative names: Common Monkshood Mother Root; Radix Aconiti Source: Chinese Materia Medica Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Haifengteng Alternative names: Kadsura Pepper Stem; Caulis Piperis Kadsurae Source: Chinese Materia Medica Liangtoujian Alternative names: Radde Anemone Rhizome; Rhizoma Ahemones Daddeanae Source: Chinese Materia Medica Miaoji Wan Alternative names: Miaoji Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qingfengteng Alternative names: Orientvine Stem; Caulis Sinomenii Source: Chinese Materia Medica Qinjiao Alternative names: Largeleaf Gentian Root; Radix Gentianae Macrophyllae Source: Chinese Materia Medica Shujin Huoluo Jiu Alternative names: hujin Huoluo Wine; Shujin Huoluo Jiu (Shu Jin Huo Luo Jiu Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Zhuzishen Alternative names: Largeleaf Japanese Ginseng Rhizome; Rhizoma Panacis Majoris Source: Chinese Materia Medica

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Herbs and Supplements Aminoglycosides Source: Integrative Medicine Communications; www.drkoop.com B-carotene Source: Integrative Medicine Communications; www.drkoop.com Beta-carotene Alternative names: b-carotene, Trans-beta Carotene; Provitamin A, Betacarotenum Source: Integrative Medicine Communications; www.drkoop.com Betacarotenum Source: Integrative Medicine Communications; www.drkoop.com Bile Acid Sequestrants Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Alternative names: Cimicifuga racemosa (actea), Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Blackberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,837,00.html Bloodroot Source: Prima Communications, Inc.www.personalhealthzone.com Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Bromelain Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,760,00.html Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Centella Source: Integrative Medicine Communications; www.drkoop.com

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Centella asiatica Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Chaparral Alternative names: Larrea tridentata Source: Healthnotes, Inc.; www.healthnotes.com Cimicifuga racemosa (Actea) Source: Integrative Medicine Communications; www.drkoop.com Dandelion Source: Prima Communications, Inc.www.personalhealthzone.com Devil's Claw Source: Prima Communications, Inc.www.personalhealthzone.com Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Hydrocotyle Source: Integrative Medicine Communications; www.drkoop.com Indian Pennywort Source: Integrative Medicine Communications; www.drkoop.com Lubricant Laxatives Source: Integrative Medicine Communications; www.drkoop.com Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Nettle Alternative names: Urtica dioica Source: Healthnotes, Inc.; www.healthnotes.com Nettle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10048,00.html Pregnenolone Source: Healthnotes, Inc.; www.healthnotes.com

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Trans-beta-carotene Source: Integrative Medicine Communications; www.drkoop.com Uricosuric Agents Source: Integrative Medicine Communications; www.drkoop.com Wild Yam Source: Prima Communications, Inc.www.personalhealthzone.com Wild Yam Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10070,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 3. DISSERTATIONS ON JOINT PAIN Overview In this chapter, we will give you a bibliography on recent dissertations relating to joint pain. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “joint pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on joint pain, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Joint Pain ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to joint pain. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Psychological factors in the development, maintenance, and treatment outcome of temporomandibular joint pain and dysfunction by Schnurr, Robert F; PhD from The University of Western Ontario (Canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL43275

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 4. PATENTS ON JOINT PAIN Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.4 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “joint pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on joint pain, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Joint Pain By performing a patent search focusing on joint pain, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

4Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on joint pain: •

Antipyretic and analgesic methods and compositions containing optically pure R(-) ketoprofen Inventor(s): Gray; Nancy M. (Marlborough, MA), Wechter; William J. (Redlands, CA), Young; James W. (Palo Alto, CA) Assignee(s): Sepracor Inc. (marlborough, Ma) Patent Number: 5,331,000 Date filed: March 1, 1993 Abstract: Methods and compositions are disclosed utilizing optically pure R(-) ketoprofen for the treatment of pain including, but not limited to, pain associated with toothaches, headaches, sprains, joint pain and post-surgical pain, for example dental pain and ophthalmic pain, while substantially reducing adverse effects including, but not limited to, gastrointestinal, renal and hepatic toxicities, and leukopenia, which are associated with the administration of racemic ketoprofen. Optically pure R(-) ketoprofen is also useful in treating pyrexia while substantially reducing the adverse effects associated with the administration of racemic ketoprofen. Excerpt(s): This invention relates to novel compositions of matter containing optically pure R(-) ketoprofen. These compositions possess potent activity in treating pain including but not limited to, pain associated with toothaches, headaches, sprains, joint pain and surgical pain, for example dental pain and ophthalmic pain, while substantially reducing adverse effects associated with the administration of the racemic mixture of ketoprofen including but not limited to gastrointestinal, renal and hepatic toxicities, as well as leukopenia. Additionally, these novel compositions of matter containing optically pure R(-) ketoprofen are useful in treating or preventing pyrexia while substantially reducing the adverse effects associated with the administration of the racemic ketoprofen. Also disclosed are methods for treating the above-described conditions in a human while substantially reducing the adverse effects that are associated with the racemic mixture of ketoprofen, by administering the R(-) isomer of ketoprofen to said human. The active compound of these compositions and methods is an optical isomer of ketoprofen. Ketoprofen is described in U.S. Pat. No. 3,641,127. Chemically, the active compound is the R(-) isomer of 2-(3-benzoylphenyl)propionic acid, hereinafter referred to as R(-) ketoprofen. The term "R(-) isomer of ketoprofen" and particularly the term "R(-) ketoprofen" encompass optically pure and substantially optically pure R(-) ketoprofen. Ketoprofen, which is the subject of the present invention, is available commercially only as the 1:1 racemic mixture. That is, ketoprofen is available only as a mixture of optical isomers, called enantiomers. Web site: http://www.delphion.com/details?pn=US05331000__

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Antipyretic and analgesic methods using optically pure R-ketorolac Inventor(s): Barberich; Timothy J. (Concord, MA), Matson; Stephen L. (Harvard, MA), Wechter; William J. (Redlands, CA) Assignee(s): Sepracor Inc. (marlborough, Ma) Patent Number: 5,382,591 Date filed: September 8, 1993 Abstract: Methods are disclosed utilizing optically pure R-ketorolac for the treatment of pain, including but not limited to pain associated with toothaches, headaches, sprains, joint pain and surgical pain, for example dental pain (e.g., after periodontal surgery) and ophthalmic pain (e.g., after cataract surgery) while avoiding adverse effects which are associated with the administration of the racemic mixture of ketorolac. The optically pure R-ketorolac is also useful in treating pyrexia while avoiding the adverse effects associated with the administration of the racemic mixture of ketorolac. Excerpt(s): This invention relates to novel compositions of matter containing optically pure R-ketorolac. These compositions possess potent activity in treating pain, including but not limited to pain associated with toothaches, headaches, sprains, joint pain and surgical pain, for example dental pain (e.g., after periodontal surgery) and ophthalmic pain (e.g., after cataract surgery) while avoiding adverse effects including but not limited to gastrointestinal, renal and hepatic toxicities, which are associated with the administration of the racemic mixture of ketorolac. Additionally, these novel compositions of matter containing optically pure R-ketorolac are useful in treating or preventing pyrexia while avoiding the adverse effects associated with the administration of the racemic mixture of ketorolac. Also disclosed are methods for treating the above-described conditions in a human while avoiding the adverse effects that are associated with the racemic mixture of ketorolac, by administering the R-isomer of ketorolac to said human. The active compound of these compositions and methods is an optical isomer of ketorolac. This compound is described in U.S. Pat. No. 4,089,969. Chemically, the active compound is the R-isomer of 5-benzoyl-1,2-dihydro-3Hpyrrolo[1,2-a]pyrrole-1-carboxylic acid, hereinafter referred to as R-ketorolac. The terms "R-isomer of ketorolac" and "R-ketorolac" encompass both the optically pure and the substantially optically pure compositions. Ketorolac is available commercially only as the 1:1 racemic mixture. That is, it is available only as a mixture of optical isomers, called enantiomers. Web site: http://www.delphion.com/details?pn=US05382591__

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Composition and method for alleviating joint pain and stiffness Inventor(s): Rein; Eydbj.o slashed.rg (Randb.o slashed.l, DK) Assignee(s): Hansen; Marianne (tullebolle, Dk), Hansen; Otto Torbjorn (tullebolle, Dk) Patent Number: 6,485,752 Date filed: October 23, 2000 Abstract: A daily administration of a rose-hip concentrate and fish oil is used to treat and/or alleviate the symptoms associated with joint disease such as osteoarthritis, specifically joint pain and stiffness. By administering the combination on a daily basis, a significant reduction in pain and stiffness of the joints affected by joint disease is

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attained which allows individuals suffering from joint disease to substantially resume daily activities. Excerpt(s): This invention relates to the use of a composition containing a rose hip extract and fish oil for the treatment of pain and stiffness in the joints, such as associated with osteoarthritis. Various rose hip formulations are known. For example, in U.S. Pat. No. 6,024,960, commonly assigned with the present application, a rose hip formulation for use as an anti-inflammatory natural medicine is described. Fish oil is also a known material that has some beneficial effects. In particular, the n-3 polyunsaturated fatty acids (n-3 PUFA) of dietary fish oil are known to reduce the level of triglycerides and very low density lipoprotein cholesterol. Dietary supplementation by, for example, 1.0 ml capsules of fish oil containing about 0.3 g of the primary n-3 PUFA, eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), have been used, though other concentrations of the PUFA's in supplements are available, ranging for example from 20 to 50% by weight. Web site: http://www.delphion.com/details?pn=US06485752__ •

External herbal composition for treating muscle aches and joint pain Inventor(s): Johnson Prillerman; Kathleen O. (1341 N. 58th St., Philadelphia, PA 19131) Assignee(s): None Reported Patent Number: 5,958,418 Date filed: January 22, 1997 Abstract: The present invention relates to a natural herbal composition of effective amounts of Aloe Vera, Capsicum, Golden Seal, Comfrey Root and water, to its method of use for external application to affected parts of the body for eliminating muscular pain and to its method of preparation. Excerpt(s): The present invention is directed to an herbal composition which has been found to have healing properties, when used on the human body to eliminate muscular aches and pains. The active ingredients are all natural herbs and include Aloe vera, Symphytum officinale (common name, Comfrey Root), Hydrastis canadenis (Golden Seal), and Capsicum annuum (Cayenne pepper). The present invention is applied externally as a poultice or a liquid herbal soak. Compositions containing Aloe vera, capsicum extract and comfrey extract have been used as a cosmetic composition in combination with other herbal and chemical ingredients (Mausner, U.S. Pat. No. 5,215,759). Certain of the active ingredients have been used as an ingestible dietary supplement (Emanuel-King, U.S. Pat. No. 5,248,503). Web site: http://www.delphion.com/details?pn=US05958418__

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Facet joint pain relief method and apparatus Inventor(s): Fitz; William R. (6500 Mariemont Ave., Cincinnati, OH 45227) Assignee(s): None Reported Patent Number: 6,014,588 Date filed: April 7, 1998

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Abstract: An apparatus depolarizes the medial branch of the spinal nerve associated with a painful spinal facet joint so as to block pain impulses from reaching the spinal cord. The preferred apparatus includes a neurostimulator and two or more electrodes which carry electrical pulses to the target nerve or nerves. The impulses are intense enough to cause depolarization of a given medial branch and its articular branches, but not so large as to cause depolarization of the spinal cord itself. In the preferred embodiment the stimulator is physically small and battery operated, facilitating implantation underneath the skin. The stimulator includes a controller and appropriate electronics operative to generate electrical impulses tailored to an individual's need for appropriate pain relief in terms of pulse frequency, pulse width, and pulse amplitude. In an alternative embodiment, the stimulator further includes electrodes and electrical circuitry operative to monitor myoelectrical activity generated by the surrounding muscles and modulate the impulses generated by the stimulator to meet the demands of the individual's activity and/or prolong battery life. Excerpt(s): This invention relates generally to electrically mediated pain relief and, in particular, to the use of electrical current to block sensory pathways associated with the medial branch of the spinal nerve root and its articular branches so as to relieve pain caused by painful zygopophysial joints. A large body of evidence now exists to support the fact that the zygopophysial joints (facet joints) can be pain-producing structures. In particular, has been shown that the facet joints can be a source of chronic spinal pain in the cervical, thoracic and lumbosacral regions. This pain, which can be due to trauma to and/or degeneration of the facet joint, can be disabling in some patients. Anatomical dissections reveal that the facet joint is innervated by the articular branches of the medial branch of the spinal nerve. Lesioning this nerve has been shown to relieve pain, but regrowth of the nerve is inevitable and pain returns. Web site: http://www.delphion.com/details?pn=US06014588__ •

Herbal chinese joint complex Inventor(s): Hou; Liping (Taiyuan, CN) Assignee(s): Shanxi Zhengzhon Pharmaceutical Co., Ltd. (taiyuan, Cn) Patent Number: 6,350,476 Date filed: May 22, 2000 Abstract: The present invention provides compositions comprising the ingredients of plants of species of the genera Stephania, Coix, Pinellia, Prunus, Phellodendron, Sophora, Tetrapanax, Stemona, Glycyrrhiza, Tripterygium, Forsythia and Siegesbeckia, wherein such compositions have analgesic, antipyretic, and antiinflammatory properties. The present invention also provides methods of using such compositions for treating various conditions and diseases, including joint swelling, joint pain, osteoarthritis and rheumatoid arthritis. Excerpt(s): The present invention pertains, in general, to the field of dietary supplements and therapeutic compounds for the treatment of pain, fever and inflammation. In particular, the present invention pertains to compositions comprising various herbs, wherein such compositions are useful for improving joint health and flexibility, for the control of swelling, and for the maintenance of healthy, mobile joint function and connective tissue health. In addition, the compositions of the present invention are useful for the treatment of rheumatoid and/or arthritic conditions. All publications and patent applications herein are incorporated by reference to the same extent as if each

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individual publication or patent application was specifically and individually indicated to be incorporated by reference. Rheumatism refers to any of several pathological conditions of the muscles, tendons, joints, bones, or nerves, characterized by discomfort and disability. It is estimated that over 100 rheumatic diseases affect the joints and other connective tissues of animals. Web site: http://www.delphion.com/details?pn=US06350476__ •

Pharmaceutical compositions containing dehydroepiandrosterone and anesthetic steroids in the treatment of arthritis and other joint disabilities

other

Inventor(s): Peat; Raymond F. (P.O. Box 3427, Eugene, OR 97403) Assignee(s): None Reported Patent Number: 4,628,052 Date filed: May 28, 1985 Abstract: The present invention is concerned with compositions and methods of treating rheumatoid arthritis, osteoarthritis, and arthritis associated with psoriasis and with lupus and other auto-immune diseases, and also for treating non-specific joint pain associated with stress or incidental to another ailment, using dehydroepiandrosterone and/or other anesthetic steroids dissolved in an oily vehicle, and preferably administered topically or orally. Excerpt(s): This invention is concerned with compositions and methods of treating rheumatoid arthritis, osteo-arthritis, and arthritis associated with psoriasis and with lupus and other auto-immune diseases, and also for treating non-specific joint pain associated with stress or incidental to another ailment, using dehydroepiandrosterone (DHEA) and/or other anesthetic steroids dissolved in an oily vehicle, and preferably administered topically or orally. The extensive use of cortisone and related antiinflammatory steroids in treating arthritis has been limited by the knowledge of several side effects, including calcium loss and osteoporosis, immune suppression, and atrophy of various tissues, including the adrenal glands. Nonsteroidal anti-inflammatory agents have been used with some success to avoid the glucocorticoids' side effects, but generally are ineffective in preventing the advance of the disease process. Other agents have been used or proposed which retard the advance of the disease, possibly by inhibiting mitosis, but they generally have toxic side effects. It would be desirable to use in treatment substances which are normally present in the body at high levels, since these normal substances, especially when used in physiological quantities, rarely have harmful side effects. Web site: http://www.delphion.com/details?pn=US04628052__ •

Sacroiliac belt Inventor(s): Goldberg; Julie E. (3930 N. Pine Grove, Chicago, IL 60657), Hyman; Alan A. (2800 N. Sheridan Rd., #610, Chicago, IL 60657) Assignee(s): None Reported Patent Number: 4,576,154 Date filed: April 2, 1984

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Abstract: An orthopedic belt eases sacroiliac joint pain by compressing soft pelvic tissue against the sacrum and ilium, to support and immobilize the sacro-iliac joints. The belt consists solely of flat, woven webbing forming a band about four to six inches wide, and a fastening device at the front. The belt encircles the patient at the level between the anterior superior iliac spines and the greater trochanters of the femurs. It is fastened with enough tension to compress the soft tissue as desired. Ends of the band forming the belt are fastened together at an angle which is selected to pass the belt horizontally across the back and to accommodate the shape of the patient's hips. The ends of the band are cut off in a taper if necessary so that no square corners are exposed. Various fastening means to place and maintain tension on the band may be used, including flexible straps extending from one end of the band through loops on the other and back to the first end, where they are connected together with cooperating press-holding pads such as Velcro.TM. hook and eye material. Excerpt(s): The present invention relates to orthopedic devices for supporting and restraining joints in the human body, particularly in the sacro-iliac region, for purposes of easing pain and discomfort and to promote healing of ligaments. Prior art corsets are generally worn too high to be effective for relieving pain in the sacroiliac joint. Known sacroiliac belts or supports use sacroiliac pads or stays rather than flat webbing. Objects of the present invention include the provision of a sacroiliac belt which is simple and straightforward in its construction and use, very inexpensive to make, washable to preserve personal hygiene, and safe and effective for the relief of pain and discomfort in the sacroiliac joint. Further objects include the provision of a sacroiliac belt which can be constructed either on a custom basis or in a fixed variety of sizes and angular configurations to fit the great majority of patients. Web site: http://www.delphion.com/details?pn=US04576154__ •

Topical preparation and method for pain relief Inventor(s): Altadonna; James (90 E. 2nd St., Deer Park, NY 11729) Assignee(s): None Reported Patent Number: 5,853,768 Date filed: March 4, 1997 Abstract: A topical preparation is provided for pain relief in humans, particularly joint pain, wherein methyl glucose, iodide salts, camphor and menthol are provided together wherein the pain relief features are enhanced by the amphoteric characteristics of the methyl glucose and iodide salts enhance penetration of the pain relief components of the composition. Excerpt(s): The present invention is related to medication, and more specifically, to a topical preparation and methods of using topical preparations for the relief of discomfort and pain in the joints of humans. Heretofore many substances have been advertised for use in relieving pain in joints of the human body, such as the elbow, knee, thumb area, ankle, neck, wrist, hand and finger, shoulder, etc. However, these substances may normally work relatively fast but with the drawback that the effects are not very long lasting. A proposal to provide long lasting topical relief has been described in U.S. Pat. No. 4,564,521 of James Altadonna, for a topical preparation for relief and joint pain, wherein the topical preparation includes iodine and sodium iodide. Other prior art topical preparations for joint relief include U.S. Pat. No. 4,731,200 for an aqueous-alcohol composition containing benzylidene-camphor derivatives, U.S.

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Pat. No. 5,013,726 for a lotion containing methyl salicylate, camphor and menthol, U.S. Pat. No. 5,124,320 for an analgesic lotion containing menthol and camphor, U.S. Pat. No. 5,144,081 for a pharmaceutical composition containing camphor and U.S. Pat. No. 5,175,152 for a composition with methyl salicylate, menthol and camphor. However, none of the prior art describe the use of methyl glucose, iodine, iodide salts, camphor and menthol together for the relief of joint pain. Web site: http://www.delphion.com/details?pn=US05853768__

Patent Applications on Joint Pain As of December 2000, U.S. patent applications are open to public viewing.5 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to joint pain: •

Composition and methods for the treatment of musculoskeletal disorders and collagen and elastin deficiencies Inventor(s): Gamay, Aly; (McLean, VA) Correspondence: Womble Carlyle Sandridge & Rice, Pllc; P.O. Box 7037; Atlanta; GA; 30357-0037; US Patent Application Number: 20040029774 Date filed: August 6, 2002 Abstract: Disclosed is a composition and method of enhanced nutrients delivery system for the treatment of musculoskeletal disorders and promotion of collagen and elastin synthesis in mammals by the oral administration of gel-like composition of hydrated Chondoritin, Glucosamine, MSM (Methyl-Sulfonyl-Methane), gelatin, hydrolyzed gelatin, collagen, and/or hydrolyzed collagen in combination with gelling agents. The increased bioavailability of the composition aids in the relief of joint pain and rebuilds cartilages, tendons, muscles, skin and connective tissues. Excerpt(s): The present invention relates to a composition for treating musculoskeletal disorders and collagen and elastin deficiencies and in particular to the administration of a gel-like composition having increased bioavailability. Damage to the collagen and elastin containing tissues of the body can lead to sever malfunction of organs and cause serious disorders. The damage can be attributed to a variety of factors such as aging, poor nutrition, diseases and physical trauma. It is important from a therapeutic point of view to conserve intact tissues and to assist in the rapid repair of damaged tissue. Proper nutrition and ingestion of rejuvenating-nutrients can help in maintaining healthy tissues. Most cells in multicellular organisms are in contact with an intricate meshwork of interacting, extracellular macromolecules that constitute the extracellular matrix. These versatile protein and polysaccharide molecules are secreted locally and assemble into an organized meshwork in the extracellular space of most tissues. In addition to serving as a type of universal biological glue, they also form highly specialized structures such as cartilage, tendons, basal laminae, and bone and teeth. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

5

This has been a common practice outside the United States prior to December 2000.

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Composition for the relief of joint pain and myofascial pain and method of preparing same Inventor(s): Knigge, Jan Donald; (St. Petersburg, FL) Correspondence: N. Whitney Wilson; Bryan Cave Llp; 245 Park Avenue; New York; NY; 10167-0034; US Patent Application Number: 20030045503 Date filed: September 30, 2002 Abstract: A stable, formulation comprising glucosamine and chondroitin compounds in a base which can be used for topical application to relieve joint pain and myofascial pain. A method of preparing the composition by adding the glucosamine and chondroitin after the rest of the components of the formulation have been mixed and heated is also disclosed. Excerpt(s): This invention relates to a topically applied composition for the treatment of joint pain and myofascial pain, a process for preparing the composition, and a method of treating joint pain and, myofascial pain using the composition. Joint pain and myofascial pain can be caused by arthritis, cartilage injury or disease, and other sources. Patients can find such pain to be debilitating, and have used a variety of treatments for relief of pain, including formulations administered orally, parenterally, and topically. A popular form of treatment for joint pain and myofascial pain is the topical application of pain relieving ointments which contain menthol. Formulations for topical application can either be water-based or substantially anhydrous. For many applications, anhydrous (i.e. oil-based) formulations are preferable because anhydrous formulations will not evaporate like those containing water or alcohol. Anhydrous formulations, therefore, are easier to use in massaging applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Crude drug patch Inventor(s): Kim, Ki Hong; (Gangwon-do, KR) Correspondence: Jacobson Holman Pllc; 400 Seventh Street N.W.; Suite 600; Washington; DC; 20004; US Patent Application Number: 20020197303 Date filed: May 22, 2002 Abstract: The present invention relates to a crude drug patch, and in particular to a crude drug patch which is fabricated using a gardenia having a certain function such as an antimicrobial function, a suppression and fever removing function. A homeostasis function, etc., a raw rehmannia glutinose is capable of softening a coagulated blood, mitigating a blood stasis, and curing a wound. In addition, it is possible to mitigate a pain by sticking on a diseased part such as a labor pain/anti-inflammation, sprain, bruise, muscle pain, joint pain, lumbago, shoulder pain, neuralgia, rheumatic pain, etc. based on a combined prescription of a fermented soybean paste (toenjang), wheat flour and green tea at a certain ratio. Even when a crude drug patch according to the present invention is stuck on a skin using a natural material as an effective component, there is not any side effect. Excerpt(s): The present invention relates to a crude drug patch, and in particular to a crude drug patch which is fabricated using a gardenia having a certain function such as

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an antimicrobial function, a suppression and fever removing function, a homeostasis function, etc., a raw rehmannia glutinose capable of softening a coagulated blood, mitigating a blood stasis, and curing a wound. In addition, it is possible to mitigate a pain by sticking a crude drug patch on a diseased part such as a labor pain/inflammation, sprain, bruise, muscle pain, joint pain, lumbago, shoulder pain, neuralgia, rheumatic pain, etc. based on a combined prescription of a fermented soybean paste (toenjang), wheat flour and green tea at a certain ratio. Even when a crude drug patch according to the present invention is stuck on a skin using a natural material as an effective component, there is no any side effect. In the conventional art, in order to medically treat a labor pain/anti-inflammation, sprain, bruise, muscle pain, joint pain, lumbago, shoulder pain, neuralgia, rheumatic pain, etc., an anodyne or a patch which is an internal medicine is generally used. However, since the above internal medicine is an oral inoculation type medicine, a gastroenteric disorder may occur. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device for the treatment of muscle or joint pain Inventor(s): Ignatius, Ronald W.; (Barneveld, WI), Martin, Todd; (Dodgeville, WI), Straubhaar, Mark; (Barneveld, WI) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20040054386 Date filed: September 2, 2003 Abstract: Apparatus is provided for the treatment of a medical condition, such as muscle or joint pain. One embodiment of the apparatus is a hand-held device including a housing and at least one optoelectronic device, such as a light-emitting diode (LED), coupled to the housing. The optoelectronic device may be cooled by a cooling system. The cooling system may include a heat sink and a temperature sensor. Excerpt(s): This application claims priority under 35 U.S.C.sctn.119 to U.S. Provisional Patent Application No. 60/408,216 filed Sep. 4, 2002. This invention relates to a device for the treatment of muscle or joint pain. The device includes arrays of optoelectronic devices, such as light emitting diodes, that emit radiation suitable for the treatment of muscle or joint pain. Biostimulation is a method of using monochromatic light to deliver photons to cytochromes in the mitochondria of cells. Cytochromes are lightsensitive organelles that act as an electron transport chain, converting energy derived from the oxidation of glucose into adenosine triphosphate (ATP)--the mitochondria's fuel. By directly stimulating cytochromes with monochromatic light, it is believed that more fuel is pumped into the mitochondria of cells, increasing the energy available to the cells. Increasing the energy available to the cell is believed to help relieve pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Electrical heat and massage vibrating glove Inventor(s): Gross, Julia; (Memphis, TN) Correspondence: Julia Gross; 2033 Warren Street; Memphis; TN; 38106; US Patent Application Number: 20040087881 Date filed: November 2, 2002 Abstract: The Electrical Heat And Vibrating Glove is a fully leather enclosed glove which combines the application of both gentle heat and gentle massage to give the wearer or user comforting sensations to facilitate a reduction in hand stiffness, joint pain and discomfort in the below-wrist area. Configured in left and right hand versions, the glove operates on electricity obtained from conventional wall sockets(heating element) and a 2-AA battery powered massage motor. Additionally, the glove has a portability feature in that the heating element can be alternately powered by a 16 volt transformer. The heat is manually regulated by a top-side heat control dial, and the strength of the massage sensation is governed by the 2-speed battery-powered massage motor. The glove is open at the fingertips so that redness and skin irritation is easily detectible; this also adds a sporty look to the glove. Excerpt(s): This invention is a self-contained leather glove with a battery(AA) powered two-speed massage motor and glass-enclosed heating element which is powered by electricity obtained from a standard wall socket outlet (or portably with a 16 volt transformer unit). The two-speed massage motor has control settings of "high", "medium" and "low". The combination of heat and gentle massage vibrations is of utility to sufferers of stiffness, pain and arthritic conditions in their hand and finger joints. The leather glove is made into multiple sizes for those with small, medium or large hands. The attached drawings illustrate the back and palm views of the glove. On the back(top of hand) side of the leather glove is vibrating massage element and the heat control dial. The massage element and the wire connecting it to the battery powered motor are both enclosed and sewn into the leather glove. The heat control dial simulates a watch in outward appearance. The palm view of the leather glove illustrates the sewn-in heating element and the wrist-area massage control setting. In both illustrations, the heating and vibrating massage elements are positioned in the glove's center so that the heat and vibrations will radiate evenly across the hand. The Electrical Heat And Massage Vibrating Glove has the outward appearance of a standard lady's or man's glove--with two(2) notable exceptions. One, the glove is open at, and does not encapsulate, the fingertips and, two, the wrist of the glove contains a watch-appearing heat control unit on the top side and a palm side vibrating massage controller. The glove can be made in either right or left hand versions, and for small, medium or large hands. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Hyaluronic acid-associated superoxide dismutase mimics and their use in the treatment of joint pain Inventor(s): Benedict, James J.; (Arvada, CO) Correspondence: Centerpulse Usa INC.; Suite 1600; 3 E Greenway Plaza; Houston; TX; 77046; US Patent Application Number: 20030232784 Date filed: June 14, 2002

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Abstract: Herein is disclosed a composition, comprising a superoxide dismutase mimic (SODm) associated with hyaluronic acid (HA), wherein the composition is a liquid at about 37.degree. C. The composition is useful in a method of treating pain or inflammation in a joint of a mammal, comprising (i) providing the composition and (ii) injecting the composition into or close to the joint. Excerpt(s): The present invention relates generally to the field of treatment of pain and inflammation in mammalian joints. More particularly, it concerns compositions comprising a biomolecule and an associated free radical scavenger, and the use of such compositions in treating pain or inflammation. Still more particularly, it concerns compositions comprising a scaffold molecule, such as hyaluronic acid, collagen, and collagen derivatives such as gelatin, polyethylene oxide, polyethylene glycol, or polypropylene glycol, wherein the scaffold molecule is associated with superoxide dismutase mimics, and the use of such compositions in the treatment of pain and inflammation in mammalian joints. A number of human and animal diseases have as symptoms pain and inflammation of the joints. One such disease is rheumatoid arthritis, a common human autoimmune disease characterized by chronic inflammation of the synovial joints (such as the knee) and by subsequent progressive destruction of articular tissue. A second such disease is osteoarthritis, which has similar symptoms. One component of the synovial joints that is degraded in both rheumatoid arthritis and osteoarthritis is hyaluronic acid (HA). HA is a linear polysaccharide comprising repeating glucuronic acid and N-acetyl glucosamine disaccharide units. HA has a high molecular weight (up to and exceeding 5-7.times.10.sup.6 Da, although HA species having molecular weights from about 1.times.10.sup.4 Da and higher can be used in compositions and methods of the present invention) and readily associates with water. Though not to be bound by any particular theory, these properties of HA are believed to impart HA solutions with high viscoelasticity, even at low concentrations of HA. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Ingestion of hyaluronic acid for improved joint function and health Inventor(s): Leneau, Harry; (Jasper, MO) Correspondence: Barnes & Thornburg; 11 South Meridian Street; Indianapolis; IN; 46204; US Patent Application Number: 20020173484 Date filed: May 18, 2001 Abstract: A method is described for relieving joint pain and discomfort in a warmblooded vertebrate by delivering via oral ingestion a nutritional supplement comprising an effective amount of hyaluronic acid, or a salt or digest thereof, and a nutritionally acceptable carrier. In another embodiment of the present invention, a method is provided for reducing the discomfort of fibromyalgia in a person afflicted with fibromyalgia by delivering via oral ingestion a nutritional supplement comprising an effective amount of hyaluronic acid, or a salt or digest thereof, and a nutritionally acceptable carrier. Excerpt(s): The present invention relates to a method for relieving joint pain or other discomfort in a warm-blooded vertebrate. More particularly, this invention provides relief of symptoms of arthritic disorders or fibromyalgia by oral ingestion of a composition comprising an effective amount of hyaluronic acid, or a salt or digest thereof. Arthritic disorders, including acute and chronic rheumatoid arthritis and

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osteoarthritis as well as inflammatory skeletal and musculoskeletal conditions, affect millions of people. It has been estimated that 80% of all individuals over the age of 55 suffer from some form of arthritic disorder. The most common arthritic disorder is osteoarthritis. Osteoarthritis develops gradually over time in many cases. Patients experience alternating periods of mild to moderate pain, stiffness, and swelling of the joint and periods of relatively symptom-free joint activity. Osteoarthritis is characterized by the deterioration of cartilage that covers the ends of bones at a joint, such as the knee or hip. In the healthy joint, cartilage acts as a shock absorber and aids the joint in bearing the stress of physical movement. In addition, synovial joint fluid produced by the synovial membrane lubricates the joint providing a slippery surface over which the bones may move. But as cartilage deteriorates, the bones begin to rub against each other causing joint pain. At the same time, the concentration of hyaluronic acid in the synovial joint decreases, reducing the lubrication ability of the synovial joint fluid. Also, joint movement may be restricted as bone ends erode or thicken, and the bones may develop painful outgrowths, or bone spurs, as a result of this erosion or thickening. If left untreated, cartilage deterioration can seriously weaken the joint, possibly to the point of deformity. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Joint pain treatment by peripheral administration of a neurotoxin Inventor(s): Aoki, Kei Roger; (Coto de Caza, CA), Cui, Minglei; (Irvine, CA), Jenkins, Stephen W.; (Mission Viejo, CA) Correspondence: Stephen Donovan; Allergan, INC.; 2525 Dupont Drive; Irvine; CA; 92612; US Patent Application Number: 20040018212 Date filed: July 29, 2003 Abstract: Hard copy appears to have lots of missing letters (mostly lower case e within words) and also what appears to be species by themselves (believe these to be illness/disease so no italics) Methods for treating a non-spasm caused pain by peripheral administration to a patient of a therapeutically effective amount of a neurotoxin, such as a botulinum toxin. Excerpt(s): The present invention relates to methods for treating pain. In particular, the present invention relates to methods for treating pain by peripheral administration of a neurotoxin. Many, if not most ailments of the body cause pain. Generally pain is experienced wh n the free nerve endings which constitute the pain receptors in the skin as well as in certain internal tissues are subjected to mechanical, thermal, chemical or other noxious stimuli. The pain receptors can transmit signals along afferent neurons into the central nervous system and thence to the brain. The causes of pain can include inflammation, injury, disease, muscle spasm and the onset of a neuropathic event or syndrome. Ineffectively treated pain can be devastating to the person experiencing it by limiting function, reducing mobility, complicating sleep, and dramatically interfering with the quality of life. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Pharmaceutically acceptable salts containing local anesthetic and anti-inflammatory activities and methods for preparing the same Inventor(s): Chen, Bin-Ken; (Taichung, TW), Chen, Shan-Chiung; (Fengyuan City, TW), Lee, Fang-Yu; (Taichung, TW), Tsai, Chiung-Ju; (Miaoli, TW), Yi, Yen-Ling; (Taichung, TW) Correspondence: Venable, Baetjer, Howard And Civiletti, Llp; P.O. Box 34385; Washington; DC; 20043-9998; US Patent Application Number: 20040068007 Date filed: October 2, 2002 Abstract: The present invention provides pharmaceutically acceptable salts having local anesthetic and anti-inflammatory activities. The preferred pharmaceutically acceptable salt is a diclofenac salt of lidocaine. Diclofenac is a non-steroidal anti-inflammatory drug ("NSAID"). Lidocaine is a local anesthetic. Other NSAID (except the salicylic acid derivatives of NSAID) can be used to replace diclofenac and/or other local anesthetics can be used to replace lidocaine. The pharmaceutically acceptable salts are crystalline compounds, which are distinctively different from either the NSAID alone or the local anesthetic alone, as indicated by differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), High Performance Liquid Chromatography (HPLC) and Fourier-Transformed Infrared Spectroscopy (FTIR) analyses. These pharmaceutically acceptable salts are suitable for use in topical treatment or parenteral injection to treat patients with localized pain, including muscle pain, joint pain, pain associated with herpes infection, and wound pain (such as surgical wound, burn wound etc.). Excerpt(s): The present invention relates to a group of novel pharmaceutically acceptable salts, each containing local anesthetic and anti-inflammatory activities. The preferred pharmaceutical acceptable salt in this group is diclofenac salt of lidocaine. Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). Lidocaine is a local anesthetic. Other NSAID (except the salicylic acid derivatives of NSAID) can be used to replace diclofenac and/or other local anesthetics can be used to replace lidocaine. The pharmaceutically acceptable salts of the present invention are physically and chemically different from either the NSAID alone or the local anesthetic alone. The pharmaceutically acceptable salts of the present invention are particularly suitable for use in topical treatment or parenteral injection to treat patients with localized pain, including, but not limited to, muscle pain, joint pain, pain associated with herpes infection, and/or wound pain (such as surgical pain or burn pain). The present invention also relates to methods for making the pharmaceutically acceptable salts. In the management of pain and discomfort, two kinds of drugs are widely used. The first kind is local anesthetics. Local anesthetics reversibly block the impulse conduction along nerves and other excitable membranes that primarily utilize sodium channels. Clinically, this action blocks the pain sensation from specific areas of the body. Local anesthetics are weak bases. There are three major classes of local anesthetics, which are ester derivatives (such as cocaine, procaine etc.), amide derivatives (such as lidocaine, bupivacaine etc.), and others (such as dyclonine, pramoxine etc.). For therapeutic application, local anesthetics are usually made available as salts for reasons of solubility and stability. In the body, they exist either as the uncharged base (i.e., "free base") or as a cation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Selective MMP inhibitors having reduced side-effects Inventor(s): Baxter, Andrew Douglas; (Cambridge, GB), Bird, John; (Cambridge, GB), Montana, John Gary; (Cambridge, GB), Owen, David Alan; (Cambridge, GB), Wills, Ruth Elizabeth; (Cambridge, GB) Correspondence: Saliwanchik Lloyd & Saliwanchik; A Professional Association; 2421 N.W. 41st Street; Suite A-1; Gainesville; FL; 326066669 Patent Application Number: 20020035065 Date filed: May 21, 2001 Abstract: The subject invention pertains to matrix metalloproteinase (MMP) inhibitors that exhibit an IC.sub.50 of below 10.sup.-4M against MMP and have substantially no activity against non-MMP metalloproteinase-related events. The MMP inhibitors of the invention have reduced side-effects, especially with respect to joint pain. Excerpt(s): This invention relates to selective MMP inhibitors having reduced sideeffects. Compounds having the ability to inhibit matrix metalloproteinases (MMPs) and optionally also TNF.alpha. release are described in WO-A-9513289, WO-A-9611209, WOA-9635711, WO-A-9635712, WO-A-9635714, WO-A-9635687, WO-A-9712902, WO-A9719075, WO-A-973 8007, WO-A-980563 5 and WO-A-9806696. All these specifications are incorporated herein by reference. By way of example, WO-A-9611209 (Examples 52 and 72) and WO-A-9712902 (Example 6) disclose (S)-N-[2-mercapto-5phthalimido]pentanoyl-L-leucyl-(S)-tert-leucine N-methylamide, 2S-[4-(2,5dioxopyrrolidin-1-y- l)-2-mercaptobutyrylamino]-4-methylpentanoic acid (2,2-dimethyl1S-methylcarbamoylpropyl)amide, and 2-[2-mercapto-4-(3,4,4-trimethyl-2,5dioxoimidaz- olidin-1-yl)butyrylamino]-4-methylpentanoic acid (2,2-dimethyl-1methylcar- bamoylpropyl)amide, as racemates. Other compounds of this general type are also known. MMPs are a group of structurally related endopeptidases that degrade the proteinaceous elements of the extracellular matrix. A number of important features are shared by members of the MMP family and include a zinc atom at the catalytic active site, catalytic activity at neutral pH, initial existence as inactive proenzymes, activation involving removal of an N-terminal domain, structural stabilisation by calcium, and inhibition of the catalytically active forms by a family of specific protein inhibitors called Tissue Inhibitor of Metalloproteinases (TIMPs). The MMP family currently consists of twenty members including MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-10, MMP-11, MMP-12, MMP-13, MMP-14, MMP-15, MMP-16, MMP-17, MMP-18, MMP-19 and MMP-20 ("classical MMPs"). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Use of neurotoxic substances in producing a medicament for treating joint pains Inventor(s): Meyer, Dominik; (Zurich, CH) Correspondence: Rankin, Hill, Porter & Clark, Llp; 700 Huntington Building; 925 Euclid Avenue, Suite 700; Cleveland; OH; 44115-1405; US Patent Application Number: 20040047807 Date filed: August 11, 2003 Abstract: The present invention relates to the use of neurotoxic substances, which have a toxic effect in particular for the axon and the nociceptive nerve endings, for the preparation of an agent for the treatment of joint pain.

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Excerpt(s): The present invention relates to the use of neurotoxic substances for the preparation of an agent for treating joint pain according to the preamble of claim 1 and a method for applying this agent into the intracapsular space or into the synovial sac of the joint according to the preamble of claim 30. Pain emanating from joints often originates in the area of the joint capsule or in the bone area close to the joint. This may involve many etiologies such as, for instance, arthrotic or arthritic diseases, mechanical or other irritation of the bone surface near the joint, infections, autoimmune processes, etc. In all cases of interest for the purpose of the present invention, the developing pain emanates from nociceptive nerve fibers in the area near the joint. Nociceptive nerve fibers are also called C-fibers and A-delta fibers. If an analgesic substance (such as local anesthetics of morphine) is injected into such a diseased joint, the patient's symptoms are alleviated. However, the effect of the most common substances today is of only limited duration, and the pain usually recurs. Arthroscopic: debridement, joint cleaning, etc. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with joint pain, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “joint pain” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on joint pain. You can also use this procedure to view pending patent applications concerning joint pain. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON JOINT PAIN Overview This chapter provides bibliographic book references relating to joint pain. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on joint pain include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “joint pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on joint pain: •

Uninvited Guests: The Inside Story on Intestinal Parasites and How to Protect Yourself from Them Source: New Canaan, CT: Keats Publishing, Inc. 1996. 48 p. Contact: Available from Keats Publishing, Inc. 27 Pine Street, Box 876, New Canaan, CT 06840-0876. (800) 540-9440. Fax (800) 998-3103. PRICE: $3.95 plus shipping and handling. ISBN: 0879837365. Summary: Human bodies are perfect homes for parasites, providing food and housing for any number of these uninvited guests. Relatively few patients and doctors realize that parasites cause some of the most common intestinal infections in the U.S. This booklet describes common parasites, from the water poisoning Cryptosporidium to the 15 foot fish tapeworm. The protozoan family of parasites, single celled organisms like Giardia intestinalis (formerly known as Giardia lamblia) and Cryptosporidium parvum are the ones most frequently found in Americans. Diarrhea, nausea, fevers, and

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abdominal pain may be some of the initial symptoms of infections. Bowel disorders, muscle and joint pain, fibromyalgia, fatigue, malnutrition, and allergic reactions may develop when parasites take up long term, undetected residence in a human body. The author discusses sources of contamination, definitions and symptoms, parasitic infections, the parasites themselves, treatment options, and prevention strategies. Sources of contamination include water, food, pets, day care centers, sexual practices, and widespread global travel. Parasites are discussed in four basic categories: Protozoa (microscopic, single celled organisms), Trematodes (flukes), Cestoda (tapeworms), and Nematoda (round, pin, and hook worms). The author reviews the incidence, symptoms, and transmission of each of these parasitic infections. A questionnaire that can be useful in diagnosis is included in the booklet. Treatment options discussed include chemotherapeutic agents, herbal alternatives, and diet and other supportive measures. The author stresses that the best prevention strategy is to build a strong, healthy immune system. 1 figure. 33 references. •

New Sjogren's Syndrome Handbook Source: New York, NY: Oxford University Press. 1998. 230 p. Contact: Available from Sjogren's Syndrome Foundation, Inc. 8120 Woodmont Avenue, Suite 530, Bethesda MD 20814-1437. (301) 718-0300 or (800) 475-6473. Fax (301) 718-0322. Website: www.sjogrens.org. PRICE: $20.00 for members; $25.00 for nonmembers; plus shipping and handling. ISBN: 0195117247. Summary: This book offers a comprehensive guide to Sjogren's syndrome (SS). Designed both for people with Sjogren's and for physicians, the 26 chapters provide readers with both medical and practical information on this disorder. The book describes the symptoms, which can range from dry eyes and dry mouth (xerostomia), to hoarseness and difficulty in eating, to chronic fatigue and joint pain that can seriously impair quality of life. The authors offer complete information about diagnosis and how SS affects the various organ systems of the body, including the kidneys, blood vessels, lungs, liver, pancreas, and brain. The book also discusses treatment options and offers tips for daily living. The authors stress that, although there is no cure for SS, many strategies can be used to alleviate the suffering and problems faced by people with SS. The book concludes with a glossary of terms, a reference list, and a subject index. 53 references.

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Living Well With Osteoarthritis: A Self-Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 32 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. E-mail: [email protected]. PRICE: Contact company for pricing information; available in bulk. Order Number 97146A-07-99. Summary: This illustrated handbook provides people who have osteoarthritis (OA) with information on the diagnosis and management of this chronic condition. OA is caused by wear and tear that damages joints. The areas commonly affected include the hands, spine, hips, knees, and feet. Risk factors for OA include aging, heredity, injury to a joint, overuse, and excess weight. In a normal joint, cartilage protects the end of each bone, synovial fluid lubricates the joint, ligaments attach bone to bone, tendons attach muscles to the bones, and muscles move the bones. In general, OA damages joints after cartilage wears away and frays, and bones grate together where cartilage is missing. Common symptoms include joint pain, swelling, and stiffness. Diagnosis is based on the results

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of a physical examination, a medical history, and x rays. Various health care professionals may be involved in the care of a person who has OA, and the patient and team will develop a self management plan. Maintaining a positive outlook and staying active are important aspects of self care. Regular physical activity will help increase flexibility, strengthen muscles and tendons, build endurance, maintain or reach a healthy weight, and lift spirits. The handbook presents examples of exercises for increasing flexibility, strengthening muscles, and building endurance. The handbook also offers guidelines on using the food guide pyramid and nutrition facts labels to follow a balanced meal plan, performing daily tasks, using mobility aids and special assistive devices, and managing pain through relaxation techniques and pain medications. The handbook concludes with information on sources of information and support. •

Diagnosis and Nonsurgical Management of Osteoarthritis, Second Edition Source: Caddo, OK: Professional Communications, Inc. 2000. 304 p. Contact: Available from Professional Communications, Inc. P.O. Box 10, Caddo, OK 74729. (800) 337-9838. Fax (580) 367-9989. PRICE: $24.95 plus shipping and handling. ISBN 1884735576. Summary: This monograph provides health professionals with information on the diagnosis and nonsurgical management of osteoarthritis (OA). Part 1 presents general information about OA, including its definition, epidemiology (prevalence and risk factors), pathology, and pathogenesis. Part 2 deals with diagnosis, focusing on the clinical features of OA; the origins of joint pain; the pitfalls in diagnosing OA such as misinterpreting pain, the deformity, the radiographs, and the laboratory results; synovial fluid analysis; and the radiographic features of OA. Part 3 examines nonmedicinal therapy for OA pain, including aerobic exercise, range of motion and strengthening exercises, joint protection, weight loss, thermal modalities, patellar taping, tidal irrigation of the knee, use of wedged insoles, and patient education. Part 4 discusses the efficacy and adverse effects of systemic pharmacologic therapy, focusing on acetaminophen and nonspecific nonsteroidal antiinflammatory drugs (NSAIDs), NSAIDs that are specific inhibitors of cyclooxygenase-2, and opioids. Part 5 explores local therapies, including rubefacients and capsaicin cream, intraarticular injection of corticosteroids, and intraarticular injection of hyaluronic acid. Part 6 presents a rational strategy for treating OA pain. Part 7 highlights other therapies, including disease modifying drugs such as NSAIDs, heparinoids, tetracyclines, diacerhein, and glucosamine sulfate, as well as surgical intervention. 34 figures, 39 tables, 23 color plates, and numerous references.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “joint pain” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “joint pain” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “joint pain” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):

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•

All You Wanted to Know About Knee Joint Pain by Savitri Ramaiah (Editor); ISBN: 8120722299; http://www.amazon.com/exec/obidos/ASIN/8120722299/icongroupinterna

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Arthritis Miracle: How Extract Can Reduce Inflammatory Joint Pain by Earl Mindell, Virginia Hopkins; ISBN: 1583330593; http://www.amazon.com/exec/obidos/ASIN/1583330593/icongroupinterna

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Healing Joint Pain Naturally : Safe and Effective Ways to Treat Arthritis, Fibromyalgia, and Other JointDiseases by ELLEN HODGSON BROWN (Author); ISBN: 076790561X; http://www.amazon.com/exec/obidos/ASIN/076790561X/icongroupinterna

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How to Deal Simply With Back Pain and Rheumatoid Joint Pain by Fereydoon Batmanghelidj (1992); ISBN: 0962994200; http://www.amazon.com/exec/obidos/ASIN/0962994200/icongroupinterna

•

It's Not Just Growing Pains: A Guide to Childhood Muscle, Bone and Joint Pain, Rheumatic Diseases, and the Latest Treatments by Thomas J. A. Lehman (2004); ISBN: 0195157281; http://www.amazon.com/exec/obidos/ASIN/0195157281/icongroupinterna

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Joint Pain by John M. Mennell; ISBN: 0316566683; http://www.amazon.com/exec/obidos/ASIN/0316566683/icongroupinterna

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Joint Pains: A Guide to Successful Herbal Remedies by Penelope Ody (2002); ISBN: 0285636227; http://www.amazon.com/exec/obidos/ASIN/0285636227/icongroupinterna

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Living Life Free from Pain: Treating Arthritis, Joint Pain, Muscle Pain, and Fibromyalgia With Maharishi Vedic Medicine by Kumuda, Md Reddy, et al (2002); ISBN: 1930051549; http://www.amazon.com/exec/obidos/ASIN/1930051549/icongroupinterna

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Managing Chronic Pain: Strategies for Dealing With Back Pain, Headaches, Muscle & Joint Pain, Cancer Pain, Abdominal Pain by Siang-Yang Tan; ISBN: 0830819894; http://www.amazon.com/exec/obidos/ASIN/0830819894/icongroupinterna

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Osteoarthritic Joint Pain - No. 260 by Novartis Foundation Symposium (Author); ISBN: 0470867612; http://www.amazon.com/exec/obidos/ASIN/0470867612/icongroupinterna

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Taking Control of Tmj: Your Total Wellness Program for Recovering from Tempromandibular Joint Pain, Whiplash, Fibromyalgia, and Related Disorders by Robert O. Uppgaard DDS (1999); ISBN: 1572241268; http://www.amazon.com/exec/obidos/ASIN/1572241268/icongroupinterna

•

The Posture Prescription : The Doctor's Rx for: Eliminating Back, Muscle, and Joint Pain; Achieving OptimumStrength and Mobility; Living a Lifetime of Fitness and Well-Being by Kate Kelly (Author), M.D. Arthur White (Author) (2003); ISBN: 0609806319; http://www.amazon.com/exec/obidos/ASIN/0609806319/icongroupinterna

Chapters on Joint Pain In order to find chapters that specifically relate to joint pain, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book

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chapters and joint pain using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “joint pain” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on joint pain: •

Temporomandibular Joint Pains Source: in Okeson, J.P. Bell's Orofacial Pains. 5th ed. Carol Stream, IL: Quintessence Publishing Company, Inc. 1995. p. 295-343. Contact: Available from Quintessence Publishing Company, Inc. 551 North Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223; Fax (630) 682-3288; E-mail: [email protected]; http://www.quintpub.com. PRICE: $68.00 plus shipping and handling. ISBN: 0867152931. Summary: This chapter, from a text on orofacial pain, discusses temporomandibular joint pains. Topics covered include the behavior of temporomandibular joint pains; the classification of orofacial pains; the normal anatomy and function of the temporomandibular joint; the types of temporomandibular joint pains including ligamentous pain; macrotrauma; microtrauma; occlusion and disc derangement disorders; retrodiscal pain; capsular pain; arthritic pain; periarticular inflammation; painful chronic mandibular hypomobilities; and painful growth disorders. The author also addresses diagnostic considerations, differential diagnosis, therapeutic options for disc-interference disorders, patient education, the role of physical therapy modalities, drug therapy, and occlusal appliance therapy. Eight patient case studies are presented. 20 figures. 114 references.

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CHAPTER 6. MULTIMEDIA ON JOINT PAIN Overview In this chapter, we show you how to keep current on multimedia sources of information on joint pain. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on joint pain is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “joint pain” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “joint pain” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on joint pain: •

Ulcerative Colitis: The Disease and Enema Therapy Source: Marietta, GA: Solvay Pharmaceuticals, Inc. 1996. (videocassette). Contact: Available from Solvay Pharmaceuticals, Inc. 901 Sawyer Road, Marietta, GA 30062. (800) 354-0026. PRICE: Single copy free. Summary: This videotape program provides information and reassurance for people recently diagnosed with ulcerative colitis (UC). The program notes that UC can have a great impact on a person's life, but that following the prescribed treatment can help relieve symptoms and return a sense of normalcy. The narrator reviews the possible causes of UC, including genetic, infectious, and autoimmune theories, noting that UC is not contagious or caused by stress or food sensitivity. UC is most often found in the developing world, and people are usually diagnosed in their teens or twenties. The program then features brief interviews with six women who describe how they felt when they first received the diagnosis. Reactions ranged from fear and anxiety to relief that they finally had a name for their symptoms. The narrator then lists the common

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symptoms of UC: diarrhea, rectal bleeding, bloody stool, loss of appetite, anemia, abdominal pain, weight loss, fever, and gas (flatulence). Less common symptoms can include joint pain, skin lesions, and eye inflammation. The program then features a man and two women talking about symptoms, particularly urgency and frequency, and the impact of these symptoms on their lifestyles. The narrator notes that there are rectal agents, oral medications, antibiotics, and combination therapies, but that the video will focus on enema therapy. The program then interviews three patients who use Rowasa (mesalamine in a rectal suspension enema form). The patients talk about enema therapy and the improved quality of life they have found using this form of the drug. The program then uses line drawings to demonstrate how to give oneself an enema. The medication should be given when the patient can stay prone for 30 minutes or, preferably, overnight. The program concludes by encouraging viewers to ask their health care provider to answer any questions they may have. The address and tollfree telephone number (800-343-3637) of the Crohn's and Colitis Foundation of America are also provided.

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CHAPTER 7. PERIODICALS AND NEWS ON JOINT PAIN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover joint pain.

News Services and Press Releases One of the simplest ways of tracking press releases on joint pain is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “joint pain” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to joint pain. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “joint pain” (or synonyms). The following was recently listed in this archive for joint pain: •

U.S. adults don't seek care for joint pain: CDC Source: Reuters Health eLine Date: May 08, 2003

•

Smoking may exacerbate muscle, joint pain Source: Reuters Health eLine Date: January 02, 2003

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Serum LDH Levels Useful In Diagnosis Of Joint Pain In Children Source: Reuters Medical News Date: January 17, 1996 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “joint pain” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “joint pain” (or synonyms). If you know the name of a company that is relevant to joint pain, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “joint pain” (or synonyms).

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “joint pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on joint pain: •

Joint Pain in Ehlers-Danlos Syndrome Source: Loose Connections. XV(3): 9-10,12. September-October 2000. Contact: Available from Ehlers-Danlos National Foundation. 6399 Wilshire Blvd., Suite 510, Los Angeles, CA 90048. (323) 651-3038. Summary: This newsletter article provides people who have Ehlers-Danlos Syndrome (EDS) with information on the causes and management of joint pain. The main theory on joint pain is based on the observation that people who have EDS have more excursion on the ends of the bones than is considered normal. This excessive motion of the joints results in abnormal stretching of the capsule that holds the bone ends together. This in turn results in abnormal stresses across the capsule and triggers nerve endings that signal pain in the area. Treatment focuses on minimizing the unusual motion of the bone ends in an effort to brace the joint. To this end, people who have EDS and joint pain are trained to perform daily exercises in an effort to strengthen the muscles adjacent to the joint to offset the capsule's lack of support. They are also instructed to avoid activities that put the joint in a position allowing abnormal movement. People who have EDS may develop degenerative arthritis (DJD) earlier than would be expected. A mechanism by which patients who have EDS may develop early DJD is based on the observations of the cellular changes that accompany altered direction of forces. The treatment approach for DJD is very similar for all patients who have joint pain. The patient is instructed to minimize activities that will further damage remaining cartilage and achieve optimal body weight. Joint protection and stabilization are the mainstays of treatment for patients who have EDS and joint pain. Nonprescription medications may be used to decrease pain. Surgical joint replacement is an option if there is adequate evidence of loss of articular cartilage and associated pain or joint dysfunction. 4 references.

Academic Periodicals covering Joint Pain Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to joint pain. In addition to these sources, you can search for articles covering joint pain that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the

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name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for joint pain. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with joint pain. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to joint pain: Anti-inflammatory Drugs, Nonsteroidal •

Systemic - U.S. Brands: Actron; Advil; Advil Caplets; Advil, Children's; Aleve; Anaprox; Anaprox DS; Ansaid; Bayer Select Ibuprofen Pain Relief Formula Caplets; Cataflam; Clinoril; Cotylbutazone; Cramp End; Daypro; Dolgesic; Dolobid; EC-Naprosyn; Excedrin IB http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202743.html

Celecoxib •

Systemic - U.S. Brands: Celebrex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203736.html

Diclofenac and Misoprostol •

Systemic - U.S. Brands: Arthrotec 50; Arthrotec 75 http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203377.html

Leflunomide •

Systemic - U.S. Brands: Arava http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203680.html

Meloxicam •

Systemic - U.S. Brands: Mobic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500131.html

Rofecoxib •

Systemic - U.S. Brands: Vioxx http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203782.html

Salicylates •

Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dosehttp://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202515.html

Valdecoxib •

Systemic - U.S. Brands: Bextra http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500345.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

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Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute6: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

6

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:8 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

7

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 8 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway9 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “joint pain” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 3609 24 1018 16 155 4822

HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.13 Simply search by “joint pain” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

9

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

10

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 13

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists14 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.15 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.16 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

14 Adapted 15

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 16 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on joint pain can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to joint pain. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to joint pain. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “joint pain”:

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Arthritis http://www.nlm.nih.gov/medlineplus/arthritis.html Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.html Knee Injuries and Disorders http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html Osteoarthritis http://www.nlm.nih.gov/medlineplus/osteoarthritis.html Rheumatoid Arthritis http://www.nlm.nih.gov/medlineplus/rheumatoidarthritis.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on joint pain. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Living With Osteoarthritis: Controlling Joint Pain Source: San Bruno, CA: StayWell Company. 1998. 6 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This brochure provides people who have osteoarthritis (OA) with information on controlling joint pain. OA causes the cartilage in the joints to break down. Symptoms include joint pain and stiffness, weak muscles and wobbly joints, and loss of normal joint shape and motion. These symptoms can be controlled by exercising, losing weight and maintaining weight loss, and using special tools and aids to reduce strain and protect joints. Medications may help relieve pain and stiffness. The brochure provides tips on obtaining the best results from medications and comments on the use of surgery to decrease pain and improve movement. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an

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ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to joint pain. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to joint pain. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with joint pain. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about joint pain. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines.

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The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “joint pain” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “joint pain”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “joint pain” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “joint pain” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.17

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

17

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)18: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

18

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on joint pain: •

Basic Guidelines for Joint Pain Joint pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm

•

Signs & Symptoms for Joint Pain Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm

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Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Joint Pain Blood differential Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Joint X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003810.htm

•

Background Topics for Joint Pain Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Fracture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Sprains Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000041.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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JOINT PAIN DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adduction: The rotation of an eye toward the midline (nasally). [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenopathy: Large or swollen lymph glands. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is

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present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy,

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magnet therapy, spiritual healing, and meditation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anhydrous: Deprived or destitute of water. [EU] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test

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new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Ankle Joint: The joint that is formed by the inferior articular and malleolar articular surfaces of the tibia, the malleolar articular surface of the fibula, and the medial malleolar, lateral malleolar, and superior surfaces of the talus. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are

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split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipruritic: Relieving or preventing itching. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteritis: Inflammation of an artery. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Arthrosis: A disease of a joint. [EU] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Aspartic: The naturally occurring substance is L-aspartic acid. One of the acidic-amino-acids is obtained by the hydrolysis of proteins. [NIH] Aspartic Endopeptidases: A sub-subclass of endopeptidases that depend on an aspartic acid residue for their activity. EC 3.4.23. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atlanto-Axial Joint: The joint involving the atlas and axis bones. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to

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strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH]

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Biliary Tract: The gallbladder and its ducts. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopterin: A natural product that has been considered as a growth factor for some insects. [NIH]

Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone metastases: Cancer that has spread from the original (primary) tumor to the bone. [NIH]

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Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brace: Any form of splint or appliance used to support the limbs or trunk. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bruxism: A disorder characterized by grinding and clenching of the teeth. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Budesonide: A glucocorticoid used in the management of asthma, the treatment of various skin disorders, and allergic rhinitis. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Calcaneus: The largest of the tarsal bones and is situated at the lower and back part of the foot forming the heel. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calcitonin Gene-Related Peptide: Calcitonin gene-related peptide. A 37-amino acid peptide derived from the calcitonin gene. It occurs as a result of alternative processing of mRNA from the calcitonin gene. The neuropeptide is widely distributed in neural tissue of the brain, gut, perivascular nerves, and other tissue. The peptide produces multiple biological effects and has both circulatory and neurotransmitter modes of action. In particular, it is a potent endogenous vasodilator. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Pyrophosphate: Diphosphoric acid, calcium salt. An inorganic pyrophosphate

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which affects calcium metabolism in mammals. Abnormalities in its metabolism occur in some human diseases, notably hypophosphatasia and pseudogout. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Camphor: A bicyclic monoterpene ketone found widely in plant (primarily the camphor tree, Cinnamomum camphora). Natural camphor is used topically as a skin antipruritic and as an anti-infective agent. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin)

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and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Celecoxib: A drug that reduces pain. Celecoxib belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is being studied for cancer prevention. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH]

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Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chondroitin sulfate: The major glycosaminoglycan (a type of sugar molecule) in cartilage. [NIH]

Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clodronate: A drug used as treatment for hypercalcemia (abnormally high levels of calcium in the blood) and for cancer that has spread to the bone (bone metastases). It may decrease pain, the risk of fractures, and the development of new bone metastases. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational

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beliefs with more realistic and functional ones.

[NIH]

Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Comet Assay: A genotoxicological technique for measuring DNA damage in an individual cell using single-cell gel electrophoresis. Cell DNA fragments assume a "comet with tail" formation on electrophoresis and are detected with an image analysis system. Alkaline assay conditions facilitate sensitive detection of single-strand damage. [NIH] Comfrey: Perennial herb Symphytum officinale, in the family Boraginaceae, used topically for wound healing. It contains allantoin, carotene, essential oils (oils, volatile), glycosides, mucilage, resin, saponins, tannins, triterpenoids, vitamin B12, and zinc. Comfrey also contains pyrrolizidine alkaloids and is hepatotoxic if ingested. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU]

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Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum

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and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or

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whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cysteine Endopeptidases: Endopeptidases which have a cysteine involved in the catalytic process. This group of enzymes is inactivated by sulfhydryl reagents. EC 3.4.22. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH]

Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and anti-

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inflammatory properties. [NIH] Diestrus: Period of sexual quiescence separating phases of the estrous cycle in polyestrous animals. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Dynamometer: An instrument for measuring the force of muscular contraction. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service

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produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emollient: Softening or soothing; called also malactic. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH]

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Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Ergometer: An instrument for measuring the force of muscular contraction. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expectorant: 1. Promoting the ejection, by spitting, of mucus or other fluids from the lungs and trachea. 2. An agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives). [EU]

Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous

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and fibrous substances. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Nerve: A nerve originating in the lumbar spinal cord (usually L2 to L4) and traveling through the lumbar plexus to provide motor innervation to extensors of the thigh and sensory innervation to parts of the thigh, lower leg, and foot, and to the hip and knee joints. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Gait: Manner or style of walking. [NIH]

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Galanin: A neurotransmitter. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH]

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Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glucuronides: Glycosides of glucuronic acid formed by the reaction of uridine diphosphate glucuronic acid with certain endogenous and exogenous substances. Their formation is important for the detoxification of drugs, steroid excretion and bilirubin metabolism to a more water-soluble compound that can be eliminated in the urine and bile. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycan: A type of long, unbranched polysaccharide molecule. Glycosaminoglycans are major structural components of cartilage and are also found in the cornea of the eye. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granisetron: A serotonin receptor (5HT-3 selective) antagonist that has been used as an antiemetic for cancer chemotherapy patients. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth Disorders: Deviations from the average values for a specific age and sex in any or

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all of the following: height, weight, skeletal proportions, osseous development, or maturation of features. Included here are both acceleration and retardation of growth. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Hammer: The largest of the three ossicles of the ear. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemiplegia: Severe or complete loss of motor function on one side of the body. This condition is usually caused by BRAIN DISEASES that are localized to the cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM lesions; cervical spinal cord diseases; peripheral nervous system diseases; and other conditions may manifest as hemiplegia. The term hemiparesis (see paresis) refers to mild to moderate weakness involving one side of the body. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma

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glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatotoxic: Toxic to liver cells. [EU] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU]

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Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incidental: 1. Small and relatively unimportant, minor; 2. Accompanying, but not a major part of something; 3. (To something) Liable to occur because of something or in connection with something (said of risks, responsibilities, .) [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an

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area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH]

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Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lactate Dehydrogenase: A tetrameric enzyme that, along with the coenzyme NAD+, catalyzes the interconversion of lactate and pyruvate. In vertebrates, genes for three different subunits (LDH-A, LDH-B and LDH-C) exist. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Leflunomide: An anticancer drug that works by inhibiting a cancer cell growth factor. Also

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called SU101. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukopenia: A condition in which the number of leukocytes (white blood cells) in the blood is reduced. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lubricants: Oily or slippery substances. [NIH] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Luciferase: Any one of several enzymes that catalyze the bioluminescent reaction in certain marine crustaceans, fish, bacteria, and insects. The enzyme is a flavoprotein; it oxidizes luciferins to an electronically excited compound that emits energy in the form of light. The color of light emitted varies with the organism. The firefly enzyme is a valuable reagent for measurement of ATP concentration. (Dorland, 27th ed) EC 1.13.12.-. [NIH]

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Lumbago: Pain in the lumbar region. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Subsets: A classification of lymphocytes based on structurally or functionally different populations of cells. [NIH] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macrophage Activation: The process of altering the morphology and functional activity of macrophages so that they become avidly phagocytic. It is initiated by lymphokines, such as the macrophage activation factor (MAF) and the macrophage migration-inhibitory factor (MMIF), immune complexes, C3b, and various peptides, polysaccharides, and immunologic adjuvants. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mandibular Condyle: The posterior process on the ramus of the mandible composed of two parts: a superior part, the articular portion, and an inferior part, the condylar neck. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e.,

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extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Nerve: The intermediate sensory division of the trigeminal (5th cranial) nerve. The maxillary nerve carries general afferents from the intermediate region of the face including the lower eyelid, nose and upper lip, the maxillary teeth, and parts of the dura. [NIH]

Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Menthol: An alcohol produced from mint oils or prepared synthetically. [NIH]

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Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metalloendopeptidases: Endopeptidases which use a metal, normally zinc, in the catalytic mechanism. This group of enzymes is inactivated by metal chelators. EC 3.4.24. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metatarsophalangeal Joint: The articulation between a metatarsal bone and a phalanx. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methyl salicylate: Non-steroidal anti-inflammatory drugs. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU]

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Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naive: Used to describe an individual who has never taken a certain drug or class of drugs (e. g., AZT-naive, antiretroviral-naive), or to refer to an undifferentiated immune system cell. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or

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stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neopterin: A pteridine derivative present in body fluids; elevated levels result from immune system activation, malignant disease, allograft rejection, and viral infections. (From Stedman, 26th ed) Neopterin also serves as a precursor in the biosynthesis of biopterin. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH]

Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord.

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Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonmalignant: Not cancerous. [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH]

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Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Osteosclerosis: An abnormal hardening or increased density of bone tissue. [NIH] Oval Window: Fenestra of the vestibule; an oval opening in the medial wall of the middle ear leading into the vestibule. Normally it is covered by the base of the stapes. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine

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consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Hydrolases: A subclass of enzymes from the hydrolase class that catalyze the hydrolysis of peptide bonds. Exopeptidases and endopeptidases make up the sub-subclasses for this group. EC 3.4. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or

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multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Perivascular: Situated around a vessel. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phonophoresis: Use of ultrasound to increase the percutaneous adsorption of drugs. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms.

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[NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plant Oils: Oils derived from plants or plant products. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from

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plants, including safflower, sunflower, corn, and soybean oils. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Citrate: A powder that dissolves in water, which is administered orally, and is used as a diuretic, expectorant, systemic alkalizer, and electrolyte replenisher. [NIH] Poultice: That made by mixing mustard and flour with water. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenstrual: Occurring before menstruation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Proenzymes: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH] Proestrus: Phase of the estrous cycle preceding estrus during which the Graafian follicle undergoes maturation. Applies to animals. [NIH]

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Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Prone: Having the front portion of the body downwards. [NIH] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH]

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Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH]

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Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pyrexia: A fever, or a febrile condition; abnormal elevation of the body temperature. [EU] Pyrrolizidine Alkaloids: Alkaloids found in various species of Senecio and other plants. There are at least ten different chemicals, many of them hepatotoxic, teratogenic, and carcinogenic. The plants may cause damage in grazing herds, but no longer have medical use. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Ramus: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU]

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Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Renal Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]

Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH]

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Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Sacroiliac Joint: The immovable joint formed by the lateral surfaces of the sacrum and ilium. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serine Endopeptidases: Any member of the group of endopeptidases containing at the active site a serine residue involved in catalysis. EC 3.4.21. [NIH]

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Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation,

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maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Sodium Iodide: Sodium iodide (NaI). A compound forming white, odorless deliquescent crystals and used as iodine supplement, expectorant or in its radioactive (I-131) form as an diagnostic aid, particularly for thyroid function determinants. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatic cells: All the body cells except the reproductive (germ) cells. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are

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ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Stabilization: The creation of a stable state. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steady state: Dynamic equilibrium. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Steroid therapy: Treatment with corticosteroid drugs to reduce swelling, pain, and other symptoms of inflammation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH]

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Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Subtalar Joint: Formed by the articulation of the talus with the calcaneus. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Tapeworm: A flatworm that is an endoparasite and belongs to the class Cestoda. [NIH] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and

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atomic weight 98.91. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermography: Measurement of the regional temperature of the body or an organ by infrared sensing devices, based on self-emanating infrared radiation. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living

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organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Traction: The act of pulling. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transcutaneous: Transdermal. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trigeminal Nerve: The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate from cells of the trigeminal ganglion and project to the trigeminal nucleus of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tryptophan Hydroxylase: An enzyme that catalyzes the hydroxylation of tryptophan to 5hydroxytryptophan in the presence of NADPH and molecular oxygen. It is important in the biosynthesis of serotonin. EC 1.14.16.4 [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines

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and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tympanic membrane: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uranium: A radioactive element of the actinide series of metals. It has an atomic symbol U, atomic number 92, and atomic weight 238.03. U-235 is used as the fissionable fuel in nuclear weapons and as fuel in nuclear power reactors. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venter: Belly. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives

Dictionary 175

oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH]

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Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygapophyseal Joint: The joint that occurs between facets of the interior and superior articular processes of adjacent vertebra. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

177

INDEX A Abdomen, 125, 132, 142, 151, 159, 166, 170, 172 Abdominal, 90, 92, 96, 125, 144, 159, 166, 174 Abdominal Pain, 90, 92, 96, 125, 144, 174 Acceptor, 125, 158 Acetaminophen, 91, 125 Acetylcholine, 125, 157 Activities of Daily Living, 33, 125 Adduction, 15, 125 Adenine, 125 Adenocarcinoma, 125, 157 Adenopathy, 33, 125 Adenosine, 82, 125, 160 Adenosine Triphosphate, 82, 125, 160 Adjuvant, 125, 144 Adrenal Cortex, 125, 138, 163 Adrenal Glands, 78, 125 Adsorption, 125, 160 Adverse Effect, 74, 75, 91, 125, 168 Aerobic, 9, 91, 125, 126, 154 Aerobic Exercise, 9, 91, 126 Afferent, 10, 22, 85, 126 Affinity, 126, 168 Age of Onset, 126, 174 Aggressiveness, 7, 126 Airway, 126, 168 Albumin, 126, 171 Algorithms, 126, 131 Alimentary, 126, 149, 159 Alkaline, 126, 132, 136 Alkaloid, 126, 133, 135, 155 Allergic Rhinitis, 126, 132 Allograft, 126, 156 Alpha Particles, 126, 165 Alternative medicine, 98, 126 Amino acid, 14, 127, 128, 129, 132, 140, 145, 148, 151, 154, 157, 159, 163, 164, 167, 168, 173 Amphetamines, 127, 135 Anaesthesia, 46, 127 Anaesthetic, 27, 127 Analgesic, 17, 31, 74, 75, 77, 80, 88, 125, 127, 139, 148, 150, 155, 158 Analog, 9, 127 Anaplasia, 127, 156 Anatomical, 10, 77, 127, 148, 167

Androgens, 125, 127, 138 Anemia, 96, 127 Anesthesia, 17, 36, 41, 47, 126, 127, 141, 162 Anesthetics, 86, 88, 127 Angina, 11, 57, 127 Angiogenesis, 127, 153 Angioplasty, 11, 127 Anhydrous, 81, 127 Animal model, 14, 127 Anions, 126, 128, 150, 171 Ankle, 14, 79, 128 Ankle Joint, 14, 128 Anomalies, 26, 128 Anorexia, 127, 128, 144 Antibacterial, 128, 169 Antibiotic, 128, 139, 140, 169 Antibodies, 128, 152 Antibody, 126, 128, 136, 139, 147, 148, 149, 150, 153, 155, 165, 175 Antiemetic, 128, 145 Antifungal, 128, 143 Antigen, 6, 126, 128, 136, 147, 148, 149, 153 Antihistamine, 31, 128 Anti-infective, 128, 133, 147, 150 Anti-Inflammatory Agents, 78, 128, 129, 134, 138, 150 Antimicrobial, 81, 82, 128 Antineoplastic, 128, 133, 138, 140, 158 Antioxidant, 12, 128 Antipruritic, 129, 133 Antipyretic, 74, 75, 77, 125, 129, 139, 150 Anus, 129, 132, 136, 141, 143, 149, 166 Anxiety, 95, 129 Aorta, 129, 138, 175 Apnea, 129 Apolipoproteins, 129, 151 Aqueous, 79, 129, 130, 147, 151 Arachidonic Acid, 129, 163 Arginine, 129, 157, 173 Arterial, 10, 14, 129, 135, 137, 148, 164 Arteries, 129, 131, 138, 151, 154, 155 Arterioles, 129, 131 Arteritis, 50, 129 Artery, 127, 129, 138, 141, 153, 165 Arthroplasty, 49, 129 Arthrosis, 28, 29, 129

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Articular, 4, 7, 14, 27, 34, 47, 54, 55, 57, 77, 84, 99, 128, 129, 150, 151, 152, 158, 176 Articulation, 129, 154, 171 Aspartic, 129, 141 Aspartic Endopeptidases, 129, 141 Aspirin, 6, 102, 129 Assay, 129, 136 Asymptomatic, 15, 23, 129 Atlanto-Axial Joint, 24, 129 Atrophy, 33, 78, 129 Attenuation, 17, 129 Atypical, 51, 129 Auditory, 130, 142, 153, 174 Autacoids, 130, 148 Autoimmune disease, 84, 130 Autonomic, 125, 130, 145, 160, 171 Autonomic Nervous System, 130, 160, 171 Axillary, 130 Axons, 130, 156, 162 B Back Pain, 13, 22, 92, 130 Bacteria, 125, 128, 130, 141, 143, 151, 154, 164, 169, 172, 173, 174 Bacteriophage, 130, 161, 173 Base, 4, 7, 81, 86, 125, 130, 139, 150, 158, 172 Basement Membrane, 130, 142 Basophils, 130, 151 Benign, 130, 144, 146, 156, 165 Bilateral, 24, 130, 159 Bile, 68, 130, 144, 145, 151, 170 Biliary, 130, 131, 133 Biliary Tract, 131, 133 Bioavailability, 80, 131 Biochemical, 9, 131, 158, 168 Biomarkers, 12, 131 Biopterin, 131, 156 Biotechnology, 20, 98, 109, 131 Biotransformation, 131 Blood Coagulation, 131, 132 Blood Platelets, 131, 168 Blood pressure, 10, 11, 131, 133, 148, 155, 168 Blood vessel, 90, 127, 131, 133, 134, 138, 141, 150, 168, 169, 170, 172, 174 Blood-Brain Barrier, 9, 131 Body Fluids, 131, 156, 168, 173 Body Mass Index, 19, 24, 131, 158 Bone Marrow, 46, 52, 64, 131, 139, 144, 152, 155, 169 Bone metastases, 131, 135 Bowel, 65, 90, 132, 141, 170, 174

Bowel Movement, 132, 170 Brace, 99, 132 Brachytherapy, 132, 149, 150, 165, 175 Bradykinin, 132, 157 Brain Diseases, 132, 159 Brain Stem, 10, 132, 173 Branch, 36, 37, 77, 121, 132, 141, 144, 153, 159, 164, 169, 172 Breakdown, 132, 140, 144 Bruxism, 52, 63, 132 Buccal, 132, 152 Budesonide, 56, 132 Bupivacaine, 86, 132, 151 C Calcaneus, 132, 171 Calcitonin, 10, 132 Calcitonin Gene-Related Peptide, 10, 132 Calcium, 4, 53, 78, 87, 132, 135, 136, 148, 153 Calcium Pyrophosphate, 4, 132 Calculi, 60, 133 Camphor, 79, 133 Candidiasis, 133, 143 Capsaicin, 91, 133 Capsicum, 68, 76, 133 Capsular, 93, 133 Capsules, 76, 133, 144 Carbohydrate, 133, 138, 145, 161 Carboplatin, 61, 133 Carcinogenic, 133, 149, 165, 170 Carcinoma, 25, 133, 157, 170 Cardiac, 7, 11, 133, 138, 146, 151, 155, 170 Cardiorespiratory, 126, 133 Cardiovascular, 9, 10, 11, 15, 133, 168 Cardiovascular disease, 15, 133 Carotene, 68, 70, 133, 136 Case report, 25, 40, 48, 133, 135 Case series, 133, 135 Cataract, 75, 133, 134 Catheterization, 127, 134 Caudal, 10, 134, 162 Causal, 13, 134 Celecoxib, 5, 102, 134 Cell Division, 130, 134, 154, 161 Cell membrane, 134, 139, 160, 169 Cell Respiration, 134, 154, 166 Cellulose, 134, 161 Central Nervous System, 85, 125, 127, 130, 132, 134, 135, 142, 144, 146, 155, 162, 168 Central Nervous System Infections, 134, 146 Cerebral, 131, 132, 134, 142, 146

179

Cerebral hemispheres, 132, 134 Cerebrovascular, 133, 134 Cervical, 26, 27, 30, 31, 37, 41, 48, 52, 54, 56, 77, 134, 146 Cervix, 134 Character, 135, 139 Chemotherapeutic agent, 90, 135 Chemotherapy, 135, 145 Cholesterol, 65, 76, 130, 135, 138, 151, 170 Cholesterol Esters, 135, 151 Chondroitin sulfate, 8, 135 Chronic Disease, 9, 18, 135 Chylomicrons, 135, 151 Cisplatin, 61, 135 Clinical study, 49, 135 Clinical trial, 8, 11, 34, 109, 135, 137, 139, 140, 165 Clodronate, 30, 135 Cloning, 131, 135 Coca, 135 Cocaine, 86, 135 Cochlear, 135, 172, 175 Cochlear Diseases, 135, 172 Coenzyme, 135, 150 Cognitive restructuring, 12, 135, 170 Colitis, 66, 95, 96, 136 Collagen, 53, 54, 63, 80, 84, 127, 130, 136, 142, 144, 152, 161, 163 Collapse, 132, 136, 168 Colon, 136, 150, 174 Comet Assay, 12, 136 Comfrey, 76, 136 Comorbidity, 3, 136 Complement, 136, 137 Complementary and alternative medicine, 59, 70, 137 Complementary medicine, 59, 137 Compress, 79, 137 Computational Biology, 109, 137 Concretion, 133, 137 Conduction, 86, 137 Conjunctiva, 137, 173 Connective Tissue, 56, 77, 80, 131, 136, 137, 143, 144, 152, 164, 166, 171, 172 Connective Tissue Cells, 137 Consciousness, 127, 137, 139 Constipation, 23, 61, 137 Consumption, 137, 144, 166 Contamination, 90, 137 Contraindications, ii, 5, 137 Control group, 9, 13, 15, 16, 137 Cor, 137

Cornea, 138, 145 Coronary, 11, 133, 138, 154, 155 Coronary Artery Bypass, 11, 138 Coronary heart disease, 133, 138 Coronary Thrombosis, 138, 154, 155 Corpus, 138, 163 Corpus Luteum, 138, 163 Cortex, 132, 138, 142 Cortical, 13, 138 Corticosteroid, 4, 7, 47, 55, 138, 170 Cortisone, 78, 138 Cranial, 138, 145, 146, 149, 153, 156, 159, 160, 173, 175 Craniocerebral Trauma, 138, 146, 172 Curative, 139, 157, 172 Cutaneous, 133, 139, 152 Cyclic, 139, 146, 157, 163 Cyclosporine, 34, 139 Cysteine Endopeptidases, 139, 141 Cytokines, 12, 139 Cytotoxicity, 12, 135, 139 D Data Collection, 19, 139 Daunorubicin, 139, 140 Day Care, 90, 139 Degenerative, 9, 99, 139, 158 Dehydroepiandrosterone, 78, 139 Dementia, 3, 139 Dendrites, 139, 156 Density, 13, 76, 131, 139, 151, 158, 161, 169 Depolarization, 77, 139 Diagnostic procedure, 73, 98, 139 Diarrhea, 6, 20, 89, 96, 139 Diarrhoea, 139, 144 Diclofenac, 29, 86, 102, 139 Diclofenac Sodium, 139 Diestrus, 19, 140 Digestion, 126, 130, 132, 140, 151, 170, 174 Dilatation, 127, 140, 162 Dimethyl, 87, 140 Diploid, 140, 161 Direct, iii, 6, 17, 18, 101, 140, 166, 171 Discrete, 5, 10, 140, 172 Disease Progression, 4, 140 Distal, 4, 18, 138, 140, 162, 164 Dopamine, 135, 140, 157 Dorsal, 29, 47, 140, 162 Double-blind, 12, 140 Doxorubicin, 61, 140 Drug Interactions, 5, 103, 140 Drug Tolerance, 140, 172 Dynamometer, 15, 140

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Dysmenorrhea, 6, 16, 140 Dyspareunia, 12, 140 E Edema, 46, 140, 149 Efficacy, 7, 11, 12, 30, 31, 44, 60, 91, 140, 173 Effusion, 36, 45, 46, 49, 141, 171 Elastin, 80, 136, 141, 142 Elective, 141 Electrolyte, 138, 141, 146, 154, 162, 169 Electrophoresis, 136, 141 Electrophysiological, 10, 14, 141 Emollient, 141, 157 Endarterectomy, 127, 141 Endogenous, 132, 140, 141, 145, 173 Endometrial, 12, 141 Endometrium, 141, 153 Endopeptidases, 87, 129, 139, 141, 154, 159, 167 Endothelial cell, 9, 131, 141 Endothelium, 141, 157 Endothelium-derived, 141, 157 Endotoxin, 141, 174 Enema, 95, 96, 141 Enhancer, 141, 166 Environmental Health, 108, 110, 141 Enzymatic, 127, 132, 133, 136, 141, 147 Enzyme, 135, 141, 144, 146, 148, 150, 151, 154, 162, 171, 173, 175, 176 Eosinophils, 141, 151 Epidemic, 18, 142 Epidemiological, 11, 16, 142 Epigastric, 142, 159 Ergometer, 15, 142 Erythrocytes, 127, 131, 142 Estrogen, 7, 14, 19, 142 Estrogen receptor, 7, 19, 142 Eukaryotic Cells, 142, 158 Evacuation, 137, 142 Evoke, 142, 170 Evoked Potentials, 54, 142 Exocrine, 142, 159 Exogenous, 125, 131, 141, 142, 145, 174 Expectorant, 142, 162, 169 Extensor, 142, 164 External-beam radiation, 142, 150, 165, 175 Extracellular, 80, 87, 137, 142, 153, 154, 168 Extracellular Matrix, 80, 87, 137, 142, 153 Extracellular Matrix Proteins, 142, 153 Extracellular Space, 80, 142, 154 Extremity, 9, 17, 143, 159

F Facial, 20, 21, 37, 49, 50, 51, 59, 143, 153 Facial Pain, 20, 21, 51, 59, 143 Family Planning, 109, 143 Fat, 11, 129, 131, 133, 137, 138, 143, 151, 158, 161, 166, 169, 171 Fatigue, 12, 39, 64, 90, 143, 146 Fatty acids, 126, 143, 163 Febrile, 143, 165 Feces, 137, 143, 170 Femoral, 41, 143 Femoral Nerve, 41, 143 Femur, 18, 143, 172 Fibrosis, 143, 167 Fibula, 128, 143, 172 Flatulence, 96, 143 Flatus, 143, 144 Fluconazole, 6, 143 Forearm, 131, 143 Free Radicals, 128, 143 Friction, 143, 151 G Gait, 9, 143 Galanin, 19, 144 Gallbladder, 125, 130, 131, 144 Ganglia, 17, 19, 125, 132, 144, 156, 160, 171 Ganglion, 144, 173, 175 Gas, 96, 143, 144, 147, 157 Gastrin, 144, 147 Gastroenteritis, 34, 144 Gastrointestinal, 4, 5, 74, 75, 132, 143, 144, 168, 173 Gastrointestinal tract, 143, 144, 168, 173 Gelatin, 80, 84, 144, 145, 171 Gene, 6, 8, 19, 42, 131, 132, 144, 166 Gene Expression, 19, 144 Gene Therapy, 8, 144 General practitioner, 38, 144 Genetics, 6, 144 Genotype, 144, 160 Gland, 40, 125, 138, 144, 152, 159, 161, 163, 167, 170, 172 Glossopharyngeal Nerve, 143, 145 Glucocorticoid, 132, 145 Gluconeogenesis, 145 Glucose, 32, 79, 80, 82, 134, 145, 146, 149, 167 Glucuronic Acid, 84, 145 Glucuronides, 145 Glutamate, 14, 145 Glycine, 127, 145, 157, 167 Glycogen, 145

181

Glycoprotein, 145, 173 Glycosaminoglycan, 14, 135, 145 Gonadal, 145, 170 Governing Board, 145, 162 Grade, 19, 145 Graft, 11, 145 Grafting, 138, 145, 148 Granisetron, 33, 145 Growth, 6, 18, 93, 127, 128, 131, 145, 150, 152, 156, 161, 164, 172, 173 Growth Disorders, 93, 145 Guanylate Cyclase, 146, 157 H Hammer, 146, 158 Haploid, 146, 161 Headache, 5, 6, 10, 17, 55, 146 Headache Disorders, 146 Health Behavior, 19, 146 Health Status, 9, 12, 146 Heart attack, 133, 146 Heart failure, 11, 146 Hemiparesis, 146 Hemiplegia, 60, 146 Hemodiafiltration, 30, 146 Hemodialysis, 146 Hemofiltration, 146 Hemoglobin, 127, 142, 146, 147, 151 Hemoglobinopathies, 144, 147 Hemorrhage, 10, 139, 146, 147, 170 Hemostasis, 147, 168 Hepatic, 6, 74, 75, 126, 147 Hepatotoxic, 136, 147, 165 Heredity, 5, 90, 144, 147 Herpes, 17, 33, 86, 147 Herpes Zoster, 147 Histamine, 128, 147 Hoarseness, 90, 147 Homeostasis, 81, 82, 147 Homologous, 144, 147 Hormonal, 16, 19, 129, 138, 147 Hormone, 16, 19, 132, 138, 144, 147, 149, 150, 163, 167, 172 Hydrogen, 125, 130, 133, 142, 147, 155, 157, 158, 164, 171 Hydrogen Peroxide, 147, 171 Hydrolysis, 129, 131, 135, 147, 159, 173 Hydrophobic, 147, 151 Hydroxylation, 147, 173 Hydroxylysine, 136, 148 Hydroxyproline, 127, 136, 148 Hypercalcemia, 135, 148 Hyperplasia, 12, 148

Hypersensitivity, 6, 148, 167 Hypertension, 133, 138, 148, 149 Hypertrophy, 138, 148 I Ibuprofen, 32, 44, 102, 148, 150 Id, 63, 115, 120, 122, 148 Ileal, 56, 148 Ileum, 148 Immune response, 125, 128, 130, 138, 148, 175 Immune system, 12, 90, 148, 152, 155, 156, 175 Immunologic, 12, 148, 152, 165 Immunosuppressive, 145, 148, 171 Impairment, 3, 148 Implant radiation, 148, 149, 150, 165, 175 Implantation, 18, 77, 148 In vitro, 14, 144, 148, 171 In vivo, 15, 18, 144, 148, 154, 171 Incidental, 78, 148 Indicative, 91, 148, 159, 174 Indomethacin, 30, 62, 148 Infarction, 148 Infection, 6, 21, 86, 133, 144, 149, 152, 157, 167, 170, 175 Infiltration, 149, 162 Ingestion, 80, 84, 149, 161 Inhalation, 149, 161 Initiation, 4, 149, 163, 173 Innervation, 143, 149 Inorganic, 132, 135, 149, 155 Insomnia, 12, 149 Insulin, 149, 174 Internal Medicine, 82, 149 Internal radiation, 149, 150, 165, 175 Interstitial, 132, 142, 149, 150, 175 Intervertebral, 149, 151 Intervertebral Disk Displacement, 149, 151 Intestinal, 89, 133, 149 Intestines, 125, 143, 144, 149 Intracellular, 149, 157, 162, 163, 166 Intracranial Hypertension, 146, 149, 172 Intramuscular, 15, 149, 159 Intravenous, 150, 159 Invasive, 150, 152 Involuntary, 150, 155, 166, 169 Iodine, 79, 150, 169 Ions, 130, 141, 147, 150, 155, 169 Irradiation, 46, 49, 150, 175 Irrigation, 91, 150 Ischemia, 129, 150

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J Joint, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 59, 61, 62, 63, 64, 65, 66, 71, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 90, 91, 92, 93, 96, 97, 98, 99, 114, 123, 124, 128, 129, 150, 158, 167, 169, 171, 176 Joint Capsule, 88, 150, 171 K Kb, 108, 150 Ketoprofen, 74, 150 Ketorolac, 75, 150 Kinetic, 150 L Labyrinth, 150, 163 Lactate Dehydrogenase, 53, 150 Large Intestine, 149, 150, 166, 168 Lavage, 45, 150 Leflunomide, 4, 102, 150 Lens, 133, 134, 151 Leucine, 87, 151 Leukemia, 64, 140, 144, 151 Leukocytes, 12, 130, 131, 139, 141, 148, 151, 155, 157, 173 Leukopenia, 74, 151 Library Services, 120, 151 Lidocaine, 86, 151 Ligaments, 7, 79, 90, 138, 151 Lipid, 11, 129, 149, 151 Lipoprotein, 14, 76, 151 Liver, 90, 125, 126, 129, 130, 143, 144, 145, 147, 151 Localized, 17, 86, 146, 149, 151, 161, 167 Locomotion, 151, 161 Locomotor, 24, 151 Low Back Pain, 5, 42, 65, 151 Low-density lipoprotein, 151 Lubricants, 151 Lubrication, 85, 151 Luciferase, 19, 151 Lumbago, 81, 82, 152 Lumbar, 27, 30, 42, 44, 130, 143, 149, 151, 152 Lupus, 6, 65, 66, 78, 152, 171 Lymph, 125, 130, 134, 141, 152 Lymph node, 130, 134, 152 Lymphatic, 141, 149, 152, 161, 169 Lymphocyte, 12, 128, 152, 153 Lymphocyte Subsets, 12, 152

Lymphokines, 152 M Macrophage, 12, 152 Macrophage Activation, 12, 152 Magnetic Resonance Imaging, 8, 9, 45, 46, 152 Malignancy, 40, 152 Malignant, 16, 53, 125, 128, 152, 156, 165 Malnutrition, 90, 126, 129, 152 Mammary, 138, 152 Mandible, 152 Mandibular Condyle, 52, 152 Manifest, 5, 146, 152 Mastication, 16, 152, 173 Matrix metalloproteinase, 87, 152 Maxillary, 25, 37, 53, 153, 159, 173 Maxillary Nerve, 153, 173 Maxillary Sinus, 25, 153 Meatus, 153, 174 Medial, 28, 37, 47, 77, 128, 153, 158, 167, 172 Mediate, 11, 14, 140, 153 Mediator, 12, 51, 153, 168 Medical Records, 3, 153 Medicament, 87, 153, 171 MEDLINE, 109, 153 Medullary, 10, 153 Membrane, 30, 126, 134, 136, 137, 139, 142, 153, 154, 155, 158, 160, 166, 171, 174 Membrane Glycoproteins, 153 Memory, 128, 139, 153 Meninges, 134, 138, 153, 169 Meningitis, 143, 153 Menopause, 153, 160, 162 Menstrual Cycle, 16, 153, 163 Menstruation, 140, 153, 162 Mental, iv, 8, 108, 110, 139, 143, 153, 164 Mental Health, iv, 8, 108, 110, 153, 164 Menthol, 79, 80, 81, 153 Metabolic disorder, 9, 154 Metabolite, 131, 140, 154 Metalloendopeptidases, 141, 154 Metastasis, 153, 154, 156 Metastatic, 61, 154 Metatarsophalangeal Joint, 40, 154 Methionine, 140, 154 Methyl salicylate, 80, 154 MI, 19, 22, 124, 154 Microbe, 154, 172 Microbiology, 129, 154 Microdialysis, 14, 154 Microorganism, 154, 175

183

Microtubules, 154, 158 Migration, 152, 154 Mineralocorticoids, 125, 138, 154 Mitochondria, 82, 154, 158 Mitosis, 78, 154 Mobility, 7, 15, 85, 91, 92, 154 Modification, 11, 127, 154, 165 Molecular, 9, 84, 109, 111, 131, 137, 146, 154, 155, 166, 171, 173, 174 Molecular Structure, 10, 155 Molecule, 84, 128, 130, 135, 136, 141, 145, 147, 155, 158, 164, 165, 166, 174 Monitor, 18, 77, 155 Monoclonal, 150, 155, 165, 175 Monocytes, 151, 155 Mononuclear, 155, 173 Morphine, 38, 57, 88, 155, 156, 158 Morphology, 134, 152, 155 Motility, 148, 155, 168 Motion Sickness, 155, 156 Mucociliary, 155, 168 Mucosa, 152, 155 Mucus, 142, 155, 174 Muscle Fibers, 5, 155 Muscle tension, 38, 155 Muscular Diseases, 155, 159 Musculoskeletal System, 7, 155, 158 Myocardial infarction, 11, 138, 154, 155 Myocardium, 154, 155 N Naive, 9, 14, 155 Narcotic, 155 Nausea, 6, 89, 128, 144, 156 Need, 3, 17, 18, 77, 89, 92, 95, 99, 116, 125, 145, 153, 156, 172 Neoplasms, 53, 128, 139, 156, 165 Neoplastic, 127, 143, 156 Neopterin, 12, 156 Nerve Endings, 85, 87, 99, 156 Nerve Fibers, 88, 156 Nerve Growth Factor, 14, 156 Nervous System, 48, 126, 130, 134, 153, 156, 157, 160, 171 Networks, 13, 156 Neural, 10, 14, 39, 126, 132, 156, 169 Neuralgia, 10, 17, 81, 82, 156 Neuroanatomy, 10, 156 Neuroeffector Junction, 156 Neurologic, 7, 41, 156 Neuromuscular, 60, 125, 156, 159 Neurons, 10, 14, 17, 19, 85, 135, 139, 144, 156, 171, 175

Neuropathy, 13, 50, 156 Neuropeptide, 19, 132, 157 Neurophysiology, 39, 139, 157 Neurotoxic, 87, 88, 157 Neurotoxin, 85, 157 Neurotransmitter, 125, 127, 132, 140, 144, 145, 147, 157 Neutrons, 126, 150, 157, 165 Neutrophils, 151, 157 Niacin, 157, 173 Nitric Oxide, 7, 49, 157 Nitrogen, 126, 127, 142, 157, 173 Nonmalignant, 38, 57, 157 Non-small cell lung cancer, 61, 157 Nuclei, 126, 144, 152, 154, 157, 164, 175 Nucleus, 10, 130, 139, 141, 142, 149, 155, 157, 164, 170, 173, 175 O Ocular, 7, 157 Ointments, 81, 157 Opacity, 134, 139, 158 Ophthalmic, 74, 75, 158, 173 Opiate, 155, 158 Opium, 155, 158 Organelles, 82, 155, 158, 161 Orofacial, 93, 143, 158 Orthopaedic, 17, 18, 36, 45, 158 Ossicles, 4, 146, 158 Osteoarthritis, 4, 6, 7, 8, 40, 43, 45, 52, 65, 75, 76, 77, 78, 84, 85, 90, 91, 114, 150, 158 Osteoclasts, 132, 158 Osteoporosis, 78, 158 Osteosclerosis, 47, 158 Oval Window, 158 Ovariectomy, 19, 158 Ovaries, 158 Overweight, 18, 158 Ovum, 138, 158, 163 Oxidation, 12, 82, 125, 129, 131, 158 P Paclitaxel, 61, 158 Palliative, 158, 172 Palpation, 5, 16, 31, 158 Pancreas, 90, 125, 131, 149, 159, 173 Paralysis, 35, 146, 159 Paranasal Sinuses, 153, 159, 168 Paraplegia, 15, 159 Parasite, 159 Parasitic, 90, 159 Parenteral, 86, 159 Paresis, 146, 159 Patch, 81, 159

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Pathogenesis, 8, 91, 159 Pathologic, 4, 132, 138, 148, 159, 164, 169 Pathophysiology, 7, 41, 159 Patient Education, 91, 93, 114, 118, 120, 124, 159 Pelvic, 5, 31, 33, 79, 159, 163 Pelvis, 125, 152, 158, 159, 174 Peptide, 127, 132, 141, 159, 164 Peptide Hydrolases, 141, 159 Perception, 13, 159 Percutaneous, 41, 160 Pericardium, 160, 171 Perimenopausal, 4, 160 Peripheral blood, 12, 160 Peripheral Nervous System, 146, 157, 159, 160, 162 Peripheral Nervous System Diseases, 146, 159, 160 Perivascular, 132, 160 Pharmaceutical Preparations, 134, 144, 160 Pharmacokinetic, 160 Pharmacologic, 91, 127, 130, 160, 172 Phenotype, 19, 160 Phonophoresis, 30, 62, 160 Phospholipids, 143, 151, 160 Phosphorus, 132, 160 Physical Examination, 7, 56, 91, 160 Physical Therapy, 5, 22, 93, 160 Physiologic, 153, 160, 163, 166 Physiology, 13, 25, 56, 141, 157, 160 Pigments, 133, 160, 161 Pilot study, 36, 38, 61, 161 Pituitary Gland, 138, 161 Placenta, 161, 163 Plant Oils, 157, 161 Plants, 77, 126, 135, 145, 155, 160, 161, 162, 165, 167, 169, 172 Plaque, 127, 161 Plasma, 56, 126, 128, 132, 134, 135, 144, 146, 147, 154, 161 Plastids, 158, 161 Platelet Aggregation, 157, 161 Platelets, 157, 161 Platinum, 135, 161 Plexus, 143, 161 Pneumonia, 137, 161 Poisoning, 64, 89, 144, 156, 161 Polyethylene, 84, 161 Polymorphism, 42, 161 Polysaccharide, 80, 84, 128, 134, 145, 161, 164

Polyunsaturated fat, 76, 161 Pons, 132, 162 Posterior, 29, 130, 140, 145, 152, 159, 162 Postmenopausal, 7, 32, 158, 162 Potassium, 60, 154, 162 Potassium Citrate, 60, 162 Poultice, 76, 162 Practicability, 162, 173 Practice Guidelines, 110, 162 Precursor, 129, 140, 141, 156, 162, 173 Premenstrual, 16, 162 Presynaptic, 156, 157, 162 Presynaptic Terminals, 156, 162 Prevalence, 16, 17, 26, 42, 43, 54, 91, 162 Probe, 154, 162 Procaine, 86, 151, 162 Proenzymes, 87, 162 Proestrus, 19, 162 Progesterone, 14, 163, 170 Prognostic factor, 9, 163 Progression, 4, 127, 163 Progressive, 6, 84, 139, 140, 145, 158, 163 Projection, 10, 163 Proline, 136, 148, 163 Promotor, 163, 166 Prone, 96, 163 Proprioception, 18, 163 Prostaglandin, 5, 34, 163 Prostaglandins A, 148, 163 Prostate, 131, 163, 173 Protein C, 126, 129, 130, 151, 164 Protein S, 131, 164 Proteoglycan, 14, 164 Protons, 126, 147, 164, 165 Proto-Oncogene Proteins, 158, 164 Proto-Oncogene Proteins c-mos, 158, 164 Protozoa, 90, 154, 164, 174 Protozoal, 164 Protozoan, 89, 134, 164 Proximal, 18, 140, 162, 164 Psoriasis, 65, 78, 164 Psychopathology, 41, 164 Psychotherapy, 41, 52, 63, 164, 166 Public Health, 9, 19, 60, 110, 164 Public Policy, 109, 164 Pulmonary, 7, 131, 137, 138, 146, 164, 165, 175 Pulmonary Artery, 131, 165, 175 Pulse, 77, 155, 165 Pyrexia, 74, 75, 165 Pyrrolizidine Alkaloids, 136, 165

185

Q Quality of Life, 12, 17, 35, 39, 85, 90, 96, 165 R Race, 6, 74, 75, 154, 165 Racemic, 74, 75, 165 Radiation, 5, 82, 142, 143, 149, 150, 165, 172, 175 Radiation therapy, 142, 149, 150, 165, 175 Radioactive, 147, 148, 149, 150, 165, 169, 171, 174, 175 Radiography, 8, 18, 165 Radiolabeled, 150, 165, 175 Radiotherapy, 132, 150, 165, 175 Ramus, 152, 165 Randomized, 9, 11, 12, 13, 60, 141, 165 Randomized clinical trial, 11, 165 Reagent, 151, 165 Reassurance, 4, 95, 166 Receptor, 15, 19, 128, 140, 142, 145, 166, 168 Receptors, Serotonin, 166, 168 Recombinant, 17, 166, 174 Recombination, 144, 166 Rectal, 96, 166 Rectum, 129, 132, 136, 143, 144, 150, 163, 166, 171 Refer, 1, 132, 136, 147, 151, 155, 157, 166, 172 Reflex, 45, 166 Refraction, 166, 169 Refractory, 27, 166 Regimen, 11, 13, 102, 140, 166 Relapse, 11, 166 Relaxation Techniques, 91, 166 Renal Dialysis, 51, 166 Respiration, 129, 155, 166 Response Elements, 19, 166 Restoration, 160, 166, 175 Retroperitoneal, 125, 166 Retroviral vector, 144, 166 Rheumatic Diseases, 6, 25, 28, 41, 42, 46, 48, 78, 92, 166 Rheumatism, 28, 33, 45, 47, 60, 78, 148, 166, 167 Rheumatoid, 4, 6, 25, 30, 33, 34, 39, 44, 46, 54, 60, 63, 66, 77, 78, 84, 92, 114, 150, 167 Rheumatoid arthritis, 4, 6, 25, 30, 33, 34, 39, 44, 46, 54, 60, 63, 77, 78, 84, 150, 167 Ribose, 125, 167 Rigidity, 161, 167 Risk factor, 4, 5, 11, 32, 46, 90, 91, 167

Rural Population, 34, 167 S Sacroiliac Joint, 22, 31, 36, 39, 49, 56, 79, 167 Sagittal, 15, 167 Salicylate, 80, 167 Salicylic, 86, 167 Salivary, 167, 175 Saphenous, 138, 167 Saphenous Vein, 138, 167 Saponins, 136, 167, 170 Scleroderma, 6, 66, 167 Sclerosis, 7, 167 Screening, 135, 167 Secretion, 138, 147, 154, 155, 167, 174 Self Care, 91, 125, 167 Senile, 158, 167 Sensor, 82, 167 Serine, 141, 164, 167, 173 Serine Endopeptidases, 141, 167 Serotonin, 25, 33, 42, 54, 145, 157, 166, 168, 173 Serum, 8, 12, 53, 66, 98, 126, 136, 151, 154, 168, 173 Shock, 85, 168, 173 Side effect, 12, 16, 78, 81, 82, 101, 125, 168, 172 Signs and Symptoms, 4, 166, 168 Sinusitis, 37, 168 Skeletal, 5, 85, 127, 146, 155, 168, 169 Skeleton, 143, 150, 163, 168, 172 Skull, 138, 168, 172 Sleep apnea, 18, 168 Small cell lung cancer, 168 Small intestine, 135, 147, 148, 149, 168, 173 Smooth muscle, 14, 127, 130, 137, 147, 155, 168, 169 Social Environment, 165, 168 Social Support, 11, 13, 168, 170 Sodium, 29, 55, 60, 79, 86, 139, 154, 168, 169 Sodium Channels, 86, 169 Sodium Iodide, 79, 169 Soft tissue, 79, 131, 168, 169 Solid tumor, 127, 140, 169 Soma, 169 Somatic, 11, 16, 145, 154, 160, 169 Somatic cells, 154, 169 Sound wave, 137, 169 Soybean Oil, 162, 169 Spasm, 85, 169 Specialist, 115, 169

186

Joint pain

Species, 77, 84, 85, 133, 144, 154, 155, 159, 165, 169, 171, 175 Spectroscopic, 13, 169 Spectrum, 21, 59, 169 Spices, 133, 169 Spinal cord, 10, 15, 77, 132, 134, 135, 143, 144, 146, 153, 156, 159, 160, 166, 169, 171 Spinal Cord Diseases, 146, 159, 169 Splint, 43, 132, 169 Spondylitis, 6, 169 Sprains and Strains, 151, 169 Squamous, 157, 170 Squamous cell carcinoma, 157, 170 Stabilization, 99, 170 Stasis, 81, 82, 170 Steady state, 5, 170 Steroid, 14, 38, 138, 145, 167, 170 Steroid therapy, 38, 170 Stimulus, 13, 142, 149, 166, 170 Stomach, 125, 144, 147, 149, 150, 156, 168, 170 Stool, 96, 136, 150, 170 Strand, 12, 136, 170 Stress, 5, 12, 48, 78, 85, 90, 95, 130, 144, 156, 167, 170 Stress management, 12, 170 Stroke, 18, 108, 133, 170 Subacute, 149, 168, 170 Subarachnoid, 146, 170 Subclinical, 149, 170 Subcutaneous, 7, 140, 159, 170 Subspecies, 169, 171 Subtalar Joint, 49, 171 Superoxide, 83, 84, 171 Superoxide Dismutase, 83, 84, 171 Supplementation, 14, 76, 171 Suppositories, 144, 171 Suppression, 78, 81, 82, 138, 171 Sympathetic Nervous System, 46, 130, 171 Symphysis, 49, 163, 171 Synapse, 156, 162, 171, 173 Synovial, 7, 8, 34, 51, 56, 84, 85, 88, 90, 91, 150, 171 Synovial Fluid, 8, 34, 51, 56, 90, 91, 171 Synovial Membrane, 85, 150, 171 Synovitis, 45, 171 Systemic, 6, 17, 33, 66, 91, 102, 129, 131, 133, 149, 150, 162, 165, 167, 171, 175 Systemic lupus erythematosus, 7, 171 T Tacrolimus, 42, 171 Talus, 128, 171, 172

Tapeworm, 89, 171 Technetium, 55, 171 Temporal, 10, 50, 146, 153, 172 Tendon, 40, 144, 172 Therapeutics, 60, 103, 172 Thermal, 85, 91, 157, 172 Thermography, 31, 172 Thigh, 143, 172 Thoracic, 56, 77, 130, 172 Thorax, 125, 152, 172 Thrombosis, 164, 170, 172 Thyroid, 132, 150, 169, 172 Tibia, 128, 143, 172 Time Management, 170, 172 Tinnitus, 5, 172, 175 Tolerance, 17, 172 Topical, 79, 81, 86, 147, 172 Toxic, iv, 78, 87, 139, 147, 157, 172 Toxicity, 4, 10, 11, 140, 172 Toxicokinetics, 172 Toxicology, 110, 172 Toxin, 85, 141, 172 Traction, 48, 173 Transcription Factors, 166, 173 Transcutaneous, 54, 63, 173 Transduction, 14, 173 Transfection, 131, 144, 173 Translation, 127, 173 Transmitter, 14, 125, 140, 153, 173 Trauma, 5, 77, 80, 173 Treatment Outcome, 23, 71, 173 Trigeminal, 10, 14, 17, 19, 143, 153, 173 Trigeminal Nerve, 17, 173 Trypsin, 162, 173, 176 Tryptophan, 19, 136, 168, 173 Tryptophan Hydroxylase, 19, 173 Tumor marker, 131, 173 Tumor Necrosis Factor, 12, 51, 173 Tympanic membrane, 158, 174 Type 2 diabetes, 18, 174 U Ulcerative colitis, 95, 174 Ultrasonography, 5, 174 Unconscious, 127, 148, 174 Uranium, 171, 174 Urinary, 20, 133, 174 Urine, 145, 174 Uterus, 134, 138, 141, 153, 158, 163, 174 V Vaccines, 174, 175 Vacuoles, 158, 174 Vagina, 133, 134, 153, 174

187

Vaginal, 12, 151, 174 Vascular, 7, 14, 141, 146, 149, 157, 161, 169, 174 Vasculitis, 47, 174 Vasodilator, 132, 140, 147, 174 Vector, 173, 174 Veins, 131, 153, 161, 174, 175 Venter, 174 Ventral, 47, 162, 174 Ventricle, 137, 165, 174 Venules, 131, 175 Vertebrae, 149, 169, 175 Vestibulocochlear Nerve, 172, 175 Vestibulocochlear Nerve Diseases, 172, 175 Veterinary Medicine, 109, 175 Viral, 7, 17, 156, 173, 175 Virulence, 172, 175

Virus, 17, 33, 130, 134, 141, 161, 166, 173, 175 Vitro, 14, 175 Vivo, 14, 18, 175 W White blood cell, 128, 151, 152, 155, 175 Wound Healing, 136, 153, 175 X Xenograft, 128, 175 Xerostomia, 90, 175 X-ray, 124, 150, 165, 175 X-ray therapy, 150, 175 Y Yeasts, 160, 176 Z Zygapophyseal Joint, 26, 37, 44, 54, 56, 176 Zymogen, 162, 164, 176

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Joint pain