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

USCLE AIN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. ...

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USCLE 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., 1960Muscle 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: 0-597-84507-7 1. Muscle 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 muscle 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 MUSCLE PAIN ........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Muscle Pain .................................................................................. 6 The National Library of Medicine: PubMed ................................................................................ 17 CHAPTER 2. NUTRITION AND MUSCLE PAIN ................................................................................. 49 Overview...................................................................................................................................... 49 Finding Nutrition Studies on Muscle Pain ................................................................................. 49 Federal Resources on Nutrition ................................................................................................... 50 Additional Web Resources ........................................................................................................... 51 CHAPTER 3. PATENTS ON MUSCLE PAIN ........................................................................................ 53 Overview...................................................................................................................................... 53 Patents on Muscle Pain ............................................................................................................... 53 Patent Applications on Muscle Pain ........................................................................................... 58 Keeping Current .......................................................................................................................... 61 CHAPTER 4. BOOKS ON MUSCLE PAIN ........................................................................................... 63 Overview...................................................................................................................................... 63 Book Summaries: Online Booksellers........................................................................................... 63 Chapters on Muscle Pain ............................................................................................................. 64 CHAPTER 5. PERIODICALS AND NEWS ON MUSCLE PAIN .............................................................. 69 Overview...................................................................................................................................... 69 News Services and Press Releases................................................................................................ 69 Newsletter Articles ...................................................................................................................... 70 Academic Periodicals covering Muscle Pain ............................................................................... 72 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................... 73 Overview...................................................................................................................................... 73 U.S. Pharmacopeia....................................................................................................................... 73 Commercial Databases ................................................................................................................. 74 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 77 Overview...................................................................................................................................... 77 NIH Guidelines............................................................................................................................ 77 NIH Databases............................................................................................................................. 79 Other Commercial Databases....................................................................................................... 81 APPENDIX B. PATIENT RESOURCES ................................................................................................. 83 Overview...................................................................................................................................... 83 Patient Guideline Sources............................................................................................................ 83 Finding Associations.................................................................................................................. 101 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 103 Overview.................................................................................................................................... 103 Preparation................................................................................................................................. 103 Finding a Local Medical Library................................................................................................ 103 Medical Libraries in the U.S. and Canada ................................................................................. 103 ONLINE GLOSSARIES................................................................................................................ 109 Online Dictionary Directories ................................................................................................... 109 MUSCLE PAIN DICTIONARY................................................................................................... 111 INDEX .............................................................................................................................................. 159

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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 muscle 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 muscle 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 muscle 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 muscle 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 muscle 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 muscle 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 MUSCLE PAIN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on muscle 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 muscle 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 “muscle 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: •

Sex Differences in Masticatory Muscle Pain After Chewing Source: Journal of Dental Research. 82(2): 112-116. February 2003. Contact: Available from International Association for Dental Research. Subscription Department, 1619 Duke Street, Alexandria, VA 22314. (703) 548-0066. Fax (703) 548-1883. Summary: Neither the etiology (cause) of muscle-related temporomandibular disorders (TMD) nor the reasons for the disproportionate number of women suffering from these disorders is well-established. This article reports on a study that tests the hypothesis that physiologically relevant exercise (i.e., chewing bubble gum for 6 minutes) increases masticatory (chewing) muscle pain in patients, but not in asymptomatic control subjects, and that female patients experience a significantly greater increase than males. Chewing increased pain in both female and male patients and, unexpectedly, also in

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female control subjects. One hour after chewing, the pain remained above pretest levels for female patients but not for the other groups. Thus, sex differences in chewinginduced pain were found in control subjects but not as hypothesized in patients. Because chewing-induced masticatory muscle pain was significantly greater in female control subjects than in males, and persisted longer in female patients than in males, these results suggest greater susceptibility in women. 3 figures. 1 table. 22 references. •

Effect of Jaw Muscle Pain and Soreness Evoked by Capsaicin Before Sleep on Orofacial Motor Activity During Sleep Source: Journal of Orofacial Pain. 15(3): 245-256. Summer 2001. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. Website: www.quintpub.com. Summary: Sleep bruxism (grinding the teeth during sleep), which is a form of orofacial motor activity (OMA), and jaw muscle pain and soreness have for a long time been thought to be mutually linked. This article reports on a study undertaken to investigate the effect of clinical and experimental jaw muscle pain and soreness on sleep OMA. Twelve healthy subjects aged 21 to 31 years old participated in this study. All of them were aware of signs or symptoms of sleep OMA and were subdivided into a group with clinical pain complaints (n = 5) and a group without pain (n = 7). All subjects slept in the laboratory for 3 consecutive nights, including a habituation night, a baseline night, and an experimental night. On the experimental night, before sleep, all subjects received an injection of capsaicin into the masseter muscle that had demonstrated the most EMG activity during the previous recordings. Results showed that this pre sleep injection of capsaicin did not cause significant differences between groups in peak pain intensity on the visual analog scale (VAS). The pain detection threshold (PDT) and maximal voluntary occlusal force (MVOF) did not show any significant differences between groups, injection and noninjection sides, or baseline and experimental nights and mornings. The number of EMG episodes per hour of sleep, the number of bursts per hour of sleep, and total area of all bursts and episodes during the baseline night were significantly higher in the subjects without pain than in the subjects with pain. However, the capsaicin injection did not cause any significant changes in these parameters. The authors conclude that an acute pre sleep painful stimulus does not have any effect on OMA during sleep, but the study extends previous findings that clinical jaw muscle pain and soreness are associated with less EMG activity in the masticatory muscles. 3 figures. 3 tables. 46 references.

•

Differential Diagnosis of Masticatory Muscle Pain and Dysfunction Source: Oral and Maxillofacial Surgery Clinics of North America. 7(1): 29-49. February 1995. Summary: This article on the differential diagnosis of masticatory muscle pain and dysfunction is from an issue of Oral and Maxillofacial Clinics on the medical management of temporomandibular disorders (TMD). The author notes that there are many local and systemic conditions besides TMD that can cause similar signs and symptoms and that need to be considered in the differential diagnosis. The author describes many of these conditions, their causes, and their distinguishing characteristics. Conditions discussed include masticatory myalgia; myositis; fibromyalgia syndrome (FS); direct muscle injury; acute cervical strain (whiplash); tendonitis; secondary pains of dental origin; complications of middle ear infections; maxillary sinus disease; paranasal

Studies

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sinus neoplasia; salivary gland disease; lymphadenitis; skeletal disease; neurogenic disturbances; vascular disturbances; psychogenic disturbances; and systemic disorders. 3 tables. 72 references. (AA-M). •

Comparison Between Masticatory Muscle Pain Patients and Intracapsular Pain Patients on Behavioral and Psychosocial Domains Source: Journal of Orofacial Pain. 16(4): 277-283. Fall 2002. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. Website: www.quintpub.com. Summary: This article reports on a study undertaken to identify differences between 2 groups of patients with temporomandibular disorders (those with masticatory, or chewing, muscle pain, MMP versus those with intracapsular pain, ICP) and to compare these differences on behavioral and psychosocial domains. There were 435 patients in the MMP group and 139 patients in the ICP group. The overall sample was 88.2 percent female and had an average age of 36.1 years (plus or minus 11.7 years). Results indicated no significant difference in pain severity or duration between the 2 groups. The ICP group, however, reported fewer affective symptoms of pain than the MMP group. The ICP group had twice as many adaptive copers as dysfunctional patients, while there was no significant difference between these 2 categories for the MMP group. Finally, the ICP group reported fewer psychological symptoms, better sleep quality, and fewer life stressors than the MP group. In contrast to many previous studies, the data set in this study showed no differences in pain severity and duration between the MMP and the ICP groups. Even though pain severity levels were equivalent, the MMP diagnostic group of chronic TMD patients demonstrated more dysfunctional behavioral profiles and significantly higher psychological distress than the ICP subgroup. 3 tables. 21 references.

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Chronic and Recurrent Muscle Pain: Pathophysiology and Treatment, and Review of Pharmacologic Studies Source: Journal of Musculoskeletal Pain. 4(1/2):123-143; 1996. Summary: This journal article for health professionals reviews pharmacologic studies that used needle electromyographically (EMG)- guided injection trigger points (TrPs) in patients with myofascial pain syndromes. Patients selected for the studies had one needle inserted in a select TrP, and a second needle was inserted into adjacent nontender muscle to monitor for voluntary motor unit contractions. Results of these studies indicate that the alpha- adrenergic antagonists phentolamine and phenoxybenzamine eliminated EMG spike activity recorded by needle EMG in the nidus of TrPs and significantly reduced subjective report of pain arising in TrPs. Findings suggest that electromyographically-guided TrP phenoxybenzamine injection is a promising lasting treatment for myofascial pain syndromes. 32 references and 7 figures. (AA-M).

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Dealing With Joint or Muscle Pain Source: Nurse Practitioner. 26(7): 23. July 2001. Summary: This journal article uses a question and answer format to provide people who have muscle or joint pain with information on managing pain caused by misuse syndrome, an injury that damages tendons, ligaments, and other soft tissues as a result

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of not using muscles correctly. The article explains how a health care provider evaluates a misuse injury, how misuse syndrome is treated, and how it can be prevented. The article also discusses the protection, rest, ice, compression, and elevation (PRICE) method of helping an injury heal.

Federally Funded Research on Muscle Pain The U.S. Government supports a variety of research studies relating to muscle 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 muscle 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 muscle pain. The following is typical of the type of information found when searching the CRISP database for muscle pain: •

Project Title: ARE FIBROMYALGIA AND CHIARI I MALFORMATION RELATED? Principal Investigator & Institution: Buchwald, Dedra S.; Professor; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2006 Summary: Fibromyalgia (FM) is a common condition of unknown etiology characterized by widespread muscle pain, sleep disturbances, fatigue, and various subjective neurological complaints. FM also frequently co-occurs with chronic fatigue syndrome, a condition similar to FM, whose hallmark is persistent, disabling fatigue. Many mechanisms for FM have been postulated but none has gained widespread acceptance or withstood the rigors of repeated scientific inquiry. Chiari I malformation (CIM), a hindbrain malformation associated with impairment of cerebral spinal fluid (CSF) flow, and syringomyelia, a cavitation of the spinal cord found in up to 80 percent of CIM patients, are neurological disorders. Although CIM patients typically seek medical attention for valsalva or exercise-related headaches, some present with non-specific complaints that are difficult to associate with CIM or syringomyelia. Common misdiagnoses for CIM include migraine, psychiatric disorder, multiple sclerosis, and FM. Successful treatment for symptomatic CIM patients, with or without syringomyelia, involves surgery to correct the presumed underlying pathophysiology by normalizing CSF flow in the hindbrain and enlarging the posterior fossa of the cranium. The overall safety and efficacy of the most common approach, a posterior fossa craniectomy and cervical laminectomy to expand the posterior fossa volume, is well supported in the literature. Recently, some FM patients have been treated with a posterior fossa and cervical operation. This procedure, performed by a select group of neurological

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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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surgeons, has attracted the attention of patients, the media, and the medical community. Hundreds, perhaps several thousand, of these operations have been performed without any scientific support for the safety or efficacy of this intervention in FM. The purpose of this study is to establish the relationship of hindbrain anomalies and cervical cord problems to FM. The Specific Aims are to: 1) determine the prevalence of CIM and cervical syringomyelia among patients with FM (with and without CFS) and pain- and fatigue-free controls using magnetic resonance (MR) imaging; 2) compare the clinical correlates and physical examination findings in these FM patients with and without CIM. There are plans to gather information on symptoms, and perform blinded neurological and MR examinations in 213 FM patients and 71 pain- and fatigue-free control subjects. MR sequences will quantitate posterior fossa anatomy, posterior fossa CSF volume, tonsillar position, and cervical spinal cord and canal pathology. To measure physiological parameters such as CSF velocity and direction of flow in the craniocervical junction, there are plans to employ cardiac gated phase-contrast cine-MR imaging. This study will assess the usefulness of MR imaging in the evaluation of FM patients with and without CFS, and may identify those who might benefit from surgery for hindbrain abnormalities and dissuade others from undergoing a potentially harmful intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRAINSTEM MECHANISMS OF CRANIOFACIAL MUSCLE PAIN Principal Investigator & Institution: Ro, Jin Y.; Oral Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): My objective during the K22 Faculty Transition Award is to gain expertise in the field of oral and craniofacial pain under the guidance of expert mentors and make a successful transition into an independent investigator. A comprehensive plan was designed to ensure timely progress of many facets in my career development. The scientific goal of the proposed research is to provide an overall understanding of the trigeminal brainstem mechanisms in craniofacial muscle pain processing. The lack of scientific information on how pain associated with masticatory muscle disorders develop and persist has hampered our ability to understand the underlying pathophysiology, and to diagnose and treat TMD and other masticatory disorders. Neural mechanisms mediating craniofacial muscle pain are further complicated by the unique organization of sensory processing in the trigeminal spinal nucleus (Vsp). We have very little understanding of how various aspects of acute and chronic muscle pain are processed across different subdivisions in the Vsp and as an integrated system. I propose that noxious inputs from masticatory muscles are distributed throughout the entire Vsp. Each subnucleus contributes to functionally different aspects of acute and inflammatory orofacial muscle pain, but significant interactions between the subnuclei exist via the intranuclear connections. Initially, the distribution and afferent convergence of trigeminal neurons that receive noxious muscle input will be examined. The effects of inflammatory muscle pain on the pattern and extent of neuronal activation and neuroplastic changes in both deep and cutaneous sensibilities will also be studied. Finally, interactions between the subnuclei and functional role of each subnucleus will be studied by intranuclear and efferent projection patterns. The mentors and advisory committee members are well qualified to provide necessary training for proposed experiments and objective evaluation of my progress. The University and the Department are fully supportive of my development and will provide the environment necessary to realize my goals. The training during this

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transition award will enable me to pursue future studies leading to the development of a NIH R01 grant proposal that will further our basic understanding of neurophysiological and neurochemical mechanisms of craniofacial muscle pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CUMULATIVE DYSFUNCTION

TRAUMA

DISORDER:

SKELETAL

MUSCLE

Principal Investigator & Institution: Stauber, William T.; Physiology and Pharmacology; West Virginia University P. O. Box 6845 Morgantown, Wv 265066845 Timing: Fiscal Year 2002; Project Start 30-SEP-1995; Project End 31-MAY-2004 Summary: Chronic pain originating from the musculoskelatal system is a dominant cause of sick-leave in modem industry and can be a very disabling and troublesome condition for the individual. Although the cause of this problem in skeletal muscle is unknown, one of the most frequent situations in which muscle pain is experienced is in industrial workers who have to move repeatedly and/or forcibly. The cumulative trauma disorder (CTD) which results from repetitive movements is of special interest because these repeat-motion injuries are one of the most difficult to anticipate and prevent. Our studies in humans have shown that exposure to a single bout of repeated strains can lead to myofiber and fascial rupture without bleeding but accompanied by muscle pain, restricted motion, and loss of strength and power. Little is known about the effect of repeated strains on muscles or the dynamic components of repeated use such as velocity and acceleration, which produce injury resulting in CTD or CTD risk. Since variations in human exposure and response together with the necessity for repeated tissue sampling makes man unsuitable as a research subject, we have developed a rat model of repeated strain injury (CTD). Using this model, the present study is designed: (1) to produce muscle strain injury in rats with and without fatigue using a custom-built dynamometer which can result in pathologic fibers, (2) to measure TGF-beta and bradykinin in response to muscle injury with and without pathology, (3) to assess the role of TGF-beta in collagen production and 4) to assay for TGF-beta in the blood of strain injured rats. Pathologic muscle fibers associated with TGF-beta will be identified using immunohistochemical techniques. Collagen content will be measured by HPLC. Active and latent forms of TGF-beta 1 and TGF-beta2 and type I and III collagens will be quantified by Western blots. Insight into the factors and conditions producing muscle injury with pathology should provide a better understanding of the healing (adaptive) or failed-healing (pathologic) processes of muscle and aid in the design of preventative regimens for individuals in specific industrial settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTIVENESS FIBROMYALGIA

OF

STATIC

MAGNETIC

FIELDS

IN

Principal Investigator & Institution: Boyden, Kathleen M.; None; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-JUN-2002 Summary: Fibromyalgia affects up to an estimate 10 percent of the population, primarily women. The syndrome is characterized as both a musculoskeletal and a subtle neurological disorder, and is associated with widespread muscle pain and tender points, along with fatigue, muscle weakness, and stiffness. Conventional medical approaches have limited success in treating fibromyalgia, leading patients to seek complementary therapies, including the use of magnetic therapies, in the hope of

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finding more effective pain relief. However, the efficacy and safety of magnetic therapy has not been definitively established through rigorously controlled trials. This doubleblind randomized placebo-controlled study is the second in a series investigating the efficacy of static magnetic field (SMF) therapies in alleviating symptoms associated with fibromyalgia. Chronic conditions are frequently associated with poor quality of life; and fibromyalgia is associated with even poorer quality of life than a variety of other chronic conditions such as rheumatoid arthritis, osteoarthritis, permanent ostomies, chronic obstructive pulmonary disease, and insulin dependent diabetes. Successful management of pain, the primary symptom of fibromyalgia, may result in improved quality of life. The study tests the primary hypotheses that locally applied quadripolar SMF devices, which have been shown to suppress the firing of action potentials of sensory neurons, will provide pain reduction and other therapeutic benefits. It is further proposed that treatment with SMF devices will lead to improved functional status and improved quality of life. The specific aims of the research are to compare the effects of quadripolar SMF devices externally applied to tender points and the effects of magnetic placebo devices. The proposed study will include a 6-month treatment period and a 9 month follow-up assessment to determine long-term effectiveness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF TRAINING ON BALANCE BETWEEN OXYGEN DELIVERY & UTILIZATION IN MUSCLE Principal Investigator & Institution: Richardson, Russell S.; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002 Summary: Since their return from the Persian Gulf region, a large number of veterans have reported health problems. Among the most frequent complaints are fatigue, muscle pain, and muscle weakness. In an effort to investigate the etiology responsible for the ongoing chronic fatigue and muscle weakness, we are performing a comprehensive evaluation of skeletal muscle in PG veterans afflicted with chronic fatigue and muscular weakness and in a control group of healthy veterans. To date, 40 Persian Gulf Veterans have been studied 25 suffering from chronic fatigue and muscle weakness (age 33$3yrs; weight 181$11lbs) and 15 controls (age 28$2yrs; weight 180$6lbs). There was only an 8% difference in the rate of PCr resynthesis, a measure of in vivo oxidative capacity, between the veterans with muscular complaints and the healthy veterans. The PCr resynthesis rate constant was 2.19$0.10 s-1 (Mean$SEM) in the sick Persian Gulf veterans and 2.36$0.11 s-1 in the healthy control veterans. Additionally, MRI measurements of subjects from both populations revealed no difference in the cross-sectional area of the calf muscles. Resting spectra from both populations showed little difference. The Pi/PCr of the healthy veterans was 0.13$0.01 [mM] compared with 0.14$0.01 [mM] in sick veterans. In order to verify the subjective reports of muscle weakness and fatigue, we measured muscular strength and endurance in both populations. The right calf was monitored during isometric and isokinetic contractions. Isometric strength differed between the populations by 50%, with an average peak torque of 86.6$10.8 in the sick veterans and 128.7$11.3 in the healthy ve terans. The relative fatiguability, in contrast, was the same in both groups. However, the sick group performed half as much total absolute work during the same number of maximal contractions (412.1$74.6J versus 795.1$124.3J for the healthy group).Further examination of skeletal muscle using a combination of electrical stimulation, muscle biopsies and EMG will be performed to confirm the myopathic origin of chronic fatigue and muscle weakness in PG illness. In addition, DNA samples will be screened for

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genetic defects, or polymorphisms, which may have predisposed individuals to develop Persian Gulf illness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENOTYPE AND TMJD VULNERABILITY TRAITS Principal Investigator & Institution: Stohler, Christian S.; Dean; Restorative Dentistry; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-MAY-2006 Summary: (provided by applicant): Temporomandibular joint disorders represent a major health problem and persistent TMJD pain is difficult to manage successfully. The majority of cases involve muscle. Laboratory evaluations proposed in this application permit new and critically important insight into the pathogenesis of persistent TMJD pain. We propose the use of approaches from several different scientific disciplines, such as genetics, endocrinology, neurobiology of pain and imaging of peripheral tissue to probe and understand the system response of human subjects with respect to disease characteristics of TMJD and for which measurement opportunities in animals are limited. Based on supporting data, this research aims to provide new knowledge regarding the significance of a candidate gene that appears to exert a strong effect on critical hallmark features of persistent TMJD muscle pain. Because sensitivity to pain and inhibition of pain are traits of considerable variability, we will study the effect of this gene on subject's response characteristics to experimentally induced jaw muscle pain. Furthermore, because women in their reproductive age make up the majority of patients treated with TMJD, our proposed research also focuses on whether estrogen significantly alters the system's response in subjects of a particular genotype. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GUIDED FIBROMYALGIA

IMAGERY:

A

NURSING

INTERVENTION

FOR

Principal Investigator & Institution: Menzies, Victoria S.; None; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 15-SEP-2002 Summary: (provided by applicant) Fibromyalgia affects up to an estimated 11 percent of the population, primarily women. The syndrome is characterized as both a musculoskeletal and a subtle neurological disorder, and is associated with widespread muscle pain and tender points, along with fatigue, muscle weakness, and stiffness. Conventional medical approaches have limited success in treating fibromyalgia, leading patients to seek complementary modalities, including the use of cognitive behavioral approaches such as relaxation and imagery, in the hope of finding more effective symptom management. The purpose of the proposed study will be to investigate the effects of guided imagery on selected outcomes in persons with fibromyalgia. The primary aim will be to investigate the effects of an eight-week intervention of guided imagery on self-efficacy and functional status. Two secondary aims will include: (1) to examine the relationship between absorption, a personality trait, and guided imagery effectiveness to identify patients who may benefit most from this modality; and (2) to explore the dose-response effect of imagery use (number of practices) on outcomes. The proposed project is a quasi-experimental study that will use a repeated measures single group design to examine the effectiveness of guided imagery, as an adjunctive modality, to enhance self-efficacy and function a status in persons diagnosed with fibromyalgia. If it can be demonstrated that self-efficacy can be increased and functional status can be

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improved in this population using a guided imagery intervention, then a future randomized controlled study will explore the effectiveness of guided imagery, as an adjunctive modality, on these outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: KINESTHETIC MECHANISMS IN THE TRIGEMINAL SYSTEM Principal Investigator & Institution: Capra, Norman F.; Associate Professor; Oral Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-AUG-1990; Project End 28-FEB-2006 Summary: (provided by applicant): The objectives of this project are to define segmental interactions between nociceptive and proprioceptive input originating from orofacial structures. Algesic stimulation of small- diameter muscle afferents excites in the spinal trigeminal nucleus and modulates proprioceptive responses. Altered jaw muscle spindles activity may disturb motor activity and kinesthetic sensibility. However, the neural basis for pain- induced modulation of craniofacial proprioception is not well understood. Three specific aims will address this issue. Aim 1. Define neural components responsible for the modulation of proprioceptive information in the presence of orofacial muscle pain. Three specific hypotheses are proposed. 1) Noxious chemical stimulation of the muscle produces differential modulation of responses from spindle primaries and secondaries to proprioceptive stimuli. 2) The caudle brainstem neurons that process small diameter muscle input are an integral link in the circuit for proprioceptive modulation. 3) The modulation of spindle afferents following noxious chemical stimulation of the muscle is mediated through the gamma fusimotor system. Aim 2. Investigate the effects of experimental muscle pain-induced modulation of spindle discharge on trigeminal alpha motoneurons. Intracellular recording techniques will be used to test whether changes in muscle spindle discharge induced by noxious chemical stimulation of the masseter muscle will cause transient changes in the excitability of masseter and synergist motoneurons during passive jaw stretch (hypothesis 4). Aim 3. Define the distribution and functional connectivity of the brainstem neurons that process jaw spindle signals, and determine their responses to noxious chemical stimulation of the craniofacial muscle. Two specific hypotheses are proposed. 5) Probst's tract collaterals from muscle spindle afferents project to functionally distinct populations of neurons throughout the rostrocaudal extent of the medical border of the spinal trigeminal nucleus and the PcRF. 6) The central proprioceptive neurons that receive input from jaw muscle spindle afferents at the level of Vi and Vc participate in coordinating changes in oral motility patterns in response to experimental muscle pain. The studies will contribute to our understanding of mechanisms underlying TMD, myofascial pain, and oromandibular dystonia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MAXIMIZING FIBROMYALGIA.

BENEFICIAL

EXERCISE

EFFECTS

IN

Principal Investigator & Institution: Jones, Kim D.; Assistant Professor; Primary Care Nursing; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-MAY-2006 Summary: (provided by applicant) Fibromyalgia (FM) is a common, costly and debilitating chronic pain syndrome diagnosed in nearly 6 million Americans, 90% of whom are women. Conservative estimates place direct and indirect costs of FM at $700 million annually. By definition, people with FM have chronic widespread pain and

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specified tender point areas. Other symptoms associated with FM include disrupted sleep, fatigue, decreased cognition, visceral and other pain syndromes, neurological symptoms, post-exertion muscle pain and exercise intolerance. The majority of people with FM are known to be aerobically unfit, have poor muscle strength and limited flexibility. Deconditioned muscle is theoretically more prone to muscle microtrauma, which causes localized pain and triggers widespread pain through disordered central nervous system processing (i.e., central sensitization). A negative cycle of deconditioning occurs in FM in large part due to exercise-induced pain that limits exercise tolerance. Dysfunction of the hypothalamic-somatotropic axis, specifically growth hormone (GH)/insulin-like growth factor-one (IGF-1), may also contribute to exercise induced pain and exercise intolerance in FM, due to the critical role of GH/IGF-1 in muscle homeostasis and repair following exercise. Over the past 25 years, the broad research theme of the Oregon Health and Science University's (OHSU) Fibromyalgia Research and Treatment Team has been investigating pain in fibromyalgia with an emphasis on exercise and pharmacological therapies. We recently documented GH/IGF-1 dysfunction in persons with FM at rest, and in response to exercise. We also pharmacologically altered the GH/IGF-1 axis in women with FM, with resultant improvements in pain and exercise tolerance by self-report. The focus of the proposed study is to test the effects of exercise training in women with FM whose GH profiles have been experimentally manipulated with low dose pyridostigmine bromide (Mestinon). To fully investigate the effects of exercise training and pyridostigmine bromide, a 2 x 2 x 2 (exercise x drug x time) design will be used. We propose a randomized clinical trial in which four groups of participants are observed over time (placebo only, pyridostigmine bromide only, exercise + placebo and exercise + pyridostigmine bromide). We will test the effects of the exercise and drug independent variables, alone and in combination, on the outcome variables of 1) pain and 2) FM associated symptoms and impact, cognition and quality of life. The specific aims of this study are to: Test the effects of a 6-month, 3-times-weekly exercise training program plus 3-times-daily 60 mg pyridostigmine bromide on pain, the primary and defining symptom of FM; and test the effects of a 6-month, 3-times-weekly exercise training program plus 3-times-daily 60 mg pyridostigmine bromide on FM-associated symptoms and impact, cognition, and quality of life. 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 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

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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: MUSCLE NOCICEPTOR ENCODING OF NOXIOUS MECHANICAL STIMULI Principal Investigator & Institution: Khalsa, Partap S.; Assistant Professor; Orthopaedics; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 29-FEB-2004 Summary: Muscle pain, due to mechanical causes, is pervasive in our lives. Acutely, it is initiated by mechanical stimulation, at tissue threatening (i.e., noxious) magnitudes, of specialized neurons innervating muscle called 'nociceptors'. The treatment of painful muscle conditions results in enormous expenditure of financial resources in the United States. Yet, our understanding of the underlying, peripheral, neural mechanisms that give rise to muscle pain due to mechanical causes if very limited. There are no quantitative biochemical studies of the neurophysiology of muscle or tendon nociceptors that encode noxious, mechanical stimuli. The relevant state of the mechanical stimulus at the level of the receptor has not been studied experimentally. Further, there are no robust mechanical models of how these sensory receptors are activated in situ. Hence, we are currently able to quantitatively predict the types of amounts of physical activity that will result in muscle pain in healthy individuals, much less those already injured or diseased. Nor can we predict the neurophysiological response to specific injuries. The aims of this research project will elucidate neural mechanisms that encode noxious, mechanical stimuli in muscle and that ultimately result in muscle pain. A first-order model will be developed to describe the activation of a nociceptor population in skeletal muscle. The 2 Specific Aims of this project are to determine 1) the relevant mechanical state that activates muscle and tendon nociceptors during stretch and passive compression; (2) how populations of muscle nociceptors encode noxious indentation. To accomplish these aims, the neural responses of single, nociceptors innervating tendon and muscle will be recording while simultaneously measuring the mechanical state that stimulates those neurons. The rat gracilis muscle will be used as a model system. Nociceptors innervating muscle or its tendons, do not experience the externally applied force or displacement during a noxious mechanical load. Rather, they experience the internally developed local stress (related to force)

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and/or local strain (related to displacement). In these experiments, the local stress and strain will be independently measured at the receptor endings of identified nociceptors. Nociceptors will be stimulated with noxious magnitudes of passive stretch and/or compression. A biomechanical model of single nociceptors and a nociceptor population response to noxious mechanical stimuli will be created. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROBIOLOGY OF CHRONIC MUSCLE PAIN Principal Investigator & Institution: Sluka, Kathleen A.; Physical Therapy and Rehabilitation Science; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 26-JUL-1999; Project End 29-FEB-2004 Summary: (taken from the application): Although 14% of the United States population suffers from chronic musculoskeletal pain, most of our knowledge about pain has been obtained from studies on cutaneous pain. The current models of musculoskeletal pain typically produce short term hyperalgesia (resolved in 24 h or less). However, clinically, chronic muscle pain, as experienced by people with fibromyalgia, is long lasting (months to years). In preliminary studies, I determined that a long lasting bilateral hyperalgesia can be induced by two injections of low pH saline, five days apart, into one gastrocnemius muscle. In the work proposed I hypothesize that the development of the long lasting bilateral hyperalgesia is dependent initially on input from the site of injection following both the first and second injection. I further propose that once the long lasting hyperalgesia develops plastic changes in the central nervous system occur that maintain the hyperalgesia through increased activity in spinal neurons. The specific aims will establish and characterize a new model of muscle pain that is chronic and widespread. The proposed studies will establish if the neural mechanisms involved in the development and maintenance of chronic pain, induced by stimulation of muscle nociceptors, involve peripheral or central nervous system processes. These proposed studies will help in the understanding and thus potential treatment of chronic muscle pain, including such conditions as fibromyalgia, myofascial pain and low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PERIPHERAL METABOLISM

ARTERIAL

DISEASE

AND

LEG

MUSCLE

Principal Investigator & Institution: Killewich, Lois A.; Surgery; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): (provided by applicant): As a vascular surgeon I treat atherosclerosis of leg arteries, known as peripheral arterial occlusive disease (PAOD). PAOD occurs when arteries to the leg become stenosed or occluded, reducing leg blood flow. Subjects experience calf muscle pain with walking, because although the blood supply is adequate to meet the metabolic demands of resting muscle, it is not adequate to meet the increased demands associated with exercise. Leg bypass surgery (femoro-popliteal bypass) increases leg blood flow, but alone does not improve walking abilities and functional status of elderly PAOD subjects. Effective treatment of PAOD will require identification and therapy for other adverse physiological conditions present in elderly PAOD subjects which contribute to their disability. Older subjects also develop sarcopenia, a condition in which muscle mass and function decline with age. At the University of Texas Medical Branch, Dr. Robert Wolfe, a nationally-known authority on leg muscle physiology, is studying sarcopenia in the elderly. He has developed a

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three-pool model of leg muscle protein metabolism, using infusion of stable isotopes and gas chromatography-mass spectroscopy methodology. He shown that nutritional supplementation (specifically, amino acids) increases leg muscle protein synthesis, and may therefore offer a method for counteracting the effects of sarcopenia. I was recruited to UTMB in 1999, and have formed a collaboration with Dr. Wolfe. In this study, I am proposing to investigate the relationship between PAOD and leg muscle protein synthesis in elderly subjects with PAOD. It is my hypothesis that reduced leg muscle blood flow associated with PAOD will limit the availability of amino acids to leg muscle, and thus further impair protein synthesis. Femoro-popliteal bypass surgery, by increasing blood flow, should increase delivery of amino acids to muscle and hence ameliorate the effects of sarcopenia. It is my ultimate hope that the combined interventions of bypass surgery and nutritional supplementation with amino acids can be used to improve overall functional status of these elderly Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF THE CAMP PATHWAY IN A CHRONIC MUSCLE PAIN MODEL Principal Investigator & Institution: Hoeger, Marie K.; Physical Therapy and Rehabilitation Science; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 15-MAY-2002 Summary: The cAMP pathway, which can be activated by extracellular signals, hormones and neurotransmitters, plays a significant role in pain transmission. The cAMP pathway activates protein kinase A (PKA). PKA then phosphorylates the NMDA receptor, making it more effective, and the cAMP-response-element-element-binding protein (CREB), resulting in gene transcription. Previous studies all investigates shortterm hyperalgesia with significant tissue damage and inflammation. The role of cAMP in chronic muscle pain is unknown. Specific aim #1 will determine if blockade of the cAMP pathway reverses mechanical hyperalgesia in a chronic muscle pain model. This will be determined by blocking the cAMP pathway by intrathecally administering inhibitors of 1) adenylate cyclase or 2) PKA and then measuring the effect on mechanical hyperalgesia. Specific aim #2 will determine if the NMDA receptor and CREB are phosphorylated in the spinal cord in chronic muscle pain. This will be determined by conducting immunohistochemical stains and western blots for phosphorylation of 1) the PKA site of the NMDA receptor (NR1) and 2) CREB. It is expected that phosphorylation will increase in the chronic pain and that blocking PKA will decrease mechanical hyperalgesia and the phosphorylation of CREB and the NMDA receptor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SENSORY NEURONS WITH MODALITIES IDENTIFIED IN CULTURE Principal Investigator & Institution: Mc Cleskey, Edwin W.; Senior Scientist/Professor; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 01-JAN-1999; Project End 28-FEB-2007 Summary: (provided by applicant): This proposal will investigate properties of a class of molecules that transduce pain caused by ischemia (insufficient delivery of oxygen to an organ) and that might contribute to neuronal damage during stroke and seizure. The molecules are called acid-sensing ion channels (ASICs). They selectively pass sodium ions and calcium ions into cells when they are opened by a drop in extracellular pH. Such pH changes occur during ischemia when lactic acid is produced and they occur

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when there is hyperactivity in the CNS or when CNS blood vessels get occluded. The long-term objective is to determine whether ASlCs are appropriate pharmaceutical targets for: a) diminishing ischemic pain, and b) neuroprotection after stroke and seizure. Ischemia is the primary source of cardiac pain, sickle cell anemia pain, and the muscle pain of intermittent claudication; it may also contribute to other forms of muscle, bone, and visceral pain. The immediate goal is to describe the properties of ASlCs that seem critical to these pathological conditions. The specific aims arise from our preliminary results that demonstrate that ASlCs open through an unexpected mechanism. ASICs were thought to open because protons (lowered pH) trigger a conformation change in the protein. Instead, we find that protons open ASlC3 because they catalyze the release of a bound calcium ion that blocks the pore. This mechanism is important in disease because pH and calcium drop simultaneously in both peripheral and cerebral ischemia, providing two stimuli acting in concert to open ASlCs. The specific aims are: 1) to define the amino acids in ASlC3 that form the calcium/proton binding site that controls channel opening; 2) to define how ASlC1a, the dominant ASlC in the CNS, behaves under ionic conditions that occur during stroke and seizure; 3) to understand the basis of persistent currents through ASlC3 that occur around pH 7.0, the crucial range for ischemic muscle pain. Experiments utilize patch clamp electrophysiology and molecular mutagenesis of cloned ion channels Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE EFFICACY OF REIKI IN THE TREATMENT OF FIBROMYALGIA Principal Investigator & Institution: Assefi, Nassim P.; Women's Health Specialist; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 28-FEB-2004 Summary: (provided by applicant): Fibromyalgia (FM), one of the most common rheumatologic diagnoses, is a condition of unknown etiology characterized by widespread muscle pain and stiffness, accompanied by a variety of other symptoms including sleep disturbance, headaches, irritable bowel syndrome, and psychological distress. Treatment is generally unsatisfactory and most randomized, controlled treatment trials have been unable to demonstrate a sustained effective intervention. Thus, it is not surprising that the vast majority of FM patients have tried complementary and alternative medicine (CAM) therapies. Reiki is a form of energy medicine in which practitioners reportedly access universal life energy to heal patients, either by direct contact at specific hand positions or from a distance. A vast body of anecdotal literature as well as 2 randomized controlled trials suggest that Reiki may be an effective treatment for FM, appearing to relieve pain and improve psychological well being. In addition, it appears to have no adverse effects and can eventually be self-administered, making it a low-risk, low-cost, potentially patient-empowering intervention. This study will investigate the efficacy of Reiki in the treatment of FM. 100 Reiki-naive FM patients will be recruited from a chronic fatigue referral clinic, and will undergo an 8-week, biweekly (16 treatments) trial. Patients will be randomized into 2 Reiki groups (directcontact and distant Reiki) and 2 control (sham and placebo) groups. The sham Reiki practitioners will be professional actors who resemble the true Reiki practitioners but have no experience with health care or healing arts and are taught to mimic the Reiki Masters' verbal and physical interactions with the patients, while distracting whatever healing intention they may possess by doing mental arithmetic. The specific aims of this study are: 1) to evaluate the short and long-term efficacy and safety of an 8-week placebo-controlled randomized trial of both direct-contact and distant Reiki in the treatment of FM; 2) establish carefully constructed control groups for their feasibility

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and scientific usefulness for future trials of Reiki and other types of energy medicine; and 3) to collect pilot data for larger trials on the mechanism, safety, and duration of clinical and subjective effects of Reiki. Patients will be assessed at enrollment, 4 and 8 weeks during treatment and 12 weeks post-treatment. Our primary outcomes will be patient global assessment, subjective pain and mean number of tender points. Secondary outcomes will include pain threshold, sleep, fatigue, and psychological indicators. This pilot study could potentially impact the clinical care of the estimated 6 million Americans with FM, and shape the design of future larger, randomized, placebocontrolled trials of Reiki and other energy therapies. 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 muscle pain, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “muscle pain” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for muscle pain (hyperlinks lead to article summaries): •

“Ischemic lactate test” in the differential diagnosis of muscle pain. Author(s): Strong C, Ross B. Source: Lancet. 1982 July 31; 2(8292): 279-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6124709

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“Self-taming” with succinylcholine and muscle pain. Author(s): Verma RS. Source: Anesthesiology. 1983 May; 58(5): 487. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6838008

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31P-NMR studies in patients with exertional muscle pain syndrome (EMPS) responding to verapamil. Author(s): Lane RJ, Arnold DL, Bore PJ, Taylor DJ, Radda GK, Walton J. Source: Muscle & Nerve. 1987 February; 10(2): 183-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3821790

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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A closed-loop system for maintaining constant experimental muscle pain in man. Author(s): Zhang X, Ashton-Miller JA, Stohler CS. Source: Ieee Transactions on Bio-Medical Engineering. 1993 April; 40(4): 344-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8375871

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A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. Author(s): Lindroth JE, Schmidt JE, Carlson CR. Source: J Orofac Pain. 2002 Fall; 16(4): 277-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12455428

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A controlled evaluation of ibuprofen and diazepam for chronic orofacial muscle pain. Author(s): Singer E, Dionne R. Source: J Orofac Pain. 1997 Spring; 11(2): 139-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10332320

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A double-blind, placebo-controlled, crossover study of verapamil in exertional muscle pain. Author(s): Lane RJ, Turnbull DM, Welch JL, Walton J. Source: Muscle & Nerve. 1986 September; 9(7): 635-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3531845

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A method of detecting the muscle pain threshold using an objective softwaremediated technique. Author(s): Edwards T, Baker S, Eston R. Source: Percept Mot Skills. 1996 June; 82(3 Pt 1): 955-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8774038

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A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. Author(s): Wright E, Anderson G, Schulte J. Source: J Orofac Pain. 1995 Spring; 9(2): 192-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7488989

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Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Author(s): Goddard G, Karibe H, McNeill C, Villafuerte E. Source: J Orofac Pain. 2002 Winter; 16(1): 71-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11889662

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Acute intermittent porphyria presenting as acute muscle pain, fever, and weakness. Author(s): Cohen PL, Hadler NM, Starkenburg R. Source: Arthritis and Rheumatism. 1997 March; 40(3): 586-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9082950

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Ambulatory electromyogram activity in the upper trapezius region: patients with muscle pain vs. pain-free control subjects. Author(s): Carlson CR, Wynn KT, Edwards J, Okeson JP, Nitz AJ, Workman DE, Cassisi J. Source: Spine. 1996 March 1; 21(5): 595-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8852315

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An association of membrane-damaging toxins from coagulase-negative staphylococci and chronic orofacial muscle pain. Author(s): Butt HL, Dunstan RH, McGregor NR, Roberts TK, Zerbes M, Klineberg IJ. Source: Journal of Medical Microbiology. 1998 July; 47(7): 577-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9839561

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An evaluation of a moist heating pad for the treatment of TMJ/muscle pain dysfunction. Author(s): Nelson SJ, Ash MM Jr. Source: Cranio. 1988 October; 6(4): 355-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3255522

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An examination of the relationships among recalled, expected, and actual intensity and unpleasantness of delayed onset muscle pain. Author(s): Dannecker EA, Price DD, Robinson ME. Source: The Journal of Pain : Official Journal of the American Pain Society. 2003 March; 4(2): 74-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14622718

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An investigation of how acute muscle pain modulates performance during computer work with digitizer and puck. Author(s): Birch L, Arendt-Nielsen L, Graven-Nielsen T, Christensen H. Source: Applied Ergonomics. 2001 June; 32(3): 281-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11394468

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An unexpected cause of muscle pain in diabetes. Author(s): Silberstein L, Britton KE, Marsh FP, Raftery MJ, D'Cruz D. Source: Annals of the Rheumatic Diseases. 2001 April; 60(4): 310-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11247854

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Analgesic profile of peroral and topical ketoprofen upon low pH-induced muscle pain. Author(s): Steen KH, Wegner H, Meller ST. Source: Pain. 2001 July; 93(1): 23-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11406335

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Bilateral experimental muscle pain changes electromyographic activity of human jawclosing muscles during mastication. Author(s): Svensson P, Houe L, Arendt-Nielsen L. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 1997 August; 116(1): 182-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9305827

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Ca2+-ATPase deficiency in a patient with an exertional muscle pain syndrome. Author(s): Taylor DJ, Brosnan MJ, Arnold DL, Bore PJ, Styles P, Walton J, Radda GK. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1988 November; 51(11): 1425-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2976810

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Capsaicin-induced muscle pain alters the excitability of the human jaw-stretch reflex. Author(s): Wang K, Arendt-Nielsen L, Svensson P. Source: Journal of Dental Research. 2002 September; 81(9): 650-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12202650

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Case management study: an elderly patient with muscle pain. Author(s): Healey LA. Source: Bulletin on the Rheumatic Diseases. 1997 February; 46(1): 7-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9046123

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Cerebral processing of acute skin and muscle pain in humans. Author(s): Svensson P, Minoshima S, Beydoun A, Morrow TJ, Casey KL. Source: Journal of Neurophysiology. 1997 July; 78(1): 450-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9242293

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Changes in human regional cerebral blood flow following hypertonic saline induced experimental muscle pain: a positron emission tomography study. Author(s): Korotkov A, Ljubisavljevic M, Thunberg J, Kataeva G, Roudas M, Pakhomov S, Radovanovic S, Lyskov E, Medvedev S, Johansson H. Source: Neuroscience Letters. 2002 December 25; 335(2): 119-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12459513

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Chlorphenesin carbamate (maolate) in the relief of muscle pain. Author(s): Turner R, Rockwood CA. Source: Military Medicine. 1967 May; 132(5): 371-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4962932

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Chronic muscle pain syndromes: an overview. Author(s): Widmer CG. Source: Canadian Journal of Physiology and Pharmacology. 1991 May; 69(5): 659-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1863917

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Chronic orofacial muscle pain: a new approach to diagnosis and management. Author(s): Klineberg I, McGregor N, Butt H, Dunstan H, Roberts T, Zerbes M. Source: Alpha Omegan. 1998 July; 91(2): 25-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9927897

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Clinical consideration in referred muscle pain and tenderness. Connective tissue reactions. Author(s): Staff PH. Source: European Journal of Applied Physiology and Occupational Physiology. 1988; 57(3): 369-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3286253

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Clinical features in patients with chronic muscle pain--with special reference to fibromyalgia. Author(s): Jacobsen S, Petersen IS, Danneskiold-Samsoe B. Source: Scandinavian Journal of Rheumatology. 1993; 22(2): 69-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8480141

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Clofibrate, serum enzymes, and muscle pain. Author(s): Smith AF, Macfie WG, Oliver MF. Source: British Medical Journal. 1970 April 11; 2(701): 86-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5420239

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Coagulase-negative staphylococcal membrane-damaging toxins, pain intensity, and metabolic changes in temporomandibular disorder patients with chronic muscle pain. Author(s): McGregor NR, Zerbes M, Niblett SH, Dunstan RH, Roberts TK, Butt HL, Klineberg IJ. Source: J Orofac Pain. 2003 Spring; 17(2): 125-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12836500

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Comparative EEG activation to skin pain and muscle pain induced by capsaicin injection. Author(s): Chang PF, Arendt-Nielsen L, Graven-Nielsen T, Svensson P, Chen AC. Source: International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology. 2004 January; 51(2): 117-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14693361

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Comparison of psychologic and physiologic functioning between patients with masticatory muscle pain and matched controls. Author(s): Carlson CR, Okeson JP, Falace DA, Nitz AJ, Curran SL, Anderson D. Source: J Orofac Pain. 1993 Winter; 7(1): 15-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8467294

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Comparison of the frequency of muscle pain associated with suxamethonium in preand post-ovulatory women and in those taking a combined oral contraceptive pill. Author(s): Reed PN, Jago RH. Source: British Journal of Anaesthesia. 1983 May; 55(5): 377-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6849723

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Considerations concerning the neurobiological basis of muscle pain. Author(s): Mense S. Source: Canadian Journal of Physiology and Pharmacology. 1991 May; 69(5): 610-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1863911

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Contraction frequency, blood supply, and muscle pain. Author(s): Rodbard S, Pragay EB. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1968 February; 24(2): 1425. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5637675

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Cramps, muscle pain, and tubular aggregates. Author(s): Lazaro RP, Fenichel GM, Kilroy AW, Saito A, Fleischer S. Source: Archives of Neurology. 1980 November; 37(11): 715-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7436815

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Craniofacial muscle pain: review of mechanisms and clinical manifestations. Author(s): Svensson P, Graven-Nielsen T. Source: J Orofac Pain. 2001 Spring; 15(2): 117-45. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11443825

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Delayed onset of masseter muscle pain in experimental tooth clenching. Author(s): Christensen LV, Mohamed SE, Harrison JD. Source: The Journal of Prosthetic Dentistry. 1982 November; 48(5): 579-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6958866

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Dental treatment of temporomandibular disorders and masticatory muscle pain. Author(s): Haber J. Source: Curr Opin Dent. 1991 August; 1(4): 507-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1802013

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Diazepam and suxamethonium muscle pain (a dose-response study). Author(s): Verma RS. Source: Anaesthesia. 1982 June; 37(6): 688-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7091627

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Differential cerebral responses to aversive auditory arousal versus muscle pain: specific EEG patterns are associated with human pain processing. Author(s): Chang PF, Arendt-Nielsen L, Chen AC. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2002 December; 147(3): 387-93. Epub 2002 October 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12428146

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Differential modulation of tremor and pulsatile control of human jaw and finger by experimental muscle pain. Author(s): Jaberzadeh S, Svensson P, Nordstrom MA, Miles TS. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2003 June; 150(4): 520-4. Epub 2003 May 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739086

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Diffuse exercise-induced muscle pain of undetermined cause relieved by verapamil. Author(s): Walton J. Source: Lancet. 1981 May 2; 1(8227): 993. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6112398

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Diffuse muscle pain with quetiapine. Author(s): Fountoulakis KN, Iacovides A, Kaprinis SG, Kaprinis GS. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 January; 182: 81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12509327

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Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor 'defensive' strategies. Author(s): Rossi S, della Volpe R, Ginanneschi F, Ulivelli M, Bartalini S, Spidalieri R, Rossi A. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2003 July; 114(7): 1351-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12842734

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Effect of caffeine on perceptions of leg muscle pain during moderate intensity cycling exercise. Author(s): Motl RW, O'Connor PJ, Dishman RK. Source: The Journal of Pain : Official Journal of the American Pain Society. 2003 August; 4(6): 316-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14622688

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Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. Author(s): Svensson P, Arendt-Nielsen L, Nielsen H, Larsen JK. Source: J Orofac Pain. 1995 Fall; 9(4): 347-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8995906

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Effect of jaw muscle pain and soreness evoked by capsaicin before sleep on orofacial motor activity during sleep. Author(s): Arima T, Arendt-Nielsen L, Svensson P. Source: J Orofac Pain. 2001 Summer; 15(3): 245-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11575195

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Effect of muscle relaxants on experimental jaw-muscle pain and jaw-stretch reflexes: a double-blind and placebo-controlled trial. Author(s): Svensson P, Wang K, Arendt-Nielsen L. Source: European Journal of Pain (London, England). 2003; 7(5): 449-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12935797

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Effect of sympathetic muscle vasoconstrictor activity on capsaicin-induced muscle pain. Author(s): Wasner G, Brechot A, Schattschneider J, Allardt A, Binder A, Jensen TS, Baron R. Source: Muscle & Nerve. 2002 July; 26(1): 113-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12115956

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Effect of tonic muscle pain on short-latency jaw-stretch reflexes in humans. Author(s): Wang K, Svensson P, Arendt-Nielsen L. Source: Pain. 2000 November; 88(2): 189-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11050374

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Effects of 5 days of repeated submaximal clenching on masticatory muscle pain and tenderness: an experimental study. Author(s): Svensson P, Arendt-Nielsen L. Source: J Orofac Pain. 1996 Winter; 10(4): 330-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9161238

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Effects of experimental muscle pain on mechanical properties of single motor units in human masseter. Author(s): Sohn MK, Graven-Nielsen T, Arendt-Nielsen L, Svensson P. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2004 January; 115(1): 76-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14706472

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Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Author(s): Graven-Nielsen T, Svensson P, Arendt-Nielsen L. Source: Electroencephalography and Clinical Neurophysiology. 1997 April; 105(2): 15664. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9152211

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Effects of local and remote muscle pain on human jaw reflexes evoked by fast stretches at different clenching levels. Author(s): Svensson P, Macaluso GM, De Laat A, Wang K. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2001 August; 139(4): 495-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11534874

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Effects of local pressure and vibration on muscle pain from eccentric exercise and hypertonic saline. Author(s): Weerakkody NS, Percival P, Hickey MW, Morgan DL, Gregory JE, Canny BJ, Proske U. Source: Pain. 2003 October; 105(3): 425-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14527703

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Effects of localization and intensity of experimental muscle pain on ankle joint proprioception. Author(s): Matre D, Arendt-Neilsen L, Knardahl S. Source: European Journal of Pain (London, England). 2002; 6(4): 245-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12161091

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Effects of low-power laser exposure on masseter muscle pain and microcirculation. Author(s): Tullberg M, Alstergren PJ, Ernberg MM. Source: Pain. 2003 September; 105(1-2): 89-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14499424

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Effects of physical and mental stressors on muscle pain. Author(s): Westgaard RH. Source: Scand J Work Environ Health. 1999; 25 Suppl 4: 19-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10628436

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Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Author(s): Jentoft ES, Kvalvik AG, Mengshoel AM. Source: Arthritis and Rheumatism. 2001 February; 45(1): 42-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11308060

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Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort. Author(s): Giamberardino MA, Dragani L, Valente R, Di Lisa F, Saggini R, Vecchiet L. Source: International Journal of Sports Medicine. 1996 July; 17(5): 320-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8858401

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Effects of shakuyaku-kanzo-to on muscle pain from combination chemotherapy with paclitaxel and carboplatin. Author(s): Yamamoto K, Hoshiai H, Noda K. Source: Gynecologic Oncology. 2001 May; 81(2): 333-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11330975

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Effects of topical diclofenac (DHEP plaster) on skin, subcutis and muscle pain thresholds in subjects without spontaneous pain. Author(s): Affaitati G, Vecchiet F, Lerza R, De Laurentis S, Iezzi S, Festa F, Giamberardino MA. Source: Drugs Exp Clin Res. 2001; 27(2): 69-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11392056

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Effects on muscle pain by intramuscular injection of granisetron in patients with fibromyalgia. Author(s): Ernberg M, Lundeberg T, Kopp S. Source: Pain. 2003 February; 101(3): 275-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12583870

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Electrical activity in muscle pain. Author(s): Cobb CR, deVries HA, Urban RT, Luekens CA, Bagg RJ. Source: Am J Phys Med. 1975 April; 54(2): 80-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1130502

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Electromyographic signal changes during exercise in human chronic jaw-muscle pain. Author(s): Koyano K, Kim YJ, Clark GT. Source: Archives of Oral Biology. 1995 March; 40(3): 221-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7605249

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EMG-force relationships are influenced by experimental jaw-muscle pain. Author(s): Wang K, Arima T, Arendt-Nielsen L, Svensson P. Source: Journal of Oral Rehabilitation. 2000 May; 27(5): 394-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10887912

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Endocrine evaluation for muscle pain. Author(s): Benvenga S, Toscano A, Rodolico C, Vita G, Trimarchi F. Source: Journal of the Royal Society of Medicine. 2001 August; 94(8): 405-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11461987

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Event-related functional MRI study on central representation of acute muscle pain induced by electrical stimulation. Author(s): Niddam DM, Yeh TC, Wu YT, Lee PL, Ho LT, Arendt-Nielsen L, Chen AC, Hsieh JC. Source: Neuroimage. 2002 November; 17(3): 1437-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12414283

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Excitatory actions of experimental muscle pain on early and late components of human jaw stretch reflexes. Author(s): Wang K, Arendt-Nielsen L, Svensson P. Source: Archives of Oral Biology. 2001 May; 46(5): 433-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11286808

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Exercise-induced muscle pain, soreness, and cramps. Author(s): Miles MP, Clarkson PM. Source: The Journal of Sports Medicine and Physical Fitness. 1994 September; 34(3): 20316. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7830383

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Experimental human muscle pain and muscular hyperalgesia induced by combinations of serotonin and bradykinin. Author(s): Babenko V, Graven-Nielsen T, Svensson P, Drewes AM, Jensen TS, ArendtNielsen L. Source: Pain. 1999 July; 82(1): 1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10422653

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Experimental jaw-muscle pain does not change heteronymous H-reflexes in the human temporalis muscle. Author(s): Svensson P, De Laat A, Graven-Nielsen T, Arendt-Nielsen L. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 1998 August; 121(3): 311-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9746137

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Experimental masticatory muscle pain. Author(s): Bowley JF, Gale EN. Source: Journal of Dental Research. 1987 December; 66(12): 1765-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3479476

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Experimental muscle pain and tenderness following infusion of endogenous substances in humans. Author(s): Mork H, Ashina M, Bendtsen L, Olesen J, Jensen R. Source: European Journal of Pain (London, England). 2003; 7(2): 145-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12600796

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Experimental muscle pain changes feedforward postural responses of the trunk muscles. Author(s): Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2003 July; 151(2): 262-71. Epub 2003 June 03. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12783146

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Experimental muscle pain does not cause long-lasting increases in resting electromyographic activity. Author(s): Svensson P, Graven-Nielsen T, Matre D, Arendt-Nielsen L. Source: Muscle & Nerve. 1998 November; 21(11): 1382-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9771660

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Experimental muscle pain increases the human stretch reflex. Author(s): Matre DA, Sinkjaer T, Svensson P, Arendt-Nielsen L. Source: Pain. 1998 April; 75(2-3): 331-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9583769

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Experimental muscle pain modulates muscle activity and work performance differently during high and low precision use of a computer mouse. Author(s): Birch L, Graven-Nielsen T, Christensen H, Arendt-Nielsen L. Source: European Journal of Applied Physiology. 2000 December; 83(6): 492-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11192055

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Experimental muscle pain produced by chemical stimulus. Author(s): Lindahl O. Source: Acta Orthopaedica Scandinavica. 1969; 40(6): 741-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5376788

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Experimental muscle pain provokes long-lasting alterations of thermal sensitivity in the referred pain area. Author(s): Tuveson B, Lindblom U, Fruhstorfer H. Source: European Journal of Pain (London, England). 2003; 7(1): 73-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12527320

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Experimentally induced muscle pain induces hypoalgesia in heterotopic deep tissues, but not in homotopic deep tissues. Author(s): Graven-Nielsen T, Babenko V, Svensson P, Arendt-Nielsen L. Source: Brain Research. 1998 March 23; 787(2): 203-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9518613

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Failure of two benzodiazepines to prevent suxamethonium-induced muscle pain. Author(s): Chestnutt WN, Lowry KG, Dundee JW, Pandit SK, Mirakhur RK. Source: Anaesthesia. 1985 March; 40(3): 263-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3158243

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Familial cramps and muscle pain. Author(s): Lazaro RP, Rollinson RD, Fenichel GM. Source: Archives of Neurology. 1981 January; 38(1): 22-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7458719

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Force, contraction frequency and energy metabolism as determinants of ischaemic muscle pain. Author(s): Mills KR, Newham DJ, Edwards RH. Source: Pain. 1982 October; 14(2): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7177679

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Hypersensitivity in muscle pain syndromes. Author(s): Henriksson KG. Source: Current Pain and Headache Reports. 2003 December; 7(6): 426-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604501

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Hypoalgesia to pressure pain in referred pain areas triggered by spatial summation of experimental muscle pain from unilateral or bilateral trapezius muscles. Author(s): Ge HY, Madeleine P, Wang K, Arendt-Nielsen L. Source: European Journal of Pain (London, England). 2003; 7(6): 531-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14575666

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Hypotheses of peripheral and central mechanisms underlying occupational muscle pain and injury. Author(s): Edwards RH. Source: European Journal of Applied Physiology and Occupational Physiology. 1988; 57(3): 275-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3286251

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In vivo model of muscle pain: quantification of intramuscular chemical, electrical, and pressure changes associated with saline-induced muscle pain in humans. Author(s): Graven-Nielsen T, McArdle A, Phoenix J, Arendt-Nielsen L, Jensen TS, Jackson MJ, Edwards RH. Source: Pain. 1997 January; 69(1-2): 137-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9060024

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Increased lipid peroxidation in a patient with CK-elevation and muscle pain during statin therapy. Author(s): Sinzinger H, Lupattelli G, Chehne F. Source: Atherosclerosis. 2000 November; 153(1): 255-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11058722

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Induction and assessment of muscle pain, referred pain, and muscular hyperalgesia. Author(s): Graven-Nielsen T, Arendt-Nielsen L. Source: Current Pain and Headache Reports. 2003 December; 7(6): 443-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604503

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Influence of muscle pain tolerance on muscle pain threshold in experimental tooth clenching in man. Author(s): Christensen LV. Source: Journal of Oral Rehabilitation. 1979 July; 6(3): 211-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=287768

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Inhibition of maximal voluntary contraction force by experimental muscle pain: a centrally mediated mechanism. Author(s): Graven-Nielsen T, Lund H, Arendt-Nielsen L, Danneskiold-Samsoe B, Bliddal H. Source: Muscle & Nerve. 2002 November; 26(5): 708-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12402294

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Inhibition of motor system excitability at cortical and spinal level by tonic muscle pain. Author(s): Le Pera D, Graven-Nielsen T, Valeriani M, Oliviero A, Di Lazzaro V, Tonali PA, Arendt-Nielsen L. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2001 September; 112(9): 1633-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11514246

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Inhibition of motor unit firing during experimental muscle pain in humans. Author(s): Sohn MK, Graven-Nielsen T, Arendt-Nielsen L, Svensson P. Source: Muscle & Nerve. 2000 August; 23(8): 1219-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10918259

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Intractable muscle pain syndrome, osteomalacia, and axonopathy in long-term use of phenytoin. Author(s): Ronin DI, Wu YC, Sahgal V, MacLean IC. Source: Archives of Physical Medicine and Rehabilitation. 1991 September; 72(10): 755-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1929800

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Intravenous lidocaine in the prevention of postoperative muscle pain caused by succinylcholine administration. Author(s): Usubiaga JE, Wikinski JA, Usubiaga LE, Molina F. Source: Anesthesia and Analgesia. 1967 March-April; 46(2): 225-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6066978

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Intravenous lignocaine for prevention of muscle pain after succinylcholine. Author(s): Haldia KN, Chatterji S, Kackar SN. Source: Anesthesia and Analgesia. 1973 September-October; 52(5): 849-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4738210

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Investigative strategies for muscle pain. Author(s): Mills KR, Edwards RH. Source: Journal of the Neurological Sciences. 1983 January; 58(1): 73-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6842260

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Iron dextran-induced muscle pain. Author(s): Crosby WH. Source: Hosp Pract (Off Ed). 1991 April; 26 Suppl 3: 49-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2010492

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Isoprostane 8-epi-PGF2alpha is frequently increased in patients with muscle pain and/or CK-elevation after HMG-Co-enzyme-A-reductase inhibitor therapy. Author(s): Sinzinger H, Lupattelli G, Chehne F, Oguogho A, Furberg CD. Source: Journal of Clinical Pharmacy and Therapeutics. 2001 August; 26(4): 303-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11493374

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Jaw muscle pain and its effect on gothic arch tracings. Author(s): Obrez A, Stohler CS. Source: The Journal of Prosthetic Dentistry. 1996 April; 75(4): 393-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8642525

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Joint and muscle pain with mononeuritis multiplex, tetraparesis, and myocardial infarction in a previously healthy adult. Author(s): Wagner AD, Feist T, Prondzinsky R, Fleig WE, Keysser G. Source: Annals of the Rheumatic Diseases. 2001 November; 60(11): 1003-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11602463

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Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Author(s): Graven-Nielsen T, Aspegren Kendall S, Henriksson KG, Bengtsson M, Sorensen J, Johnson A, Gerdle B, Arendt-Nielsen L. Source: Pain. 2000 April; 85(3): 483-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10781923

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Lack of both sex differences and influence of resting blood pressure on muscle pain intensity. Author(s): Poudevigne MS, O'Connor PJ, Pasley JD. Source: The Clinical Journal of Pain. 2002 November-December; 18(6): 386-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12441833

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Laparoscopy and suxamethonium muscle pain. Author(s): Dodson ME. Source: British Journal of Anaesthesia. 1978 January; 50(1): 84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=146508

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Letter: Muscle pain induced by exercise in coxsackie pericarditis. Author(s): Jones JV. Source: British Medical Journal. 1975 July 12; 3(5975): 100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1139222

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Long-lasting effect evoked by tonic muscle pain on parietal EEG activity in humans. Author(s): Le Pera D, Svensson P, Valeriani M, Watanabe I, Arendt-Nielsen L, Chen AC. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2000 December; 111(12): 2130-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11090762

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Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Author(s): Bennett RM, Clark SR, Campbell SM, Burckhardt CS. Source: Arthritis and Rheumatism. 1992 October; 35(10): 1113-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1418002

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Lumbar epidural fentanyl: segmental spread and effect on temporal summation and muscle pain. Author(s): Eichenberger U, Giani C, Petersen-Felix S, Graven-Nielsen T, Arendt-Nielsen L, Curatolo M. Source: British Journal of Anaesthesia. 2003 April; 90(4): 467-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12644419

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Masticatory muscle pain before, during, and after treatment with orthopedic protraction headgear: a pilot study. Author(s): Ngan PW, Yiu C, Hagg U, Wei SH, Bowley J. Source: Angle Orthod. 1997; 67(6): 433-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9428961

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Masticatory muscle pain: a review of clinical features, research findings and possible mechanisms. Author(s): Delcanho RE. Source: Aust Prosthodont J. 1995; 9: 49-59. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9063135

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Masticatory muscle pain: an important indicator of giant cell arteritis. Author(s): Hayreh SS. Source: Spec Care Dentist. 1998 March-April; 18(2): 60-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9680912

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Mechanical performance, level of continuous contraction and muscle pain symptoms in home care personnel. Author(s): Elert J, Brulin C, Gerdle B, Johansson H. Source: Scandinavian Journal of Rehabilitation Medicine. 1992 September; 24(3): 141-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1411360

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MMPI patterns in chronic muscle pain, tension headache, and migraine. Author(s): Ellertsen B, Klove H. Source: Cephalalgia : an International Journal of Headache. 1987 March; 7(1): 65-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3581161

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Moderate-intensity muscle pain can be produced and sustained during cycle ergometry. Author(s): O'Connor PJ, Cook DB. Source: Medicine and Science in Sports and Exercise. 2001 June; 33(6): 1046-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11404672

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Modulation of exteroceptive suppression periods in human jaw-closing muscles by local and remote experimental muscle pain. Author(s): Wang K, Svensson P, Arendt-Nielsen L. Source: Pain. 1999 September; 82(3): 253-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10488676

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Motor activity in sleep bruxism with concomitant jaw muscle pain. A retrospective pilot study. Author(s): Lavigne GJ, Rompre PH, Montplaisir JY, Lobbezoo F. Source: European Journal of Oral Sciences. 1997 February; 105(1): 92-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9085035

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Muscle pain after exercise is linked with an inorganic phosphate increase as shown by 31P NMR. Author(s): Aldridge R, Cady EB, Jones DA, Obletter G. Source: Bioscience Reports. 1986 July; 6(7): 663-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3779042

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Muscle pain after exercise. Author(s): Nielsen C, Mazzone P. Source: Lancet. 1999 March 27; 353(9158): 1062. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10199355

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Muscle pain after outpatient laparoscopy--influence of propofol versus thiopental and enflurane. Author(s): Smith I, Ding Y, White PF. Source: Anesthesia and Analgesia. 1993 June; 76(6): 1181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8498652

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Muscle pain and tianeptine? A case report. Author(s): Vandel P, Mareschal B, Vittouris N, Bonin B. Source: Therapie. 1994 January-February; 49(1): 54-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8091370

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Muscle pain and wasting in osteomalacia. Author(s): Golding DN. Source: Journal of the Royal Society of Medicine. 1985 June; 78(6): 495-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3999087

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Muscle pain as a prominent feature of facioscapulohumeral muscular dystrophy (FSHD): four illustrative case reports. Author(s): Bushby KM, Pollitt C, Johnson MA, Rogers MT, Chinnery PF. Source: Neuromuscular Disorders : Nmd. 1998 December; 8(8): 574-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10093064

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Muscle pain associated with tubular aggregates and structures resembling cylindrical spirals. Author(s): Danon MJ, Carpenter S, Harati Y. Source: Muscle & Nerve. 1989 April; 12(4): 265-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2770779

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Muscle pain due to injury. Author(s): Wheeler AH, Aaron GW. Source: Current Pain and Headache Reports. 2001 October; 5(5): 441-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11560809

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Muscle pain following administration of suxamethonium to pregnant and nonpregnant patients undergoing laparoscopic tubal ligation. Author(s): Datta S, Crocker JS, Alper MH. Source: British Journal of Anaesthesia. 1977 June; 49(6): 625-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=141299

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Muscle pain following administration of suxamethonium: the aetiological role of muscular fitness. Author(s): Newnam PT, Loudon JM. Source: British Journal of Anaesthesia. 1966 July; 38(7): 533-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5943809

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Muscle pain following anaesthetized outpatient bronchoscopy. Author(s): Lambie RS. Source: Middle East J Anaesthesiol. 1979 June; 5(4): 295-303. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=556282

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Muscle pain following suxamethonium. Author(s): Meadows JC. Source: British Journal of Anaesthesia. 1971 April; 43(4): 418. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5575194

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Muscle pain in athletes with locomotor disability. Author(s): Bernardi M, Castellano V, Ferrara MS, Sbriccoli P, Sera F, Marchetti M. Source: Medicine and Science in Sports and Exercise. 2003 February; 35(2): 199-206. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12569204

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Muscle pain in neuromuscular disorders and primary fibromyalgia. Author(s): Henriksson KG. Source: Neurologija. 1989; 38(3): 213-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2702325

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Muscle pain in neuromuscular disorders and primary fibromyalgia. Author(s): Henriksson KG. Source: European Journal of Applied Physiology and Occupational Physiology. 1988; 57(3): 348-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3163551

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Muscle pain index in relation to pain, dysfunction, and dizziness associated with the myofascial pain-dysfunction syndrome. Author(s): Sharav Y, Tzukert A, Refaeli B. Source: Oral Surg Oral Med Oral Pathol. 1978 December; 46(6): 742-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=282537

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Muscle pain inhibits cutaneous touch perception. Author(s): Stohler CS, Kowalski CJ, Lund JP. Source: Pain. 2001 June; 92(3): 327-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11376905

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Muscle pain modulates mastication: an experimental study in humans. Author(s): Svensson P, Arendt-Nielsen L, Houe L. Source: J Orofac Pain. 1998 Winter; 12(1): 7-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9656894

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Muscle pain occurs after outpatient laparoscopy despite the substitution of vecuronium for succinylcholine. Author(s): Zahl K, Apfelbaum JL. Source: Anesthesiology. 1989 March; 70(3): 408-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2564262

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Muscle pain perception and sympathetic nerve activity to exercise during opioid modulation. Author(s): Cook DB, O'Connor PJ, Ray CA. Source: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 2000 November; 279(5): R1565-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11049837

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Muscle pain syndromes--Part I. Author(s): Simons DG. Source: Am J Phys Med. 1975 December; 54(6): 289-311. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1106214

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Muscle pain syndromes--Part II. Author(s): Simons DG. Source: Am J Phys Med. 1976 February; 55(1): 15-42. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1108670

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Muscle pain, dyskinesia, and sleep. Author(s): Lavigne GJ, Velly-Miguel AM, Montplaisir J. Source: Canadian Journal of Physiology and Pharmacology. 1991 May; 69(5): 678-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1863920

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Muscle pain, fatigue, and fasiculations. Author(s): Kincaid JC. Source: Neurologic Clinics. 1997 August; 15(3): 697-709. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9227959

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Muscle pain, fatigue, and mitochondriopathies. Author(s): Griggs RC, Karpati G. Source: The New England Journal of Medicine. 1999 September 30; 341(14): 1077-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10502600

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Muscle pain. Author(s): Simmons VP. Source: Occup Health Saf. 1983 April; 52(4): 44. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6856237

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Muscle pain: animal and human experimental and clinical studies. Author(s): Marchettini P. Source: Muscle & Nerve. 1993 October; 16(10): 1033-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8413356

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Muscle stiffness and muscle pain. Author(s): Klawans HL, Weiner WJ. Source: Clinical Therapeutics. 1981; 4(2): 62-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7296595

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Myoadenylate deaminase deficiency in a 5-year-old boy with intermittent muscle pain. Author(s): Rossi LN, Cornelio F, Dworzak F, Morandi L, Rossi G, Di Mauro S. Source: Helv Paediatr Acta. 1984 March; 39(1): 89-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6724999

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Myoadenylate deaminase deficiency or not? Observations on two brothers with exercise-induced muscle pain. Author(s): Hayes DJ, Summers BA, Morgan-Hughes JA. Source: Journal of the Neurological Sciences. 1982 January; 53(1): 125-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7057200

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Myopathic evolution of an exertional muscle pain syndrome with phosphorylase b kinase deficiency. Author(s): Carrier H, Maire I, Vial C, Rambaud G, Flocard F, Flechaire A. Source: Acta Neuropathologica. 1990; 81(1): 84-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2128163

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Naturally occurring muscle pain during exercise: assessment and experimental evidence. Author(s): Cook DB, O'Connor PJ, Eubanks SA, Smith JC, Lee M. Source: Medicine and Science in Sports and Exercise. 1997 August; 29(8): 999-1012. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9268956

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Nociception from skeletal muscle in relation to clinical muscle pain. Author(s): Mense S. Source: Pain. 1993 September; 54(3): 241-89. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8233542

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Observations on muscle pain in man, with particular reference to pain during needle electromyography. Author(s): Meadows JC. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1970 August; 33(4): 519-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5505680

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Occlusal conditions just after the relief of temporomandibular joint and masticatory muscle pain. Author(s): Fujii T. Source: Journal of Oral Rehabilitation. 2002 April; 29(4): 323-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11966964

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Occupational muscle pain and injury; scientific challenge. Author(s): Sejersted OM, Westgaard RH. Source: European Journal of Applied Physiology and Occupational Physiology. 1988; 57(3): 271-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3371335

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Opioid-insensitive hypoalgesia to mechanical stimuli at sites ipsilateral and contralateral to experimental muscle pain in human volunteers. Author(s): Graven-Nielsen T, Gibson SJ, Laursen RJ, Svensson P, Arendt-Nielsen L. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2002 September; 146(2): 213-22. Epub 2002 July 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12195523

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Pain intensity, illness duration, and protein catabolism in temporomandibular disorder patients with chronic muscle pain. Author(s): McGregor NR, Zerbes M, Niblett SH, Dunstan RH, Roberts TK, Butt HL, Klineberg IJ. Source: J Orofac Pain. 2003 Spring; 17(2): 112-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12836499

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Pathologic quiz case. A 36-year-old woman with muscle pain and weakness. Phosphaturic mesenchymal tumor (mixed connective tissue variant)/oncogenic osteomalacia. Author(s): Reis-Filho JS, Paiva ME, Lopes JM. Source: Archives of Pathology & Laboratory Medicine. 2002 October; 126(10): 1245-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12385334

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Pathophysiological mechanisms behind work-related muscle pain syndromes. Author(s): Johansson H, Sjolander P, Djupsjobacka M, Bergenheim M, Pedersen J. Source: American Journal of Industrial Medicine. 1999 September; Suppl 1: 104-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10519802

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Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis. Author(s): Johansson H, Sojka P. Source: Medical Hypotheses. 1991 July; 35(3): 196-203. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1943863

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Pattern of muscle activity during stereotyped work and its relation to muscle pain. Author(s): Veiersted KB, Westgaard RH, Andersen P. Source: International Archives of Occupational and Environmental Health. 1990; 62(1): 31-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2295521

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Pharmacological modulation of experimental phasic and tonic muscle pain by morphine, alfentanil and ketamine in healthy volunteers. Author(s): Schulte H, Graven-Nielsen T, Sollevi A, Jansson Y, Arendt-Nielsen L, Segerdahl M. Source: Acta Anaesthesiologica Scandinavica. 2003 September; 47(8): 1020-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904196

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Plasma levels after peroral and topical ibuprofen and effects upon low pH-induced cutaneous and muscle pain. Author(s): Steen AE, Reeh PW, Geisslinger G, Steen KH. Source: European Journal of Pain (London, England). 2000; 4(2): 195-209. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10957700

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Polysomnography in idiopathic muscle pain syndrome (fibrositis). Author(s): Silva AB, Bertorini TE, Lemmi H. Source: Arquivos De Neuro-Psiquiatria. 1991 December; 49(4): 437-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1842193

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Post-operative muscle pain and serum potassium changes following self-taming of succinyl choline-induced fasciculations. Author(s): Katre AM, Parab SG. Source: Journal of Postgraduate Medicine. 1982 January; 28(1): 18-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7108814

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Post-succinylcholine muscle pain and smoking. Author(s): Nigrovic V, Wierda JM. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1994 May; 41(5 Pt 1): 453-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8055621

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Pretreatment with vecuronium as a prophylactic against post-suxamethonium muscle pain. Comparison with other non-depolarizing neuromuscular blocking drugs. Author(s): Ferres CJ, Mirakhur RK, Craig HJ, Browne ES, Clarke RS. Source: British Journal of Anaesthesia. 1983 August; 55(8): 735-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6136287

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Progressive muscle pain, weight gain, fatique and unusual body shape change. Author(s): Heckmann JG, Kraus B, Stefan H, Neundorfer B. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2000 March; 7(2): 243-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10809951

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Psychological and physiological parameters of masticatory muscle pain. Author(s): Carlson CR, Reid KI, Curran SL, Studts J, Okeson JP, Falace D, Nitz A, Bertrand PM. Source: Pain. 1998 June; 76(3): 297-307. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9718248

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Psychological factors and self-reports of muscle pain. Author(s): Ursin H, Endresen IM, Ursin G. Source: European Journal of Applied Physiology and Occupational Physiology. 1988; 57(3): 282-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3371336

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Psychophysical and EEG responses to repeated experimental muscle pain in humans: pain intensity encodes EEG activity. Author(s): Chang PF, Arendt-Nielsen L, Graven-Nielsen T, Chen AC. Source: Brain Research Bulletin. 2003 February 15; 59(6): 533-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12576151

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Quantification of deep and superficial sensibility in saline-induced muscle pain--a psychophysical study. Author(s): Graven-Nielsen T, Fenger-Gron LS, Svensson P, Steengaard-Pedersen K, Arendt-Nielsen L, Staehelin Jensen T. Source: Somatosensory & Motor Research. 1998; 15(1): 46-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9583576

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Quantification of local and referred muscle pain in humans after sequential i.m. injections of hypertonic saline. Author(s): Graven-Nielsen T, Arendt-Nielsen L, Svensson P, Jensen TS. Source: Pain. 1997 January; 69(1-2): 111-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9060020

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Quantitative electromyographic investigation of the spasm theory of muscle pain. Author(s): De Vries HA. Source: Am J Phys Med. 1966 June; 45(3): 119-34. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5938206

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Referred muscle pain: basic and clinical findings. Author(s): Arendt-Nielsen L, Svensson P. Source: The Clinical Journal of Pain. 2001 March; 17(1): 11-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11289083

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Relationships between characteristics of electrical stimulation, muscle pain and blink responses in man. Author(s): Duranti R, Galletti R, Pantaleo T. Source: Electroencephalography and Clinical Neurophysiology. 1983 June; 55(6): 637-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6189693

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Release of algesic substances in human experimental muscle pain. Author(s): Tegeder L, Zimmermann J, Meller ST, Geisslinger G. Source: Inflammation Research : Official Journal of the European Histamine Research Society. [et Al.]. 2002 August; 51(8): 393-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12234056

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Reorganisation of human step initiation during acute experimental muscle pain. Author(s): Madeleine P, Voigt M, Arendt-Nielsen L. Source: Gait & Posture. 1999 December; 10(3): 240-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10567756

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Repeated high-force eccentric exercise: effects on muscle pain and damage. Author(s): Newham DJ, Jones DA, Clarkson PM. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1987 October; 63(4): 13816. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3693172

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Response of pathological ischaemic muscle pain to analgesics. Author(s): Sacchetti G, Lampugnani R, Battistini C, Mandelli V. Source: British Journal of Clinical Pharmacology. 1980 February; 9(2): 165-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7356905

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Responses to conservative treatment in temporomandibular disorders with locking versus with muscle pain. Author(s): Yamaoka M, Yamamoto M, Furusawa K. Source: Cranio. 1997 October; 15(4): 296-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9481991

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Sensibility threshold in patients with masticatory muscle pain. Author(s): Xie Q, Hampf G. Source: Acta Odontologica Scandinavica. 1994 February; 52(1): 33-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8184677

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Sensory-motor interactions of human experimental unilateral jaw muscle pain: a quantitative analysis. Author(s): Svensson P, Arendt-Nielsen L, Houe L. Source: Pain. 1996 February; 64(2): 241-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8740600

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Sex differences in masticatory muscle pain after chewing. Author(s): Karibe H, Goddard G, Gear RW. Source: Journal of Dental Research. 2003 February; 82(2): 112-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12562883

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Sex differences in naturally occurring leg muscle pain and exertion during maximal cycle ergometry. Author(s): Cook DB, O'Connor PJ, Oliver SE, Lee Y. Source: The International Journal of Neuroscience. 1998 September; 95(3-4): 183-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9777439

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Signs and symptoms of temporomandibular joint muscle pain dysfunction syndrome: a retrospective study of one hundred patients. Author(s): Brunello GE, Brunello DL. Source: Aust Prosthodont J. 1991; 5: 9-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1812940

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Single cell morphology of muscle in patients with chronic muscle pain. Author(s): Jacobsen S, Bartels EM, Danneskiold-Samsoe B. Source: Scandinavian Journal of Rheumatology. 1991; 20(5): 336-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1947896

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Single dose suxamethonium and muscle pain in pregnancy. Author(s): Thind GS, Bryson TH. Source: British Journal of Anaesthesia. 1983 August; 55(8): 743-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6882612

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Site- and modality-specific modulation of experimental muscle pain in humans. Author(s): Svensson P, Hashikawa CH, Casey KL. Source: Brain Research. 1999 December 18; 851(1-2): 32-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10642825

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Standards for long-term management of the pediatric patient who manifests temporomandibular joint or masticatory muscle pain and dysfunction. Author(s): Currier GF, Hertzberg JL. Source: Pediatr Dent. 1989 December; 11(4): 332-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2639332

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Stimulus-response functions in areas with experimentally induced referred muscle pain--a psychophysical study. Author(s): Graven-Nielsen T, Arendt-Nielsen L, Svensson P, Jensen TS. Source: Brain Research. 1997 January 2; 744(1): 121-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9030420

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Stretch-based relaxation and the reduction of EMG activity among masticatory muscle pain patients. Author(s): Carlson CR, Okeson JP, Falace DA, Nitz AJ, Anderson D. Source: J Craniomandib Disord. 1991 Summer; 5(3): 205-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1812149

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Subclinical myositis is common in primary Sjogren's syndrome and is not related to muscle pain. Author(s): Lindvall B, Bengtsson A, Ernerudh J, Eriksson P. Source: The Journal of Rheumatology. 2002 April; 29(4): 717-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950012

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The activity of jaw elevator muscles during peanut chewing in patients with temporomandibular joint and muscle pain dysfunction syndrome. Author(s): Shiau YY, Chen KC. Source: Proc Natl Sci Counc Repub China B. 1986 January; 10(1): 57-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3714906

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The concept of affective spectrum disorder: relationship to fibromyalgia and other syndromes of chronic fatigue and chronic muscle pain. Author(s): Hudson JI, Pope HG. Source: Baillieres Clin Rheumatol. 1994 November; 8(4): 839-56. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7850883

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The correlation between suxamethonium injection and post-operative muscle pain in Chinese. Author(s): Chu HY, Chung CH, Lin YK, Wong CH. Source: Ma Zui Xue Za Zhi. 1988 December; 26(4): 411-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3073293

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The effect of differential and complete nerve block on experimental muscle pain in humans. Author(s): Laursen RJ, Graven-Nielsen T, Jensen TS, Arendt-Nielsen L. Source: Muscle & Nerve. 1999 November; 22(11): 1564-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10514235

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The effect of experimental jaw muscle pain on postural muscle activity. Author(s): Stohler CS, Zhang X, Lund JP. Source: Pain. 1996 August; 66(2-3): 215-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8880843

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The effect of experimental muscle pain on the background electrical brain activity. Author(s): Veerasarn P, Stohler CS. Source: Pain. 1992 June; 49(3): 349-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1408301

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The effect of glutamate-evoked masseter muscle pain on the human jaw-stretch reflex differs in men and women. Author(s): Cairns BE, Wang K, Hu JW, Sessle BJ, Arendt-Nielsen L, Svensson P. Source: J Orofac Pain. 2003 Fall; 17(4): 317-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14737876

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The effects of masseter muscle pain on biting performance. Author(s): Shiau YY, Peng CC, Wen SC, Lin LD, Wang JS, Lou KL. Source: Journal of Oral Rehabilitation. 2003 October; 30(10): 978-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974856

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The electromyographic silent periods in the patients with temporomandibular joint and muscle pain dysfunction syndrome. Author(s): Shiau YY. Source: Taiwan Yi Xue Hui Za Zhi. 1985 January; 84(1): 102-12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3858422

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The influence of experimental muscle pain on motor unit activity during low-level contraction. Author(s): Birch L, Christensen H, Arendt-Nielsen L, Graven-Nielsen T, Sogaard K. Source: European Journal of Applied Physiology. 2000 October; 83(2-3): 200-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11104061

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The influence of experimental muscle pain on the human soleus stretch reflex during sitting and walking. Author(s): Matre DA, Sinkjaer T, Knardahl S, Andersen JB, Arendt-Nielsen L. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 1999 December; 110(12): 2033-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10616108

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The metabolic consequences of reduced habitual activities in patients with muscle pain and disease. Author(s): Wagenmakers AJ, Coakley JH, Edwards RH. Source: Ergonomics. 1988 November; 31(11): 1519-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3229402

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The neural basis of temporomandibular joint and masticatory muscle pain. Author(s): Sessle BJ. Source: J Orofac Pain. 1999 Fall; 13(4): 238-45. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10823036

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The pathogenesis of muscle pain. Author(s): Mense S. Source: Current Pain and Headache Reports. 2003 December; 7(6): 419-25. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604500

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The peripheral apparatus of muscle pain: evidence from animal and human studies. Author(s): Graven-Nielsen T, Mense S. Source: The Clinical Journal of Pain. 2001 March; 17(1): 2-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11289084

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The prolonged exercise test in patients with muscle pain and fatigue. Author(s): Brooke MH, Carroll JE, Davis JE. Source: Trans Am Neurol Assoc. 1977; 102: 56-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=616116

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The role of the free-way space in the generation of muscle pain among denturewearers. Author(s): Monteith B. Source: Journal of Oral Rehabilitation. 1984 September; 11(5): 483-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6239019

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The role of the gamma-motor system in increasing muscle tone and muscle pain syndromes: a review of the Johansson/Sojka hypothesis. Author(s): Knutson GA. Source: Journal of Manipulative and Physiological Therapeutics. 2000 October; 23(8): 564-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11050614

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The use of electromyography to quantify muscle pain. Author(s): Myslinski NR, Buxbaum JD, Parente FJ. Source: Methods Find Exp Clin Pharmacol. 1985 October; 7(10): 551-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4079589

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The use of topical 4% lidocaine in spheno-palatine ganglion blocks for the treatment of chronic muscle pain syndromes: a randomized, controlled trial. Author(s): Scudds RA, Janzen V, Delaney G, Heck C, McCain GA, Russell AL, Teasell RW, Varkey G, Woodbury MG. Source: Pain. 1995 July; 62(1): 69-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7478710

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Thermosensitivity of muscle: high-intensity thermal stimulation of muscle tissue induces muscle pain in humans. Author(s): Graven-Nielsen T, Arendt-Nielsen L, Mense S. Source: The Journal of Physiology. 2002 April 15; 540(Pt 2): 647-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11956350

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Two different types of exercise-induced muscle pain without myopathy and CKelevation during HMG-Co-enzyme-A-reductase inhibitor treatment. Author(s): Sinzinger H, Schmid P, O'Grady J. Source: Atherosclerosis. 1999 April; 143(2): 459-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10217378

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Understanding and measurement of muscle tone as related to clinical muscle pain. Author(s): Simons DG, Mense S. Source: Pain. 1998 March; 75(1): 1-17. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9539669

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Unusual muscle pain in two patients with diabetic renal failure. Author(s): Chow KM, Szeto CC, Griffith JF, Wong TY, Li PK. Source: Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi / Hong Kong Academy of Medicine. 2002 October; 8(5): 368-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12376716

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Using moist heat to treat acute temporomandibular muscle pain dysfunction. Author(s): Nelson SJ, dos Santos J Jr, Barghi N, Narendran S. Source: Compendium. 1991 November; 12(11): 808, 810, 812 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1810638

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Ventilatory disturbances resulting from muscle pain following the administration of succinylcholine chloride. Author(s): Shibuya J, Cuevo N, Quarnstrom FC, Albert SN. Source: Med Ann Dist Columbia. 1968 September; 37(9): 457-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5248390

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Xanthine, hypoxanthine and muscle pain. Histochemical and biochemical observations. Author(s): Isaacs H, Heffron JJ, Berman L, Badenhorst M, Pickering A. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1975 June 21; 49(26): 1035-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=125457

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CHAPTER 2. NUTRITION AND MUSCLE PAIN Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and muscle pain.

Finding Nutrition Studies on Muscle Pain The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “muscle pain” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “muscle pain” (or a synonym): •

Chronic muscle pain induced by repeated acid Injection is reversed by spinally administered mu- and delta-, but not kappa-, opioid receptor agonists. Author(s): Physical Therapy and Rehabilitation Science Graduate Program, Neuroscience Graduate Program, Pain Research Program, University of Iowa, 2600 Steindler Building, Iowa City, IA 52242, USA. [email protected] Source: Sluka, K A Rohlwing, J J Bussey, R A Eikenberry, S A Wilken, J M J-PharmacolExp-Ther. 2002 September; 302(3): 1146-50 0022-3565

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Effects of experimental muscle pain on electromyographic activity of masticatory muscles in the rat. Author(s): Department of Oral and Craniofacial Biological Sciences, University of Maryland Baltimore School of Dentistry, 666 West Baltimore Street, Baltimore, Maryland 21201, USA. [email protected] Source: Ro, Jin Y Svensson, Peter Capra, Norman Muscle-Nerve. 2002 Apr; 25(4): 576-84 0148-639X

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Nutrition

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

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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

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

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

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

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

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

The following is a specific Web list relating to muscle 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: •

Vitamins Niacin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892,00.html

•

Minerals Carnitine Source: Prima Communications, Inc.www.personalhealthzone.com Copper Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,886,00.html L-carnitine Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. PATENTS ON MUSCLE 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.5 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 “muscle pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on muscle pain, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Muscle Pain By performing a patent search focusing on muscle 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 will tell you how to obtain this information later in the chapter. The following is an 5Adapted

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

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example of the type of information that you can expect to obtain from a patent search on muscle pain: •

Arthritis, muscle pain, and dry skin remedy Inventor(s): Merich, deceased; Nick (late of Daytona Beach, FL) Assignee(s): None Reported Patent Number: 6,146,639 Date filed: July 26, 1999 Abstract: An arthritis, muscle pain, and dry skin remedy is provided containing rubbing alcohol, witch hazel, and olive oil. In the preferred embodiment, the remedy contains sixteen parts rubbing alcohol, sixteen parts witch hazel, and four parts olive oil. An alternate embodiment arthritis, muscle pain, and dry skin remedy is also disclosed which relieves symptoms of muscle pain, arthritis, and dry, scaly skin in horses. This alternate remedy uses castor oil instead of olive oil. Excerpt(s): This invention relates to arthritis remedies, and in particular to an arthritis and muscle pain remedy which also treats dry or scaly skin. Arthritis is a term which refers to a group of diseases which affect the joint. Symptoms of arthritis include pain, stiffness and swelling of the affected joints. The disease is a serious problem in that it is very widely spread. For example, in the United States alone more than 31 million individuals suffer from arthritis. The two main types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis is also referred to as degenerative joint disease, and occurs where the joint itself wears out. This strain of arthritis is common in elderly people, and it may also occur where a joint has been injured repeatedly. The most commonly affected joints are in the hands, knees, lower back and neck. Web site: http://www.delphion.com/details?pn=US06146639__

•

Methods and equipment for treating or preventing muscle pain or injury Inventor(s): Hubbard; David R. (San Diego, CA), Johnson; Paul (San Diego, CA) Assignee(s): Corsolutions, Inc. (buffalo Grove, Il) Patent Number: 6,464,652 Date filed: March 6, 1997 Abstract: Machines for treating or preventing neuromuscular pain conditions and injuries by slow patientcontrolled stretching of a muscle or group of muscles when they and surrounding muscles are in a relaxed state (i.e., with little or no extrafusal muscle fiber contractions). The machines include a fixed support such as seat. An adjustable support, such as a back or side rest is adjusted for the particular patient. A controllable support moved in an alternating motion, under the patient's control, allows the injured or painful muscle to be slowly stretched by gravity, while the muscles are relaxed. The controllable support is preferably moved by a hydraulic cylinder. Excerpt(s): The field of the invention is apparatus and methods for treating muscles and neuromuscular pain conditions. Muscle injuries and pain, common among athletes and manual laborers, occur in the general population, due to accidents, over-exertion, and/or poor ergodynamic and working conditions. These types of injuries occur often in the neck, arms, hip, back, and shoulders. Traditional therapies, such as in muscle

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strengthening, the most common approach to physical therapy, have no proven effect and often aggravate the pain. Other techniques such as heat or ultrasound are passive and also unproven. Active stretching of the muscle is more effective but has been traditionally performed by physical manipulation of the patient by the therapist, often resulting in over-stretch and a reaction of muscle tightening. Web site: http://www.delphion.com/details?pn=US06464652__ •

Multi-electrode and needle injection device for diagnosis and treatment of muscle injury and pain Inventor(s): Hubbard, Jr.; David R. (2999 Health Center Dr., San Diego, CA 92123) Assignee(s): None Reported Patent Number: 6,356,783 Date filed: November 20, 1997 Abstract: A multi electrode and needle injection device for identifying and treating muscle pain using two simultaneous electrode EMG recordings to locate an active trigger point. The two electrodes are displaced so that one electrode detects EMG activity at the trigger point and the other detects EMG activity adjacent to the trigger point, within the same muscle. The combination of the electrodes with a drug delivery system allows the user to inject a medication locally at the trigger point to block the trigger point activity and reduce or eliminate muscle pain. The electrodes are on a hypodermic needle. The needle is used to both facilitate the location of the trigger points, and for treatment, by injecting a drug into the trigger points. Excerpt(s): The field of the invention is the diagnosis and treatment of muscle injuries associated with pain and stiffness. It is estimated that up to 20% of the adult population in the United States suffers from chronic and recurrent muscle pain. There is currently no FDA-approved or proven effective treatment for these conditions. Treatments now used give only limited temporary relief. Chronic and recurring muscle pain is a neuromuscular abnormality typically following a strain injury, and manifested by what has been termed trigger point (TrP) phenomena. As used herein,trigger point means a localized area of tenderness within a muscle associated with spontaneous electromyographic (EMG) activity. Thus, a trigger point is a location of spontaneous EMG activity within a muscle associated with pain. Trigger points may be within muscle spindles. TrPs can be objectively diagnosed by identification of spontaneous EMG activity in a trigger point while adjacent muscle fibers are electromyographically quiet. Once the trigger point EMG activity is identified, chronic and recurrent muscle pain associated with this localized EMG activity can be treated through the use of medications including sympathetic blocking agents, as described in U.S. Pat. No. 5,513,661, incorporated herein by reference. This patent describes a method of identifying trigger points in muscle associated with a characteristic spontaneous EMG activity. The activity is then blocked by injecting adrenergic blocking agents. The methods of diagnosis and treatment described in U.S. Pat. No. 5,513,661 involves simultaneously measuring both the trigger point activity and the EMG activity adjacent to the trigger point to determine whether the observed trigger point EMG activity is spontaneous localized, and not due to other phenomena such as voluntary contraction. To effectively block sympathetic activity at a trigger point, it is desirable to localize the trigger point as precisely as possible. For effective treatment, the blocking is agent should be delivered precisely at the trigger point. Accordingly, there remains a need for a device for simultaneously locating and treating TrP EMG activity.

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Web site: http://www.delphion.com/details?pn=US06356783__ •

Transdermal delivery of an anti-inflammatory composition Inventor(s): Dickson; James R. (4 Upper Dogwood La., Rye, NY 10580) Assignee(s): None Reported Patent Number: 6,689,399 Date filed: March 16, 2000 Abstract: The present invention provides an anti-inflammatory composition for treatment of joint and muscle pain through transdermnal delivery of a capsacinoid in conjunction with glucosamine. The ingredients of the composition of the present invention, namely, a capsacinoid in combination with a primary amine, such as glucosamine, at a high concentration, interact in a synergistic manner to provide a prolonged effect of pain relief when used in the treatment of joint and/or muscle pain associated with an inflammatory response. The prolonged pain relief effect is achieved without incurring the intense burning or stinging sensation usually associated with topical capsaicin administration. The present invention also provides methods for relieving joint and/or muscle pain associated with an inflammatory response, which employ the composition of the present invention. Excerpt(s): The present invention relates to an anti-inflammatory composition for treatment of joint and muscle pain. More specifically, the present invention provides a composition that alleviates pain associated with joint and/or muscle injuries, diseases or conditions through transdermal delivery of a casaicinoid in conjunction with a primary amine, such a glucosamine. The combination of the ingredients of the present invention, namely a capsaicinoid and a primary amine, interact in a synergistic manner to provide unexpectedly beneficial results in relief of joint and/or muscle pain associated with an inflammatory response. The connective tissue of mammals, such as humans, are subjected to a constant barrage of stresses and injuries throughout the life of the individual. These stresses may result from acute or chronic impacts or from the progress of various degenerative diseases, and produce painful inflammation in joint regions, such as the neck, back, arms, hips, ankles and feet. These afflictions are common, afflicting millions of Americans, and in many cases, debilitating. As a result, there is a great need for an effective and simple treatment to ease the pain associated with inflammatory connective tissue conditions. There are a number of approaches directed to controlling the symptoms of such inflammatory connective tissue conditions. Steroids, especially corticosteroids, and non-steroidal anti-inflammatory drugs (socalled "NSAIDs"), such as aspirin (acetylsalicylic acid), ibuprofen ((2-(isobutylphenyl) propionic acid), naproxen (2-naphthaleneacetic acid, 6-methoxy-9-methyl, sodium salt), and piroxicam (4-hydroxy-2-methyl-N-2-pyridinyl-2H-1,2-benzothiazine-2-carboxamide 1,1 dioxide), are used to control the inflammation associated with connective tissue disorders. However, these drugs relieve the symptoms associated with the connective tissue disorders, but do nothing to slow the progression of the disease. Furthermore, these drugs have a number of undesirable side-effects. With respect to NSAIDS, first, NSAIDS may inhibit the body's own natural healing mechanisms, leading to further connective tissue degeneration. Second, NSAIDS also affect enzymes involved in maintaining healthy liver and kidney function, so that administration of these drugs weakens these organ systems. Finally, NSAIDS can produce gastropathy and gastric ulceration. With respect to corticosteroids, while dramatic improvements are often seen upon initial administration, corticosteroids begin to lose their effectiveness after

Patents 57

prolonged administration. Further increases in dosage are required to overcome the loss of effectiveness, but the higher dosages themselves also eventually lose effectiveness. Furthermore, upon cessation of corticosteroid treatment, the symptoms of inflammation and swelling recur at higher levels than were experienced prior to administration. In addition, fluid retention is a serious side effect, and can lead to significant weight gain and, more importantly, dangerous levels of hypertension. Corticosteroids may also induce or contribute to osteoporosis, exacerbating what is often already a significant problem with elderly patients. Web site: http://www.delphion.com/details?pn=US06689399__ •

Use of Epinastine for the treatment of pain Inventor(s): Jung; Birgit (Schwabenheim, DE), Meade; Christopher John Montague (Bingen, DE), Pairet; Michel (Biberach, DE) Assignee(s): Boehringer Indelheim KG (ingelhiem, De) Patent Number: 5,942,503 Date filed: June 9, 1998 Abstract: Disclosed herein is the use of epinastine for the treatment of pain, including migraine, Bing-Horton syndrome, tension headaches, muscle pain, inflammatory pain, and neuralgias. Epinastine may also be administered in combination with an additional analgesic for treating pain. Excerpt(s): This application is a 371 of PCT/EP96/04957, filed Nov. 13, 1996. The present invention relates to a new use of epinastine for the treatment and prophylaxis of pain, especially chronic or inflammation-induced pain and in particular migraine. Epinastine (3-amino-9,13b-dihydro-1H-dibenz›c,f!-imidazo›5,1-a!azepine hydrochloride) was described by Fugner et al. ›Arzneimittelforschung 38 (1988): 1446-1453!. The active principle can be used in the form of a racemate or in the form of pure enantiomers or as a mixture of different proportions of both enantiomers. Therapeutically, epinastine is used as the hydrochloride. The invention described herein, however, is not limited to the hydrochloride but relates to any addition salt with a pharmacologically acceptable acid as well as the free base. Web site: http://www.delphion.com/details?pn=US05942503__

•

Use of sympathetic blockade for treatment of chronic muscle pain Inventor(s): Hubbard; David R. (4150 Regents Park Row, Ste. 255, La Jolla, CA 920371467) Assignee(s): None Reported Patent Number: 5,513,661 Date filed: October 14, 1993 Abstract: Methods are provided for intramuscular needle diagnosis and treatment of muscle pain that is believed to be the result of sympathetically mediated spindle spasm. Two simultaneous needle EMG needle recordings are used to establish the presence of and magnitude of the "trigger points" in painful muscle. The abnormal muscle activity so identified can then be treated by blocking the sympathetic activation muscle blocker

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or other agent that would have the same effect of inhibiting the abnormal muscle activity. Excerpt(s): This invention relates to methods for treating chronic muscle pain using sympathetic blocking agents. The method is exemplified by injection of phenoxybenzamine directly into myofascial trigger points. Myofascial pain syndrome is a neuromuscular dysfunction of skeletal muscle fibers manifested by trigger point (TrP) phenomena of various origins and referred phenomena. The underlying pathophysiology of TrPs is unknown. However, specific criteria have been defined for identifying TrPs (Simons, D., (1990) Adv. Pain Res. Ther. 17:1-41; Travell et al. Myofascial pain and dysfunction, the trigger point manual, New York; Williams & Wilkins (1983) 5-44). These criteria include a palpable firm area of muscle, referred to as the taut band; within the taut band, a localized spot of exquisite tenderness to manual pressure, the TrP; a characteristic pattern of pain, tingling, or numbness in response to sustained pressure on the TrP within the taut band; and a local twitch of the taut band when the TrP is distorted transversely. Although the taut band may be several centimeters long, the TrP itself is reported to be only a few millimeters in diameter. The referral phenomena include referred pain, referred tenderness, or referred autonomic phenomena, such as vasoconstriction, coldness, sweating, pilomotor response, ptosis and hypersecretion. There are both active TrPs that cause clinical pain syndromes, and latent TrPs, which are painless, and not associated with clinical pain syndromes. Latent TrPs are, like active ones, identified by manual palpation of taut bands, tenderness, and characteristic referral pattern of pain in response to sustained manual pressure. Fifty percent of asymptomatic persons have latent TrPs on examination of the shoulder-girdle musculature. Sola et al. (1955) Am. J. Phys. Med. 34:585-90. TrPs can also be distinguished from Tender points (TePs). Tender points are areas of tenderness that may or may not be in muscle tissue, do not have palpable taut bands, and do not refer pain to adjacent areas. Travell et al. Myofascial pain and dysfunction, the trigger point manual, New York; Williams & Wilkins (1983) 5-44). Web site: http://www.delphion.com/details?pn=US05513661__

Patent Applications on Muscle Pain As of December 2000, U.S. patent applications are open to public viewing.6 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 muscle pain: •

Cardiac glycosides for treating muscle pain and spasm Inventor(s): Davis, Matthew; (Media, PA), Laudadio, Charles; (Chadds Ford, PA) Correspondence: Connolly Bove Lodge & Hutz Llp; P.O. Box 2207; Wilmington; DE; 19899-2207; US Patent Application Number: 20030229029 Date filed: June 4, 2003

6

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

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Abstract: This invention provides methods of treating muscle spasm and/or pain by treatment with a cardiac glycoside or aglycone derivative. These methods are useful in treatment of conditions associated with muscle pain. Excerpt(s): This application is based upon provisional application Serial No. 60/386,261, filed Jun. 6, 2002. The present invention relates generally to use of administering a cardiac glycoside (topically, orally, parenterally or anally) for the relief of striated muscle pain. Foxglove is the common name for plants of the Digitalis species, primarily represented by common foxglove, Digitalis purpurea L., and Grecian foxglove, Digitalis lanata J. F. Ehrh. Digitalis is poisonous, and symptoms include vomiting, headache, irregular heartbeat, and convulsions. Overdoses can be fatal. Cardiac glycosides such as digitalis have been used extensively to treat heart failure. The assumed mechanism of action is inhibition of Na.sup.+, K.sup.+-ATPase resulting in increased intracellular sodium and subsequent intracellular calcium leading to enhanced muscle contraction in cardiac tissue. This enhanced muscle contraction is thought to include increasing the contractility of the heart. Various cardiac glycosides may have cardiotonic or cardiotoxic effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

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 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,

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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 •

Multi electrode and needle injection device for diagnosis and treatment of muscle injury and pain Inventor(s): Hubbard, David R. JR.; (San Diego, CA) Correspondence: Edward O. Kruesser; Brobeck Phleger & Harrison; 12390 EL Camino Real; San Diego; CA; 92130; US Patent Application Number: 20020042590 Date filed: December 7, 2001 Abstract: A multi electrode and needle injection device for identifying and treating muscle pain using two simultaneous electrode EMG recordings to locate an active trigger point. The two electrodes are displaced so that one electrode detects EMG activity at the trigger point and the other detects EMG activity adjacent to the trigger point, within the same muscle. The combination of the electrodes with a drug delivery system allows the user to inject a medication locally at the trigger point to block the trigger point activity and reduce or eliminate muscle pain. The electrodes are on a hypodermic needle. The needle is used to both facilitate the location of the trigger points, and for treatment, by injecting a drug into the trigger points. Excerpt(s): The field of the invention is the diagnosis and treatment of muscle injuries associated with pain and stiffness. It is estimated that up to 20% of the adult population in the United States suffers from chronic and recurrent muscle pain. There is currently no FDA-approved or proven effective treatment for these conditions. Treatments now used give only limited temporary relief. Chronic and recurring muscle pain is a neuromuscular abnormality typically following a strain injury, and manifested by what has been termed trigger point (TrP) phenomena. As used herein, trigger point means a localized area of tenderness within a muscle associated with spontaneous electromyographic (EMG) activity. Thus, a trigger point is a location of spontaneous EMG activity within a muscle associated with pain. Trigger points may be within muscle spindles. TrPs can be objectively diagnosed by identification of spontaneous EMG activity in a trigger point while adjacent muscle fibers are electromyographically quiet. Once the trigger point EMG activity is identified, chronic and recurrent muscle pain associated with this localized EMG activity can be treated through the use of medications including sympathetic blocking agents, as described in U.S. Pat. No. 5,513,661, incorporated herein by reference. This patent describes a method of identifying trigger points in muscle associated with a characteristic spontaneous EMG activity. The activity is then blocked by injecting adrenergic blocking agents. The methods of diagnosis and treatment described in U.S. Pat. No. 5,513,661 involves simultaneously measuring both the trigger point activity and the EMG activity adjacent to the trigger point to determine whether the observed trigger point EMG activity is spontaneous localized, and not due to other phenomena such as voluntary contraction. To effectively block sympathetic activity at a trigger point, it is desirable to localize the trigger point as precisely as possible. For effective treatment, the blocking agent should be delivered precisely at the trigger point. Accordingly, there remains a need for a device for simultaneously locating and treating TrP EMG activity.

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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 muscle 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 “muscle 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 muscle pain. You can also use this procedure to view pending patent applications concerning muscle 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 4. BOOKS ON MUSCLE PAIN Overview This chapter provides bibliographic book references relating to muscle pain. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on muscle 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: 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 “muscle pain” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “muscle pain” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “muscle pain” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

90 Seconds to Muscle Pain Relief: The Fold and Hold Method by Dale L. Anderson; ISBN: 0896382427; http://www.amazon.com/exec/obidos/ASIN/0896382427/icongroupinterna

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Chronic Muscle Pain by Paul Davidson; ISBN: 0425130541; http://www.amazon.com/exec/obidos/ASIN/0425130541/icongroupinterna

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Chronic Muscle Pain Syndrome: The 7-Step Plan to Recognize and Treat It - and Feel Better All Over by Paul, M.D. Davidson; ISBN: 0425181804; http://www.amazon.com/exec/obidos/ASIN/0425181804/icongroupinterna

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Diagnosis and Treatment of Muscle Pain by Hans Kraus (Editor); ISBN: 0867151668; http://www.amazon.com/exec/obidos/ASIN/0867151668/icongroupinterna

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Fibromyalgia and Muscle Pain: What Causes It, How It Feels and What to Do About It (Thorsons Health Series) by Leon Chaitow; ISBN: 0722537352; http://www.amazon.com/exec/obidos/ASIN/0722537352/icongroupinterna

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Fibromyalgia: Relief from Chronic Muscle Pain by Paul Davidson (Illustrator); ISBN: 0965349322; http://www.amazon.com/exec/obidos/ASIN/0965349322/icongroupinterna

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Healing Muscle Pain : Tools, Techniques, and Tips to Bring Your Muscles Back to Health by Elisabeth Aaslid (Author); ISBN: 0471378917; http://www.amazon.com/exec/obidos/ASIN/0471378917/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; ISBN: 1930051549; http://www.amazon.com/exec/obidos/ASIN/1930051549/icongroupinterna

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Muscle Hugs: A Spiritual Approach to Muscle Pain by Vickie Lynn Ford; ISBN: 0972587802; http://www.amazon.com/exec/obidos/ASIN/0972587802/icongroupinterna

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Muscle Pain Relief in 90 Seconds: The Fold and Hold Method by Dale L. Anderson (Author); ISBN: 0471346896; http://www.amazon.com/exec/obidos/ASIN/0471346896/icongroupinterna

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Muscle Pain Syndromes and Fibromyalgia: Pressure Algometry for Quantification of Diagnosis and Treatment Outcome (Journal of Musculoskeletal Pain, V. 6, No. 1) by Andrew A. Fischer (Editor), B.C.) World Congress on Pain 1996 Vancouver; ISBN: 0789005107; http://www.amazon.com/exec/obidos/ASIN/0789005107/icongroupinterna

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Muscle Pain, Myofascial Pain, and Fibromyalgia: Recent Advances (Journal of Musculoskeletal Pain, V. 7, No. 1/2) by Leonardo Vecchiet (Editor), et al; ISBN: 0789008289; http://www.amazon.com/exec/obidos/ASIN/0789008289/icongroupinterna

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Muscle Pain: Understanding Its Nature, Diagnosis and Treatment by Siegfried Mense, et al; ISBN: 0683059289; http://www.amazon.com/exec/obidos/ASIN/0683059289/icongroupinterna

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When Muscle Pain Won't Go Away by Gayle Backstrom, Bernard Dr Rubin (Contributor); ISBN: 0878337946; http://www.amazon.com/exec/obidos/ASIN/0878337946/icongroupinterna

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When Muscle Pain Won't Go Away: The Relief Handbook for Fibromyaliga and Chronic Muscle Pain by Gayle Backstrom, et al; ISBN: 0878339981; http://www.amazon.com/exec/obidos/ASIN/0878339981/icongroupinterna

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When the Pain is Real!! Fibromyalgia: The Chronic Muscle Pain Syndrome by Teresa Kruckenberg; ISBN: 0646267590; http://www.amazon.com/exec/obidos/ASIN/0646267590/icongroupinterna

Chapters on Muscle Pain In order to find chapters that specifically relate to muscle pain, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and muscle 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 “muscle pain” (or

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synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on muscle pain: •

Temporomandibular Joint Disorders Source: in Kwon, P.H. and Laskin, D.M. Clinician's Manual of Oral and Maxillofacial Surgery. Chicago, IL: Quintessence Publishing Co, Inc. 2001. p. 407-425. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $58.00 plus shipping and handling. ISBN: 0867153962. Summary: Temporomandibular joint disorders (TMDs) is a collective term embracing a number of clinical problems that involve the jaw musculature or the temporomandibular joint (TMJ), or both. This chapter on TMDs is from a spiral-bound handbook that offers quick reference information to the oral and maxillofacial surgeon. The outline and chart-based format is designed to offer quick access to information that may be needed in situations that do not allow time for a leisurely perusal of textbooks and journals. The introduction of the chapter describes the two distinct categories of TMD: masticatory muscle pain and dysfunction (MPD) and intraarticular pathology. The introduction also notes that the consequences of inappropriately treated TMD can be devastating. Most patients who have extraarticular (outside the joint) TMD can be successfully treated and rehabilitated nonsurgically with a combination of resting the jaw, medication, change in habits, and an orthotic appliance. However, those patients whose cause of TMD is intraarticular (within the joint) pathology often cannot be treated successfully without surgery. The chapter covers the differential diagnosis of TMD, masticatory muscle pain and dysfunction, intraarticular pathology, neoplastic disorders, arthritic disorders, ankylosis, internal derangement, preoperative TMJ evaluation, surgical procedures, postoperative management, and complications and their treatment. 1 table.

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Neurological Complications of Rheumatic Diseases Source: in Maddison, P.J.; et al., Eds. Oxford Textbook of Rheumatology. Volume 1. New York, NY: Oxford University Press, Inc. 1993. p. 107-116. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals explores the neurological complications of rheumatic diseases. Neurologic symptoms are discussed, including muscle weakness, muscle pain, muscle twitching, contractures, absent or exaggerated reflexes, sensory loss, and pain. Central nervous system disorders that present to the rheumatologist are described, including neuropsychiatric systemic lupus erythematosus, antiphospholipid syndrome, various connective tissue diseases, brain stem syndromes, and cranial nerve palsies. Spinal cord complications seen in rheumatic diseases are highlighted, including cervical myelopathy, myelopathy, and transverse myelitis. Peripheral nervous involvement in rheumatic diseases is discussed in terms of radicular pain, peripheral neuropathies, entrapment neuropathies, and peripheral neuropathies. 37 references, 1 figure, and 12 tables.

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Chapter 21-C: Vasculitides: Giant Cell Arteritis, Polymyalgia Rheumatica, and Takayasu's Arteritis Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 397-405. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This chapter provides health professionals with information on the epidemiology, etiology, pathogenesis, clinical features, diagnosis, and treatment of giant cell arteritis (GCA), polymyalgia rheumatica (PMR), and Takayasu's arteritis (TA). GCA, also known as temporal arteritis, occurs more frequently in women than in men and is most likely to occur in people older than 50 years. The prevalence is highest in Scandinavian countries and in regions settled by people of northern European descent. This suggests an inherited risk. GCA presents with two major symptomatic complexes: signs of vascular insufficiency resulting from impaired blood flow and signs of systemic inflammation. The extracranial branches of the carotid arteries are most often affected. The predominant histologic feature of GCA is a mononuclear cell infiltrate dominated by T lymphocytes and macrophages that penetrate all layers of the wall of a mid sized artery. There is no pathognomonic laboratory test for GCA, and specific autoantibodies have not been identified. Diagnosis is based on clinical features and arterial biopsy results. Corticosteroids are effective in suppressing the symptoms. No other immunosuppressive agent used to manage other rheumatic diseases has proved useful in treating GCA. Vision loss, the most feared complication of GCA, can be prevented with early diagnosis and prompt treatment. PMR, a syndrome of muscle pain and stiffness in the neck, shoulders, and hips, can accompany, precede, or follow GCA, but it may also occur independently. The disease appears more frequently in women than in men and is more prevalent in Scandinavians and people of northern European descent. The cause of PMR is unknown. Most pathogenic abnormalities in people who have PMR are similar to those of GCA, supporting the emerging concept that PMR is a GCA variant characterized by dominance of the systemic inflammatory syndrome over the vascular component. The onset of PMR is abrupt and the myalgias are symmetrical and initially affect the shoulders. Malaise, weight loss, sweats, and low grade fever are common. The diagnosis of PMR is a clinical one. The differential diagnosis includes arthropathies, shoulder disorders, inflammatory myopathies, hypothyroidism, Parkinson's disease, malignancies, and infections. Although PMR is responsive to corticosteroid therapy, a critical issue in treating the disease is the dosage required for successful suppression of symptoms because the steroid requirements may differ markedly among patients. PMR is self limiting in most patients. TA is a rare granulomatous polyarteritis of the large elastic arteries, but it also may affect the coronary and pulmonary arteries. The disease affects primarily adolescent girls and young women. Incidence rates are highest in Asia. Although the etiology of TA is unknown, microbial infections have been implicated; however, no conclusive evidence for infectious organisms has been found. Clinical manifestations include fever, night sweats, malaise, anorexia, weight loss, diffuse myalgias, neurologic and ophthalmologic symptoms, and cardiac disease. Diagnosis is made by characteristic findings on vascular imaging. Corticosteroids are the therapy of choice for TA. Early diagnosis, immunosuppression, and aggressive surgical management have led to improved prognosis. 4 figures and 21 references.

Books

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Pains of Muscular Origin Source: in Okeson, J.P. Bell's Orofacial Pains. 5th ed. Carol Stream, IL: Quintessence Publishing Company, Inc. 1995. p. 259-294. 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 pains, discusses pains of muscular origin. After an introductory section describing the anatomy of the muscles and how it can contribute to pain, the author discusses the behavior of muscular pain; the five types of masticatory muscle pain, i.e., protective co-contraction, delayed onset muscle soreness, myofascial pain, myospasm, and myositis; referral patterns of myofascial pain in the orofacial region; tension-type headache; acute versus chronic muscle disorders; perpetuating factors for the progression of acute pain to a chronic pain disorder; muscular toothache; referred pain mistaken for masticatory pain; differentiating various masticatory muscle points; and differential diagnosis; and treatment options. The author presents four detailed case studies. 11 figures. 76 references.

•

Chronic Tinnitus Following Electroconvulsive Therapy Source: in Hazell, J., ed. Proceedings of the Sixth International Tinnitus Seminar. London, England: Tinnitus and Hyperacusis Centre. 1999. p. 243-245. Contact: Available from Tinnitus and Hyperacusis Centre. 32 Devonshire Place, London, W1N 1PE, United Kingdom. Fax 44 + (0) 207 486 2218. E-mail: [email protected]. Website: www.tinnitus.org. PRICE: Contact publisher for price. ISBN: 0953695700. Also available on CD-ROM. Summary: Tinnitus can be caused by almost any pathology involving the auditory system and can also result from head trauma, a variety of medications, and electrical shock, including lightning strikes. This article is from a lengthy document that reprints the proceedings of the Sixth International Tinnitus Seminar, held in Cambridge, United Kingdom, in September 1999 and hosted by the British Society of Audiology. In this article, the authors report a case study of chronic tinnitus that began immediately following electroconvulsive therapy (ECT). A 43 year old female with a 27 year history of obsessive compulsive disorder and major depression had previously been treated with psychotherapy, antidepressant and antipsychotic medications. Because these treatments were minimally effective and because the frequency and duration of her depressive episodes continued to increase, the patient was scheduled to undergo a series of ECT procedures. The patient received four ECT treatments during one week. Stimulating current was delivered through a unilateral electrode to the right frontotemporal region of the head. EEG seizures occurred during each of the ECT procedures. After the patient recovered from anesthesia, she complained of headaches, muscle pain, amnesia, and, after the fourth ECT, she reported a ringing sound in her right ear. Audiometric testing the day after the fourth ECT revealed a slight increase in threshold for 8000 Hz tones in her right ear. The authors conclude that it is likely that current delivered during the fourth ECT treatment triggered the perception of tinnitus for this patient. The unique organization of this patient's central nervous and auditory systems combined with her particular pharmacological history might have predisposed her to developing this symptom.

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CHAPTER 5. PERIODICALS AND NEWS ON MUSCLE PAIN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover muscle pain.

News Services and Press Releases One of the simplest ways of tracking press releases on muscle 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 “muscle 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 muscle 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 “muscle pain” (or synonyms). The following was recently listed in this archive for muscle pain: •

Working teens likely to feel joint, muscle pain Source: Reuters Health eLine Date: December 06, 2000

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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 “muscle 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 “muscle pain” (or synonyms). If you know the name of a company that is relevant to muscle 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 “muscle pain” (or synonyms).

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

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71

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 “muscle 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 muscle pain: •

Referred Pain and Hyperalgesia Related to Muscle and Visceral Pain Source: Lifeline: The Newsletter of the National Chronic Pain Outreach Association. p. 10-13. Summer 1999. Contact: Available from National Chronic Pain Outreach Association. P.O. Box 274, Millboro, VA 24460. (540) 862-9437. Fax (540) 862-9485. E-mail: [email protected]. Summary: This newsletter article for health professionals and people who have chronic pain reviews current knowledge of referred pain and hyperalgesia from muscle and visceral pain. Hyperplasia from deep tissue can be detected as increased pain responses to normally nonpainful stimuli or increased pain to normally painful stimuli. Research on muscle pain indicates that at least two mechanisms may be operating during local and referred muscle pain. Central hyperexcitability is one mechanism that may be involved in the generation of referred pain. This mechanism generates referred pain and increased modality specific responses. In another mechanism, descending or segmental inhibition modulates the sensory neurons in the dorsal horn. These mechanisms may be competitive, resulting in the complex sensory findings involved in muscle pain. The extent of referred pain is related to the degree and duration of continuing pain and the degree of central hyperexcitability. Temporal summation may be strongly facilitated by hyperexcitability. Some aspects of the pain associated with inflammatory and functional disorders of the gut may be explained by sensitization of visceral afferents, recruitment of silent nociceptors, central summation of noxious input, and central hyperexcitability. These mechanisms are usually reversible. 1 figure and 35 references.

•

Ehlers-Danlos Syndrome and Water Resistance Exercise Source: Loose Connections. XIV(2): 10. May 1999. Contact: Available from Ehlers-Danlos National Foundation. 6399 Wilshire Boulevard, Suite 510, Los Angeles, CA 90048. (323) 651-3038. Website: www.ednf.org. Summary: This newsletter article provides health professionals and people who have Ehlers-Danlos syndrome with information on the benefits of water resistance exercise. Although water exercise cannot decrease the effects of problems related to the skin, it can provide increased strength and joint stability, decreased joint and muscle pain, improved circulation, and enhanced well being. Water exercises can be adapted to the principles of progressive resistive exercise. When a patient is first introduced to water exercise, the first level of movement is to use the water only as resistance. The article describes the three levels of resistance and explains how speed and surface area will increase using these levels of resistance. In addition, the article identifies conditions that contraindicate a water exercise program.

•

Headaches After Acoustic Neuroma Surgery Source: ANA Notes. Number 75: 1, 8-10. March 2001. Contact: Available from Acoustic Neuroma Association (ANA). 600 Peachtree Parkway, Suite 108, Cumming, GA 30041-8211. (770) 205-8211. Fax (770 www.ANAUSA.org.

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Summary: This newsletter article reports on the incidence of headaches after acoustic neuroma surgery. The author notes that although headaches as a symptom prior to treatment are relatively uncommon for vestibular schwannoma, they occur with surprising frequency after treatment and can have a profound impact upon quality of life in acoustic neuroma patients. The pain often persists for prolonged periods of time and does not always respond well to a number of medical and surgical treatments directed at the headache. The author discusses the frequency of headache following neuroma surgery, the nature of the headache, their causes, and current therapies. Causes of the headaches can include the surgical approach (craniectomy versus craniotomy), aspetic meningitis, muscle pain, nerve entrapment, and low cerebrospinal fluid pressure. The best treatment is prevention, since these headaches have proven to be difficult to treat once they occur. The author also discusses the use of cranioplasty, medication, local therapy to neck muscles, nerve block or section, stress reduction and antidepressants, and care from a multidisciplinary pain center. The author notes that most surgeons are aware of the need to prevent these headaches and take measures to minimize muscle incisions, to replace skull bone whenever possible, and to limit the distribution of bone dust within the operative field.

Academic Periodicals covering Muscle Pain Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to muscle pain. In addition to these sources, you can search for articles covering muscle 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 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 6. 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 muscle 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 nonprofit 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 muscle 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 muscle pain: Gemcitabine •

Systemic - U.S. Brands: Gemzar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203038.html

Lyme Disease Vaccine •

Systemic - U.S. Brands: LYMErix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203759.html

Orphenadrine and Aspirin •

Systemic - U.S. Brands: Norgesic; Norphadrine; Orphenagesic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202427.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.

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 Institute7: •

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

•

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

•

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

•

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

•

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/

7

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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.8 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:9 •

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

•

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

•

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/

•

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

•

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

8

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). 9 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 Gateway10 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.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “muscle 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 17002 119 990 44 1724 19879

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 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.14 Simply search by “muscle pain” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

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

11

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). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

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 Biologists15 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.16 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.17 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/.

15 Adapted 16

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. 17 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 muscle 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 muscle 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 muscle 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 “muscle pain”:

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Muscle Disorders http://www.nlm.nih.gov/medlineplus/muscledisorders.html Neck Disorders and Injuries http://www.nlm.nih.gov/medlineplus/neckdisordersandinjuries.html Sprains and Strains http://www.nlm.nih.gov/medlineplus/sprainsandstrains.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 muscle 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: •

Joint and Muscle Pain in Systemic Lupus Erythematosus (SLE) Source: Washington, DC: Lupus Foundation of America. 2003. 6 p. Contact: Available from Lupus Foundation of America. 2000 L. St., Suite 710, Washington, DC 20036-4916. (202) 349-1155 or (800) 558-0121. (800) 558-0231 (information in Spanish). Fax: (202) 349-1156. Website: www.lupus.org. Summary: This brochure provides information about joint and muscle pain to patients with systemic lupus erythematosus (SLE). More than 90 percent of patients with SLE will experience joint and/or muscle pain during the course of their illness. The main cause of joint pain is inflammation, which results in pain, swelling, tenderness, warmth, and fluid collection in the joint. Pain in or around the joints may also be due to other medical disorders, including fibromyalgia, avascular necrosis, tendinitis and bursitis, and other types of arthritis. Myositis (inflammation of skeletal muscle) may develop in patients with SLE. Symptoms of lupus myositis include muscle pain in the neck, pelvic girdle and thighs, shoulder girdle, and upper arms, and weakness. Diagnosis is confirmed by certain enzymes in the blood and abnormalities in the electromyogram test (a test which measures the electrical activity of muscle fibers). Corticosteroids are used to treat lupus myositis. Immunosuppressive drugs are prescribed for patients who do not respond to prednisone. Exercise may also help patients to regain muscle strength and function. Physicians should rule out drug-induced muscle disease (a possible sideeffect of medications such as prednsone and other corticosteroids) as a cause of weakness in patients with SLE.

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The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “muscle pain” (or synonyms). The following was recently posted: •

1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infar Source: American College of Cardiology Foundation - Medical Specialty Society; 1996 November 1 (revised 1999 Sep); 22 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2006&nbr=1232&a mp;string=muscle+AND+pain

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2002 national guideline on the management of sexually acquired reactive arthritis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3045&nbr=2271&a mp;string=muscle+AND+pain

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AACE medical guidelines for clinical practice for management of menopause Source: American Association of Clinical Endocrinologists - Medical Specialty Society; 1999 Nov-December; 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2138&nbr=1364&a mp;string=muscle+AND+pain

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AACE medical guidelines for clinical practice for the diagnosis and treatment of dyslipidemia and prevention of atherogenesis Source: American Association of Clinical Endocrinologists - Medical Specialty Society; 2000 Mar-April; 52 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2199&nbr=1425&a mp;string=muscle+AND+pain

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AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma Source: American Association of Clinical Endocrinologists - Medical Specialty Society; 1997 (updated 2001 May-Jun); 19 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2848&nbr=2074&a mp;string=muscle+AND+pain

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AAOS clinical guideline on osteoarthritis of the knee Source: American Academy of Orthopaedic Surgeons - Medical Specialty Society; 1996 (revised 2003); 17 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3856&nbr=3069&a mp;string=muscle+AND+pain

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AAOS clinical guideline on shoulder pain Source: American Academy of Orthopaedic Surgeons - Medical Specialty Society; 2001; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2998&nbr=2224&a mp;string=muscle+AND+pain

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ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Source: American College of Cardiology Foundation - Medical Specialty Society; 2000 (revised online 2002 Mar); 95 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3190&nbr=2416&a mp;string=muscle+AND+pain

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ACR Appropriateness Criteriatm for chronic elbow pain Source: American College of Radiology - Medical Specialty Society; 1998 (revised 2001); 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3260&nbr=2486&a mp;string=muscle+AND+pain

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ACR Appropriateness Criteriatm for orbits, vision and visual loss Source: American College of Radiology - Medical Specialty Society; 1999; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2450&nbr=1676&a mp;string=muscle+AND+pain

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ACR Appropriateness Criteriatm for suspected cervical spine trauma Source: American College of Radiology - Medical Specialty Society; 1995 (revised 2002); 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3564&nbr=2790&a mp;string=muscle+AND+pain

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Acute low back pain Source: University of Michigan Health System - Academic Institution; 1997 (revised 2003 Apr); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4112&nbr=3157&a mp;string=muscle+AND+pain

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Acute pain management Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1997 (revised 1999 April 6); 38 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1888&nbr=1114&a mp;string=muscle+AND+pain

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Adult low back pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1994 June (revised 2002 Sep); 61 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3498&nbr=2724&a mp;string=muscle+AND+pain

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American Gastroenterological Association medical position statement on anorectal testing techniques Source: American Gastroenterological Association - Medical Specialty Society; 1998 July 24 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3066&nbr=2292&a mp;string=muscle+AND+pain

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American Gastroenterological Association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3064&nbr=2290&a mp;string=muscle+AND+pain

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American Gastroenterological Association medical position statement: celiac sprue Source: American Gastroenterological Association - Medical Specialty Society; 2000 November 12 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3058&nbr=2284&a mp;string=muscle+AND+pain

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American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure Source: American Gastroenterological Association - Medical Specialty Society; 2003 January; 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3684&nbr=2910&a mp;string=muscle+AND+pain

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American Gastroenterological Association medical position statement: guidelines on constipation Source: American Gastroenterological Association - Medical Specialty Society; 2000 May 21 (reviewed 2001); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3061&nbr=2287&a mp;string=muscle+AND+pain

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Angina pectoris and coronary artery disease (CAD) Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2003 October 5); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=4372&nbr=3294&a mp;string=muscle+AND+pain

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Ankle sprain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 August (revised 2002 Mar); 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3356&nbr=2582&a mp;string=muscle+AND+pain

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ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery Source: American Society of Health-System Pharmacists - Professional Association; 1999; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1875&nbr=1101&a mp;string=muscle+AND+pain

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Assessment and management of acute pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 2000 October (revised 2002 Oct); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3500&nbr=2726&a mp;string=muscle+AND+pain

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Attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2001 June; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2917&nbr=2143&a mp;string=muscle+AND+pain

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Benign prostatic hyperplasia Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2002 March 22); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3811&nbr=3037&a mp;string=muscle+AND+pain

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Bland aerosol administration: 2003 revision and update Source: American Association for Respiratory Care - Professional Association; 1993 December (revised 2003); 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3752&nbr=2978&a mp;string=muscle+AND+pain

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Cancer pain Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2003 March; 88 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3748&nbr=2974&a mp;string=muscle+AND+pain

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Cardiovascular disease in women: a guide to risk factor screening, prevention and management Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2002; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3487&nbr=2713&a mp;string=muscle+AND+pain

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Carpal tunnel syndrome Source: Work Loss Data Institute - Public For Profit Organization; 2003; 99 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3799&nbr=3025&a mp;string=muscle+AND+pain

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Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=muscle+AND+pain

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Clinical practice guideline (second edition) for the diagnosis, treatment, and management of reflex sympathetic dystrophy/complex regional pain syndrome (RSD/CRPS) Source: Reflex Sympathetic Dystrophy Syndrome Association - Private Nonprofit Organization; 2002 February; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3204&nbr=2430&a mp;string=muscle+AND+pain

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Clinical practice guideline for post-deployment health evaluation and management Source: Department of Defense - Federal Government Agency [U.S.]; 2000 September (revised 2001 Dec); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3223&nbr=2449&a mp;string=muscle+AND+pain

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Clinical practice guideline for the management of postoperative pain Source: Department of Defense - Federal Government Agency [U.S.]; 2001 July (revised 2002 May); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3284&nbr=2510&a mp;string=muscle+AND+pain

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Clinical practice guidelines for chronic non-malignant pain syndrome patients II: An evidence-based approach Source: Siskin Hospital for Physical Rehabilitation Hospital/Medical Center; 1995 (updated 1999); 12 pages

(Chattanooga,

TN)

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http://www.guideline.gov/summary/summary.aspx?doc_id=2812&nbr=2038&a mp;string=muscle+AND+pain •

Clinical utility of surface EMG: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Source: American Academy of Neurology - Medical Specialty Society; 2000 July; 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2828&nbr=2054&a mp;string=muscle+AND+pain

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Common gynecologic problems: a guide to diagnosis and treatment Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2002; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3486&nbr=2712&a mp;string=muscle+AND+pain

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Criteria for shoulder surgery Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999 (revised 2002); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3424&nbr=2650&a mp;string=muscle+AND+pain

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Deep venous thrombosis Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2002 Apr 20); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3384&nbr=2610&a mp;string=muscle+AND+pain

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Diabetic foot disorders: a clinical practice guideline. Source: American College of Foot and Ankle Orthopedics and Medicine - Professional Association; 2000 September; 60 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2892&nbr=2118&a mp;string=muscle+AND+pain

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Diagnosis and management of foodborne illnesses: a primer for physicians Source: American Medical Association - Medical Specialty Society; Reprint released 2001 January; 88 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2707&nbr=1933&a mp;string=muscle+AND+pain

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Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 June (revised 2002 May); 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3355&nbr=2581&a mp;string=muscle+AND+pain

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Diagnosis of chest pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1995 July (revised 2002 Oct); 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3674&nbr=2900&a mp;string=muscle+AND+pain

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Disorders of the ankle and foot Source: Work Loss Data Institute - Public For Profit Organization; 2003; 76 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3798&nbr=3024&a mp;string=muscle+AND+pain

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Disorders of the elbow Source: Work Loss Data Institute - Public For Profit Organization; 2003; 78 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3800&nbr=3026&a mp;string=muscle+AND+pain

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Disorders of the neck and upper back Source: Work Loss Data Institute - Public For Profit Organization; 2003; 109 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3803&nbr=3030&a mp;string=muscle+AND+pain

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Evidence based clinical practice guideline for children with hypertrophic pyloric stenosis Source: Cincinnati Children's Hospital Medical Center - Hospital/Medical Center; 2001 August 8; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3119&nbr=2345&a mp;string=muscle+AND+pain

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Evidence based clinical practice guideline for managing an acute exacerbation of asthma Source: Cincinnati Children's Hospital Medical Center - Hospital/Medical Center; 1998 July 20 (revised 2002 September 3); 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3444&nbr=2670&a mp;string=muscle+AND+pain

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Evidence-based protocol. Exercise promotion: walking in elders Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2001 February; 53 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3074&nbr=2300&a mp;string=muscle+AND+pain

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Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations Source: American Geriatrics Society - Medical Specialty Society; 2001 June; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3188&nbr=2414&a mp;string=muscle+AND+pain

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Fibromyalgia Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1906&nbr=1132&a mp;string=muscle+AND+pain

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General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) Source: American Academy of Family Physicians - Medical Specialty Society; 2002 February 8; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3180&nbr=2406&a mp;string=muscle+AND+pain

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Global initiative for asthma. Global strategy for asthma management and prevention Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 1995 January (revised 2002); 176 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3203&nbr=2429&a mp;string=muscle+AND+pain

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Herniated disc. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 104 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2803&nbr=2029&a mp;string=muscle+AND+pain

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Hyperglycemic crises in patients with diabetes mellitus Source: American Diabetes Association - Professional Association; 2000 October (revised 2001; republished 2003 Jan); 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3582&nbr=2808&a mp;string=muscle+AND+pain

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Infant and family-centered developmental care Source: National Association of Neonatal Nurses - Professional Association; 1993 (revised 2000); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2193&nbr=1419&a mp;string=muscle+AND+pain

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Ingrown toenails Source: Academy of Ambulatory Foot and Ankle Surgery - Medical Specialty Society; 2000 (revised 2003 Sep); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4241&nbr=3241&a mp;string=muscle+AND+pain

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Intermittent positive pressure breathing: 2003 revision and update Source: American Association for Respiratory Care - Professional Association; 1993 December (revised 2003); 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3753&nbr=2979&a mp;string=muscle+AND+pain

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Low back Source: Work Loss Data Institute - Public For Profit Organization; 2003; 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3802&nbr=3029&a mp;string=muscle+AND+pain

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Low back pain or sciatica in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2578&nbr=1804&a mp;string=muscle+AND+pain

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Lung cancer. Palliative care Source: American College of Chest Physicians - Medical Specialty Society; 2003 January; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3653&nbr=2879&a mp;string=muscle+AND+pain

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Management of chronic kidney disease and pre-ESRD in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 2000 November; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3099&nbr=2325&a mp;string=muscle+AND+pain

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Management of patients with stroke. Rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1998 April (revised 2002 Nov); 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3538&nbr=2764&a mp;string=muscle+AND+pain

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Management of postmenopausal osteoporosis: position statement of The North American Menopause Society Source: The North American Menopause Society - Private Nonprofit Organization; 2002 March; 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3179&nbr=2405&a mp;string=muscle+AND+pain

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Management of type 2 diabetes mellitus Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 March (revised 2002 Sep); 77 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3499&nbr=2725&a mp;string=muscle+AND+pain

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Management of unerupted and impacted third molar teeth. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 March; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2305&nbr=1531&a mp;string=muscle+AND+pain

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Migraine headache Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1998 November (revised 2002 Jul); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3441&nbr=2667&a mp;string=muscle+AND+pain

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Myocardial infarction Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30 (revised 2003 July 11); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=4373&nbr=3295&a mp;string=muscle+AND+pain

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North American Spine Society Phase III: clinical guidelines for multidisciplinary spine care specialists. Spinal stenosis version 1.0. Source: North American Spine Society - Medical Specialty Society; 2002; 91 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3609&nbr=2835&a mp;string=muscle+AND+pain

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Oral hygiene care for functionally dependent and cognitively impaired older adults Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2002 November; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3611&nbr=2837&a mp;string=muscle+AND+pain

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Overview of implementation of outcome assessment case management in the clinical practice Source: Washington State Chiropractic Association - Professional Association; 2001; 54 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2786&nbr=2012&a mp;string=muscle+AND+pain

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Pain Source: Work Loss Data Institute - Public For Profit Organization; 2003; 65 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3804&nbr=3031&a mp;string=muscle+AND+pain

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Pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis Source: American Pain Society - Professional Association; 2002; 179 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3691&nbr=2917&a mp;string=muscle+AND+pain

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Physical activity in the prevention, treatment and rehabilitation of diseases Source: Finnish Medical Society Duodecim - Professional Association; 2002 May 7; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3398&nbr=2624&a mp;string=muscle+AND+pain

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Practice guidelines for obstetrical anesthesia Source: American Society of Anesthesiologists - Medical Specialty Society; 1999; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1853&nbr=1079&a mp;string=muscle+AND+pain

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Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force Source: American Academy of Neurology - Medical Specialty Society; 1999 April; 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2819&nbr=2045&a mp;string=muscle+AND+pain

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Pressure ulcers Source: American Medical Directors Association - Professional Association; 1996 (reviewed January 2001, 2002, and 2003); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1811&nbr=1037&a mp;string=muscle+AND+pain

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Prevention of pressure ulcers Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1997 (revised 2002 May); 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3458&nbr=2684&a mp;string=muscle+AND+pain

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Prevention of thromboembolism in spinal cord injury Source: Consortium for Spinal Cord Medicine - Private Nonprofit Organization; 1997 February (updated 1999 Sep); 29 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2965&nbr=2191&a mp;string=muscle+AND+pain

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Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update Source: American College of Rheumatology - Medical Specialty Society; 2000 September; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2935&nbr=2161&a mp;string=muscle+AND+pain

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Recommendations regarding selected conditions affecting women's health Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2000 March 31 http://www.guideline.gov/summary/summary.aspx?doc_id=2277&nbr=1503&a mp;string=muscle+AND+pain

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Reflex sympathetic dystrophy/complex regional pain syndrome clinical practice guidelines - third edition Source: International Research Foundation for RSD/CRPS - Private Nonprofit Research Organization; 2003 January 1; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4117&nbr=3162&a mp;string=muscle+AND+pain

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Specialty referral guidelines for cardiovascular evaluation and management Source: American Healthways, Inc - Public For Profit Organization; 2002; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3168&nbr=2394&a mp;string=muscle+AND+pain

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Spondylolysis, lytic spondylolisthesis and degenerative spondylolisthesis (SLD). In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 106 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2804&nbr=2030&a mp;string=muscle+AND+pain

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Surgical management of hemorrhoids Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2171&nbr=1397&a mp;string=muscle+AND+pain

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The management of diabetes mellitus in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 December; 147 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2583&nbr=1809&a mp;string=muscle+AND+pain

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The management of persistent pain in older persons Source: American Geriatrics Society - Medical Specialty Society; 1998 October (revised 2002 Jun); 20 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3365&nbr=2591&a mp;string=muscle+AND+pain

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Treatment for stimulant use disorders Source: Substance Abuse and Mental Health Services Administration (U.S.) - Federal Government Agency [U.S.]; 1999; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2540&nbr=1766&a mp;string=muscle+AND+pain

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Treatment of acute myocardial infarction Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 May (revised 2002 Nov); 68 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3659&nbr=2885&a mp;string=muscle+AND+pain

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Treatment of pressure ulcers Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1997 (revised 2002 Aug); 30 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3457&nbr=2683&a mp;string=muscle+AND+pain

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Ultrasonographic examinations: indications and preparation of the patient Source: Finnish Medical Society Duodecim - Professional Association; 2000 April 18 (revised 2001 October 24); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3385&nbr=2611&a mp;string=muscle+AND+pain

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Unremitting low back pain. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 96 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2805&nbr=2031&a mp;string=muscle+AND+pain

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Vaccine preventable STDs. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3242&nbr=2468&a mp;string=muscle+AND+pain

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VHA/DOD clinical practice guideline for the management of chronic obstructive pulmonary disease. Source: Department of Defense - Federal Government Agency [U.S.]; 1999 August; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2584&nbr=1810&a mp;string=muscle+AND+pain

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VHA/DoD clinical practice guideline for the management of medically unexplained symptoms: chronic pain and fatigue Source: Department of Defense - Federal Government Agency [U.S.]; 2002 August; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3415&nbr=2641&a mp;string=muscle+AND+pain

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VHA/DoD clinical practice guideline for the management of substance use disorders Source: Department of Defense - Federal Government Agency [U.S.]; 2001 September; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3169&nbr=2395&a mp;string=muscle+AND+pain Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Polymyalgia Rheumatica--NLM Summary: Polymyalgia rheumatica is a rheumatic disorder that is associated with moderate to severe muscle pain and stiffness in the neck, shoulder, and hip area. Stiffness is most noticeable in the morning. Source: National Library of Medicine, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6981

•

Questions and Answers about Polymyalgia Rheumatica and Giant Cell Arteritis Summary: Polymyalgia rheumatica is a rheumatic disorder that is associated with moderate to severe muscle pain and stiffness in the neck, shoulder, and hip area. Stiffness is most noticeable in the morning. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6729

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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 ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to muscle 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

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

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

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

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

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

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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 muscle pain. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with muscle 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 muscle 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

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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. 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 “muscle 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 “muscle 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 “muscle 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 “muscle 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.18

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

18

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)19: •

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

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

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

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

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

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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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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

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

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

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

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

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

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

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

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

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

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

19

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

Finding Medical Libraries 105

•

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

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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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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

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

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

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

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

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

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

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

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

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

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

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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

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

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

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

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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/

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

Finding Medical Libraries 107

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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

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

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

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

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

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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/

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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

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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).

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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MUSCLE 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] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] 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] 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] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [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] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Antagonists: Drugs that bind to but do not activate adrenergic receptors. Adrenergic antagonists block the actions of the endogenous adrenergic transmitters epinephrine and norepinephrine. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is 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]

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Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Affective Symptoms: Mood or emotional responses dissonant with or inappropriate to the behavior and/or stimulus. [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] Agonists: Drugs that trigger an action from a cell or another drug. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alfentanil: A short-acting opioid anesthetic and analgesic derivative of fentanyl. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] 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] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [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] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments.

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Alternative 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] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] 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] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnesia: Lack or loss of memory; inability to remember past experiences. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] 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] 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] Angina: Chest pain that originates in the heart. [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] Ankylosis: Fixation and immobility of a joint. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory

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and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [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] Antibodies, Anticardiolipin: Antiphospholipid antibodies found in association with systemic lupus erythematosus (lupus erythematosus, systemic), antiphospholipid syndrome, and in a variety of other diseases as well as in healthy individuals. The antibodies are detected by solid-phase immunoassay employing the purified phospholipid antigen cardiolipin. [NIH] Antibodies, Antiphospholipid: Autoantibodies directed against phospholipids. These antibodies are characteristically found in patients with systemic lupus erythematosus, antiphospholipid syndrome, related autoimmune diseases, some non-autoimmune diseases, and also in healthy individuals. [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] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [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] 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] Antiphospholipid Syndrome: The presence of antibodies directed against phospholipids (antibodies, antiphospholipid). The condition is associated with a variety of diseases, notably systemic lupus erythematosus and other connective tissue diseases, thrombopenia,

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and arterial or venous thromboses. In pregnancy it can cause abortion. Of the phospholipids, the cardiolipins show markedly elevated levels of anticardiolipin antibodies (antibodies, anticardiolipin). Present also are high levels of lupus anticoagulant (lupus coagulation inhibitor). [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [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] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Aqueous: Having to do with water. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteritis: Inflammation of an artery. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] 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] Auditory: Pertaining to the sense of hearing. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH]

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Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [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] 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] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [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] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [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] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [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] Bladder: The organ that stores urine. [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

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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] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [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] 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] 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 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] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [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] Bupivacaine: A widely used local anesthetic agent. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases,

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antagonism of adenosine receptors, and modulation of intracellular calcium handling. [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 channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [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] Cardiac Glycosides: Substances obtained from species of Digitalis, Strophanthus, and other plants that contain specific steroid glycosides or their semisynthetic derivatives and used in congestive heart failure. They increase the force of cardiac contraction without significantly affecting other parameters, but are very toxic at larger doses. Their mechanism of action usually involves inhibition of the Na(+)-K(+)-exchanging ATPase and they are often used in cell biological studies for that purpose. [NIH] Cardiolipins: Acidic phospholipids composed of two molecules of phosphatidic acid covalently linked to a molecule of glycerol. They occur primarily in mitochondrial inner membranes and in bacterial plasma membranes. They are the main antigenic components of the Wassermann-type antigen that is used in nontreponemal syphilis serodiagnosis. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiotoxic: Having a poisonous or deleterious effect upon the heart. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate

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gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [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] Castor Oil: Oil obtained from seeds of Ricinus communis that is used as a cathartic and as a plasticizer. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] 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] 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] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [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] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrospinal Fluid Pressure: Manometric pressure of the cerebrospinal fluid as measured by lumbar, cerebroventricular, or cisternal puncture. Within the cranial cavity it is called intracranial pressure. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also

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controls speech, emotions, reading, writing, and learning. [NIH] 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] 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] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [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] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of prolonged fatigue. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [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] 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]

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Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] 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] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [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] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [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] 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,

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megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [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] Concomitant: Accompanying; accessory; joined with another. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] 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] Connective Tissue Diseases: A heterogeneous group of disorders, some hereditary, others acquired, characterized by abnormal structure or function of one or more of the elements of connective tissue, i.e., collagen, elastin, or the mucopolysaccharides. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [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] Contralateral: Having to do with the opposite side of the body. [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] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [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 Thrombosis: Presence of a thrombus in a coronary artery, often causing a

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myocardial infarction. [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 whether there is an associated hemorrhage. [NIH] Craniotomy: An operation in which an opening is made in the skull. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [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] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU]

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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] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [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 antiinflammatory properties. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digitalis: A genus of toxic herbaceous Eurasian plants of the Scrophulaceae which yield cardiotonic glycosides. The most useful are Digitalis lanata and D. purpurea. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [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] 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] Diuresis: Increased excretion of urine. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [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

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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] 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] Duct: A tube through which body fluids pass. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dynamometer: An instrument for measuring the force of muscular contraction. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Electroconvulsive Therapy: Electrically induced convulsions primarily used in the

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treatment of severe affective disorders and schizophrenia. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Enflurane: An extremely stable inhalation anesthetic that allows rapid adjustments of anesthesia depth with little change in pulse or respiratory rate. [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] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Ergometer: An instrument for measuring the force of muscular contraction. [NIH] Ergometry: Any method of measuring the amount of work done by an organism, usually during exertion. Ergometry also includes measures of power. Some instruments used in these determinations include the hand crank and the bicycle ergometer. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

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Estrogen: One of the two female sex hormones. [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] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exercise Tolerance: The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an exercise test. [NIH]

Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] 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] Extrapyramidal: Outside of the pyramidal tracts. [EU] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [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]

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] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibrositis: Aching, soreness or stiffness of muscles; often caused by inexpedient work postures. [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]

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Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Flexor: Muscles which flex a joint. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Foodborne Illness: An acute gastrointestinal infection caused by food that contains harmful bacteria. Symptoms include diarrhea, abdominal pain, fever, and chills. Also called food poisoning. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Frostbite: Damage to tissues as the result of low environmental temperatures. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [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] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid.

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[NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [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]

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] Gliosis: The production of a dense fibrous network of neuroglia; includes astrocytosis, which is a proliferation of astrocytes in the area of a degenerative lesion. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

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] 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] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [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] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH]

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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] Granisetron: A serotonin receptor (5HT-3 selective) antagonist that has been used as an antiemetic for cancer chemotherapy patients. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Habituation: Decline in response of an organism to environmental or other stimuli with repeated or maintained exposure. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [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] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [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 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] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [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]

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Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [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] 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] Host: Any animal that receives a transplanted graft. [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] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] 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] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersecretion: Excessive secretion. [EU] 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] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypodermic: Applied or administered beneath the skin. [EU]

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Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypoxanthine: A purine and a reaction intermediate in the metabolism of adenosine and in the formation of nucleic acids by the salvage pathway. [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] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [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] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [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] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence)

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or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an 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]

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] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [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] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [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] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intermittent Claudication: A symptom complex characterized by leg pain and weakness brought on by walking, with the disappearance of the symptoms following a brief rest. [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,

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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] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [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] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [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] Ipsilateral: Having to do with the same side of the body. [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] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [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] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an

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osseous and a membranous portion. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] 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] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [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] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Local therapy: Treatment that affects cells in the tumor and the area close to it. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [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] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] 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

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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] 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]

Lymphadenitis: Inflammation of the lymph nodes. [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] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Manic: Affected with mania. [EU] Masseter Muscle: A masticatory muscle whose action is closing the jaws. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Masticatory: 1. subserving or pertaining to mastication; affecting the muscles of mastication. 2. a remedy to be chewed but not swallowed. [EU] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] 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] 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

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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] Membrane: A very thin layer of tissue that covers a surface. [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] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [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] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] 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] 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] 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

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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] 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] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [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 relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH]

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Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myalgia: Pain in a muscle or muscles. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelitis: Inflammation of the spinal cord. Relatively common etiologies include infections; autoimmune diseases; spinal cord; and ischemia (see also spinal cord vascular diseases). Clinical features generally include weakness, sensory loss, localized pain, incontinence, and other signs of autonomic dysfunction. [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] Myofascial Pain Syndromes: Muscular pain in numerous body regions that can be reproduced by pressure on trigger points, localized hardenings in skeletal muscle tissue. Pain is referred to a location distant from the trigger points. A prime example is the temporomandibular joint dysfunction syndrome. [NIH] Myopathy: Any disease of a muscle. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myositis: Inflammation of a voluntary muscle. [EU] 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] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasociliary: A branch of the ophthalmic nerve which receives most of the fibers of general sensation from the eyeball. [NIH] 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] Neck Muscles: The neck muscles consist of the platysma, splenius cervicis, sternocleidomastoid(eus), longus colli, the anterior, medius, and posterior scalenes, digastric(us), stylohyoid(eus), mylohyoid(eus), geniohyoid(eus), sternohyoid(eus), omohyoid(eus), sternothyroid(eus), and thyrohyoid(eus). [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] Neoplasia: Abnormal and uncontrolled cell growth. [NIH]

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Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nephropathy: Disease of the kidneys. [EU] 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] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [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] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [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. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [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

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nuclei during their decay. [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] Nociceptors: Peripheral receptors for pain. Nociceptors include receptors which are sensitive to painful mechanical stimuli, extreme heat or cold, and chemical stimuli. All nociceptors are free nerve endings. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] 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] Orofacial: Of or relating to the mouth and face. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] 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] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU]

Osteoporosis: Reduction of bone mass without alteration in the composition of bone,

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leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [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] 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]

Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] 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] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [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 consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Palsies: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [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] Pancreatic: Having to do with the pancreas. [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]

Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] 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]

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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] 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 multiple sets of these or other symbols such as geometric figures. [NIH] Pericarditis: Inflammation of the pericardium. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [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 Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peroral: Performed through or administered through the mouth. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenoxybenzamine: An alpha-adrenergic anatagonist with long duration of action. It has been used to treat hypertension and as a peripheral vasodilator. [NIH] Phentolamine: A nonselective alpha-adrenergic antagonist. It is used in the treatment of hypertension and hypertensive emergencies, pheochromocytoma, vasospasm of Raynaud's disease and frostbite, clonidine withdrawal syndrome, impotence, and peripheral vascular disease. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other 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

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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] Phosphorylase: An enzyme of the transferase class that catalyzes the phosphorylysis of a terminal alpha-1,4-glycosidic bond at the non-reducing end of a glycogen molecule, releasing a glucose 1-phosphate residue. Phosphorylase should be qualified by the natural substance acted upon. EC 2.4.1.1. [NIH] Phosphorylase b: The relatively inactive form of phosphorylase that is reactivated to form phosphorylase A by phosphorylase kinase, which catalyzes the enzymatic phosphorylation of the serine residues at the expense of ATP. [NIH] Phosphorylase Kinase: An enzyme that catalyzes the conversion of ATP and phosphorylase b to ADP and phosphorylase a. EC 2.7.1.38. [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylates: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [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] Pilot study: The initial study examining a new method or treatment. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3-carboxamide 1,1dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [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] 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]

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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] Polymyalgia Rheumatica: A syndrome in the elderly characterized by proximal joint and muscle pain, high erythrocyte sedimentation rate, and a self-limiting course. Pain is usually accompanied by evidence of an inflammatory reaction. Women are affected twice as commonly as men and Caucasians more frequently than other groups. The condition is frequently associated with temporal arteritis and some theories pose the possibility that the two diseases arise from a single etiology or even that they are the same entity. [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] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [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] Postoperative: After surgery. [NIH] Postural: Pertaining to posture or position. [EU] 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] 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] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]

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Premenstrual: Occurring before menstruation. [EU] Preoperative: Preceding an operation. [EU] 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] 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] 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] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [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] 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] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] 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]

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Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [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] Protraction: A method of administration of radiation by delivering it continuously over a relatively long period at a low absorbed dose rate. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Ptosis: 1. Prolapse of an organ or part. 2. Drooping of the upper eyelid from paralysis of the third nerve or from sympathetic innervation. [EU] 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] 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]

Pyloric Stenosis: Obstruction of the pyloric canal. [NIH] Pyridostigmine Bromide: A cholinesterase inhibitor with a slightly longer duration of action than neostigmine. It is used in the treatment of myasthenia gravis and to reverse the actions

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of muscle relaxants. [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] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] 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] Radicular: Having the character of or relating to a radicle or root. [NIH] Radioactive: Giving off radiation. [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] 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] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [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] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH]

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Reductase: Enzyme converting testosterone to dihydrotestosterone. [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] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [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] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [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] 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] 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] Rod: A reception for vision, located in the retina. [NIH] S-1: A drug that is being studied for its ability to enhance the effectiveness of fluorouracil and prevent gastrointestinal side effects caused by fluorouracil. It belongs to the family of drugs called anitmetabolites. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each

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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] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [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] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [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] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU]

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Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [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] 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] 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 Bruxism: A sleep disorder characterized by grinding and clenching of the teeth and forceful lateral or protrusive jaw movements. Sleep bruxism may be associated with tooth injuries; temporomandibular joint disorders; sleep disturbances; and other conditions. [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 Security: Government sponsored social insurance programs. [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, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH]

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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] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [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] 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] Spheno: A branch of the nasociliary nerve that supplies the sphenoidal and ethmoidal sinuses and leaves. [NIH] Sphenoidal: Relating or belonging to the sphenoid bone. [NIH] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [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 Vascular Diseases: Hypoxic-ischemic and hemorrhagic disorders of the spinal cord. Arteriosclerosis, emboli, and vascular malformations are potential causes of these conditions. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] 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 ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Sprue: A non febrile tropical disease of uncertain origin. [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] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and

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instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [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] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

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] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [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] 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] 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] Succinylcholine: A quaternary skeletal muscle relaxant usually used in the form of its bromide, chloride, or iodide. It is a depolarizing relaxant, acting in about 30 seconds and with a duration of effect averaging three to five minutes. Succinylcholine is used in surgical, anesthetic, and other procedures in which a brief period of muscle relaxation is called for. [NIH]

Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [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] Synergist: A medicament which supplements the action of another. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syringomyelia: The presence in the spinal cord of elongated central fluid containing cavities surrounded by gliosis. [NIH] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease

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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] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] 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] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] 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] Tendonitis: Inflammation of tendons attached to the biceps muscle, i. e. the main flexor muscle of the upper arm. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [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] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombopenia: Reduction in the number of platelets in the blood. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth

Dictionary 155

of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [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] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [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] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Injuries: Traumatic or other damage to teeth including fractures (tooth fractures) or displacements (tooth luxation). [NIH] Toothache: Pain in the adjacent areas of the teeth. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [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] 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 organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU]

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Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [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] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [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] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] 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] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] 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] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness,

Dictionary 157

and mental confusion. [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] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [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] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality

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disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [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]

159

INDEX A Abdomen, 111, 117, 134, 135, 143, 153 Abdominal, 111, 128, 142 Abortion, 111, 115 Acceptor, 111, 135, 142 Acetylcholine, 111, 120, 140 Acoustic, 71, 72, 111, 157 Actin, 111, 138, 139 Action Potentials, 9, 111 Adenosine, 111, 118, 132, 144 Adenylate Cyclase, 15, 111 Adrenal Cortex, 111, 123, 146 Adrenergic, 5, 55, 60, 111, 115, 125, 126, 143 Adrenergic Antagonists, 5, 111 Adverse Effect, 16, 111, 143, 151 Aerobic, 26, 111, 127 Aerobic Exercise, 26, 111 Aerosol, 89, 112 Affective Symptoms, 5, 112 Afferent, 7, 112, 152 Affinity, 112, 151 Age of Onset, 112, 156 Agonists, 50, 112 Akathisia, 112, 115 Alertness, 112, 117 Alfentanil, 40, 112 Algorithms, 112, 116 Alkaline, 112, 113, 118 Alkaloid, 112, 118, 138 Allergen, 112, 150 Allylamine, 112, 113 Alpha Particles, 112, 148 Alpha-1, 112, 144 Alternative medicine, 70, 112 Amine, 56, 113, 131 Amino acid, 15, 16, 113, 114, 129, 131, 143, 146, 151, 156 Ammonia, 113 Amnesia, 67, 113 Anal, 88, 113, 128 Anal Fissure, 88, 113 Analgesic, 20, 57, 112, 113, 124, 132, 134, 138, 139, 141 Analog, 4, 113, 128 Anatomical, 113, 117, 120, 122, 132, 150 Androgens, 111, 113, 123 Anemia, 16, 113

Anesthesia, 31, 35, 67, 96, 113, 123, 126, 134, 146 Angina, 86, 88, 113 Anions, 113, 134 Ankle, 25, 88, 91, 93, 113 Ankle Joint, 25, 113 Ankylosis, 65, 113 Anomalies, 7, 113 Anorectal, 87, 113 Anorexia, 66, 113, 141 Antagonism, 114, 118 Antibacterial, 114, 152 Antibiotic, 114, 152 Antibodies, 114, 115, 132 Antibodies, Anticardiolipin, 114, 115 Antibodies, Antiphospholipid, 114 Antibody, 112, 114, 121, 131, 132, 133, 137, 138, 148, 150 Anticoagulant, 114, 115, 146 Anticonvulsant, 114, 143 Antidepressant, 67, 114 Antiemetic, 114, 115, 130 Antigen, 112, 114, 118, 121, 131, 132, 133, 136, 150 Anti-inflammatory, 56, 114, 115, 123, 124, 129, 132, 134, 139, 144, 145 Anti-Inflammatory Agents, 114, 115, 123 Antimicrobial, 59, 114 Antineoplastic, 114, 118, 123, 128, 142 Antiphospholipid Syndrome, 65, 114 Antipsychotic, 67, 115, 140 Antipyretic, 115, 124, 134, 139 Anus, 113, 115 Aponeurosis, 115, 128 Aqueous, 115, 116, 123, 131 Arrhythmia, 115, 157 Arterial, 14, 66, 112, 115, 131, 146, 154 Arteries, 14, 66, 115, 117, 119, 122, 135, 137, 139 Arteriolar, 115, 117 Arterioles, 115, 117, 118, 137 Arteriovenous, 115, 137 Arteritis, 33, 66, 100, 115, 145 Artery, 66, 88, 115, 119, 122, 126, 136, 147 Articular, 113, 115, 135, 141 Aspirin, 56, 74, 115 Assay, 8, 115 Asymptomatic, 3, 58, 115

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Auditory, 23, 67, 115, 136 Autoantibodies, 66, 114, 115, 116 Autoantigens, 115, 116 Autoimmune disease, 114, 116, 138, 139 Autonomic, 58, 111, 115, 116, 139, 141, 143, 152 B Back Pain, 94, 116 Bacteria, 114, 116, 126, 127, 128, 152, 155, 157 Basal Ganglia, 115, 116, 120, 128 Base, 57, 116, 123, 124, 134, 154 Benign, 87, 89, 116, 128, 130, 140, 148, 150 Benzene, 116 Benzodiazepines, 29, 116 Bilateral, 14, 20, 30, 116 Bile, 116, 135, 153 Biochemical, 13, 48, 116, 141, 151 Biopsy, 66, 116 Biotechnology, 17, 70, 79, 116 Bladder, 116, 132, 138, 140, 146 Blood Coagulation, 116, 118, 154 Blood Platelets, 116, 151 Blood pressure, 32, 116, 120, 131, 132, 138, 143, 151 Blood vessel, 16, 116, 117, 118, 120, 134, 137, 143, 151, 153, 154, 157 Body Fluids, 117, 125, 151 Body Regions, 117, 139 Bone Marrow, 116, 117, 132, 136 Bowel, 16, 113, 117, 128, 134 Brachytherapy, 117, 134, 148 Bradykinin, 8, 28, 117, 134 Brain Stem, 65, 117 Branch, 14, 107, 117, 136, 139, 141, 143, 152, 154 Breakdown, 117, 124, 128 Bronchi, 117, 126, 156 Bronchitis, 117, 120 Bronchoscopy, 36, 117 Bruxism, 4, 117, 151 Buccal, 117, 136 Bupivacaine, 117, 135 Bursitis, 84, 117 Bypass, 14, 117 C Caffeine, 24, 117 Calcium, 15, 59, 118, 121, 141, 157 Calcium channel blocker, 118, 157 Capillary, 117, 118, 157 Capillary Permeability, 117, 118 Capsaicin, 4, 20, 22, 24, 56, 118

Carbohydrate, 118, 123, 129 Carboplatin, 26, 118 Carcinogenic, 116, 118, 133, 141, 153 Carcinoma, 85, 118 Cardiac, 7, 16, 58, 59, 66, 112, 117, 118, 126, 127, 135, 139, 153 Cardiac Glycosides, 59, 118 Cardiolipins, 115, 118 Cardiorespiratory, 111, 118 Cardiotonic, 59, 118, 124 Cardiotoxic, 59, 118 Cardiovascular, 89, 98, 118, 127, 151 Carnitine, 26, 51, 118 Carotid Arteries, 66, 119 Case report, 35, 119 Castor Oil, 54, 119 Cations, 119, 134 Cauda Equina, 119, 150 Caudal, 119, 132, 145 Cell Division, 116, 119, 144 Cellulose, 119, 144 Central Nervous System, 12, 14, 111, 116, 117, 119, 125, 128, 130, 138, 145, 151 Central Nervous System Infections, 119, 130 Cerebellar, 119, 156 Cerebellar Diseases, 119, 156 Cerebral, 6, 16, 20, 23, 116, 117, 119, 122, 123, 126, 127, 142 Cerebral hemispheres, 116, 117, 119 Cerebrospinal, 72, 119 Cerebrospinal fluid, 72, 119 Cerebrospinal Fluid Pressure, 72, 119 Cerebrum, 119 Cervical, 4, 6, 65, 86, 120 Cervix, 111, 120 Character, 120, 123, 148 Chemoreceptor, 115, 120 Chemotherapy, 88, 89, 120, 130 Chest Pain, 91, 120 Chin, 120, 137 Cholesterol, 116, 120, 125, 131, 135, 153 Choline, 41, 120 Cholinergic, 115, 120 Chorea, 115, 120 Chromatin, 120, 136 Chronic Fatigue Syndrome, 6, 120 Chronic Obstructive Pulmonary Disease, 9, 100, 120 Clamp, 16, 120 Clinical trial, 6, 79, 120, 122, 125, 147, 148 Cloning, 116, 120

Index 161

Coagulation, 115, 116, 121, 130, 154 Cochlear, 121, 155, 157 Cochlear Diseases, 121, 155 Cofactor, 121, 146, 154 Cognition, 12, 121, 140 Collagen, 8, 113, 121, 122, 146 Combination chemotherapy, 26, 121 Communis, 119, 121 Complement, 121, 150 Complementary and alternative medicine, 16, 121 Computational Biology, 79, 122 Concomitant, 34, 122 Congestion, 115, 122 Congestive heart failure, 118, 122 Conjunctiva, 122, 156 Connective Tissue, 40, 56, 65, 114, 117, 121, 122, 124, 127, 128, 136, 137, 149, 153, 154 Connective Tissue Cells, 122 Connective Tissue Diseases, 65, 114, 122 Consciousness, 112, 113, 122, 123, 124 Constipation, 88, 115, 122, 128 Constriction, 122, 134, 157 Constriction, Pathologic, 122, 157 Contractility, 59, 122 Contraindications, ii, 122 Contralateral, 39, 122 Control group, 9, 16, 122 Controlled study, 9, 11, 122 Convulsions, 59, 114, 122, 125 Coordination, 122, 138 Coronary, 66, 88, 122, 137, 139 Coronary Thrombosis, 122, 137, 139 Cortex, 123, 127 Cortical, 31, 123, 150 Corticosteroid, 57, 66, 123, 145 Cortisone, 123, 145 Cranial, 65, 119, 123, 130, 134, 140, 142, 143, 156, 157 Craniocerebral Trauma, 123, 130, 155 Craniotomy, 72, 123 Curare, 123, 138 Curative, 123, 154 Cutaneous, 7, 14, 37, 40, 123, 136 Cyclic, 111, 117, 123, 145, 150 Cytoplasm, 123, 136 D Degenerative, 54, 56, 91, 98, 123, 129, 138, 141 Delirium, 115, 123 Dementia, 115, 124

Dendrites, 124, 140 Dendritic, 124, 152 Density, 124, 125, 135 Dermis, 124, 156 Diabetes Mellitus, 93, 98, 124, 129, 130 Diagnostic procedure, 53, 70, 124 Diarrhea, 124, 128 Diastolic, 124, 131 Diclofenac, 26, 124 Diclofenac Sodium, 124 Digestion, 116, 117, 124, 134, 135, 153 Digitalis, 59, 118, 124 Dihydrotestosterone, 124, 149 Dilatation, 111, 124, 146 Dilation, 117, 124 Diploid, 124, 144 Direct, iii, 4, 11, 16, 73, 124, 125, 131, 149, 153 Discrete, 124, 154 Distal, 87, 124, 126, 147 Diuresis, 117, 124 Dizziness, 36, 124 Dominance, 66, 124 Dopamine, 115, 124, 140 Dorsal, 71, 125, 145, 152 Double-blind, 9, 18, 24, 125 Drug Interactions, 74, 125 Drug Tolerance, 125, 155 Duct, 125, 149, 153 Dura mater, 125, 137, 142 Dynamometer, 8, 125 Dyskinesia, 37, 115, 125 Dyslipidemia, 85, 125 Dysmenorrhea, 13, 125, 139, 144 Dysphagia, 87, 125 Dystonia, 11, 115, 125 Dystrophy, 35, 90, 98, 125 E Effector, 111, 121, 125 Effector cell, 125 Efferent, 7, 125, 138, 152 Efficacy, 6, 9, 10, 16, 125 Elastic, 66, 125 Elastin, 121, 122, 125 Electroconvulsive Therapy, 67, 125 Electrode, 55, 60, 67, 126 Electrolyte, 123, 126, 137, 145, 151 Electromyography, 39, 47, 126 Elementary Particles, 126, 140, 147 Embolus, 126, 133 Emphysema, 120, 126 Endocrine System, 126

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Endocrinology, 10, 126 Endogenous, 28, 111, 116, 124, 126 Endometrium, 126, 137 Enflurane, 35, 126 Environmental Health, 40, 78, 80, 126 Enzymatic, 113, 118, 121, 126, 131, 144 Enzyme, 32, 48, 111, 125, 126, 144, 149, 154, 158 Epidural, 33, 126 Epinephrine, 111, 124, 126, 140, 141 Ergometer, 126 Ergometry, 34, 43, 126 Erythrocytes, 113, 117, 126, 150 Esophagus, 87, 126, 153 Estrogen, 10, 127 Evacuation, 122, 127 Evoke, 127, 153 Excitability, 11, 20, 31, 127 Exercise Test, 47, 127 Exercise Tolerance, 12, 127 Exogenous, 126, 127, 156 External-beam radiation, 127, 148 Extracellular, 15, 122, 127, 151 Extracellular Matrix, 122, 127 Extrapyramidal, 112, 115, 124, 127 F Fallopian tube, 127, 156 Family Planning, 79, 127 Fat, 117, 123, 126, 127, 135, 138, 149, 151 Fatigue, 6, 8, 9, 10, 12, 16, 38, 45, 47, 100, 120, 127, 130 Febrile, 127, 152 Feces, 122, 127 Fentanyl, 33, 112, 127 Fibrosis, 112, 127, 150 Fibrositis, 40, 127 Fibula, 113, 127, 145, 155 Fixation, 113, 128, 150 Flatus, 128 Flexor, 128, 154 Fluorouracil, 128, 149 Foodborne Illness, 91, 128 Forearm, 117, 128 Fossa, 6, 128 Frostbite, 128, 143 Fructose, 128, 129 Functional Disorders, 71, 128 G Gamma Rays, 128, 148 Ganglia, 111, 128, 140, 143, 152 Ganglion, 47, 128, 157 Gas, 15, 113, 128, 131, 141, 157

Gastric, 56, 119, 128, 131 Gastrin, 128, 131 Gastrointestinal, 117, 126, 128, 129, 144, 149, 151 Gastrointestinal tract, 129, 151 Gene, 10, 15, 116, 124, 129 Genetics, 10, 124, 129 Genotype, 10, 129 Gland, 5, 111, 123, 129, 136, 142, 144, 146, 150, 153, 154, 155 Gliosis, 129, 153 Glomerular, 129, 149 Glucocorticoid, 129, 145 Glucose, 119, 124, 129, 130, 133, 144, 150 Glucose Intolerance, 124, 129 Glutamate, 46, 129 Glycine, 113, 129, 140, 151 Glycogen, 129, 144 Glycoproteins, 129, 134 Glycoside, 59, 129, 149 Glycosidic, 129, 144 Gonadal, 129, 153 Gout, 129, 139 Governing Board, 129, 145 Grade, 66, 130 Granisetron, 26, 130 Gravis, 130, 140, 147 Growth, 12, 113, 114, 130, 133, 136, 139, 140, 144, 147, 150, 154, 156 H Habitual, 46, 120, 130 Habituation, 4, 130 Half-Life, 130, 144 Haploid, 130, 144 Headache, 30, 34, 35, 47, 59, 67, 72, 95, 117, 130 Headache Disorders, 130 Heart failure, 59, 130 Heartbeat, 59, 130 Heme, 130, 145 Hemoglobin, 113, 126, 130, 145 Hemorrhage, 123, 130, 153 Hemorrhoids, 98, 130 Hemostasis, 130, 151 Hepatic, 123, 131, 145 Hereditary, 122, 129, 131, 138 Heredity, 129, 131 Heterozygotes, 124, 131 Histamine, 42, 115, 131 Homeostasis, 12, 59, 131 Homologous, 131, 150 Hormonal, 12, 123, 131

Index 163

Hormone, 12, 13, 123, 126, 128, 131, 133, 146, 149, 150, 154 Host, 131, 132 Hydrogen, 111, 113, 116, 118, 131, 135, 138, 140, 142, 147 Hydrogen Peroxide, 131, 135 Hydrogenation, 116, 131 Hydroxylysine, 121, 131 Hydroxyproline, 113, 121, 131 Hyperalgesia, 14, 15, 28, 30, 71, 131 Hypercholesterolemia, 125, 131 Hyperlipidemia, 125, 131 Hypersecretion, 58, 131 Hypersensitivity, 30, 112, 131, 149, 150 Hypertension, 57, 131, 134, 143 Hypertriglyceridemia, 125, 131 Hypodermic, 55, 60, 131 Hypotension, 115, 122, 132 Hypothalamic, 12, 132 Hypothalamus, 132, 144 Hypothyroidism, 66, 132 Hypoxanthine, 48, 132 I Ibuprofen, 18, 40, 56, 132, 134 Id, 51, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 106, 108, 132 Idiopathic, 40, 132 Immune response, 114, 116, 123, 132, 150 Immune Sera, 132 Immune system, 125, 132, 138, 139, 157 Immunization, 93, 132, 150 Immunologic, 132, 148 Immunosuppressive, 66, 84, 129, 132 Impairment, 6, 123, 125, 132, 147 Implant radiation, 132, 134, 148 Impotence, 132, 143 In situ, 13, 65, 132 In vitro, 132 In vivo, 9, 30, 132 Incontinence, 132, 139 Indicative, 63, 133, 143, 157 Induction, 30, 113, 115, 133, 134 Infarction, 133 Infection, 123, 128, 132, 133, 136, 140, 149, 153 Infusion, 15, 28, 133 Inhalation, 112, 126, 133, 145 Initiation, 42, 133 Innervation, 133, 147 Inorganic, 34, 133 Insight, 8, 10, 133 Insulator, 133, 138

Insulin, 9, 12, 133, 156 Insulin-dependent diabetes mellitus, 133 Insulin-like, 12, 133 Intermittent, 16, 19, 38, 94, 133 Intermittent Claudication, 16, 133 Internal Medicine, 60, 126, 133 Internal radiation, 133, 148 Interstitial, 117, 134, 149 Intervertebral, 134, 135, 150 Intervertebral Disk Displacement, 134, 135, 150 Intestine, 117, 134, 148, 151 Intracellular, 11, 59, 118, 133, 134, 145, 148, 150 Intracranial Hypertension, 130, 134, 155 Intracranial Pressure, 119, 134 Intramuscular, 26, 30, 57, 134 Intramuscular injection, 26, 134 Intravenous, 31, 133, 134 Involuntary, 120, 134, 139, 149, 152 Ion Channels, 15, 134, 143 Ions, 15, 116, 126, 131, 134 Ipsilateral, 39, 134 Ischemia, 15, 134, 139 K Kallidin, 117, 134 Kb, 78, 134 Ketamine, 32, 40, 134 Ketoprofen, 20, 134 Kidney Disease, 78, 94, 134 L Labyrinth, 134, 146, 157 Laparoscopy, 32, 35, 37, 135 Latency, 25, 135 Latent, 8, 58, 135 Lethargy, 132, 135 Library Services, 106, 135 Lidocaine, 31, 47, 135 Ligaments, 5, 122, 135 Ligation, 135 Lipid, 30, 118, 120, 133, 135, 138 Lipid Peroxidation, 30, 135 Lipoprotein, 125, 135 Lithium, 115, 135 Liver, 56, 111, 116, 118, 127, 129, 131, 135, 145 Local therapy, 72, 135 Localization, 25, 135 Localized, 12, 55, 58, 60, 128, 133, 135, 139, 144, 156 Locomotion, 135, 144 Locomotor, 36, 135

164

Muscle Pain

Loop, 18, 135 Low Back Pain, 14, 87, 99, 135 Low-density lipoprotein, 125, 135 Lumbago, 59, 136 Lumbar, 33, 116, 119, 134, 135, 136 Lupus, 84, 114, 115, 136, 154 Lymph, 120, 136 Lymph node, 120, 136 Lymphadenitis, 5, 136 Lymphatic, 133, 136, 137, 154 Lymphocytes, 66, 114, 132, 136, 154 Lymphoid, 114, 136 Lytic, 98, 136 M Malaise, 66, 136 Malformation, 6, 136 Malignant, 90, 114, 136, 140, 148, 150 Manic, 115, 135, 136, 147 Masseter Muscle, 4, 11, 23, 26, 46, 136 Mastication, 12, 20, 37, 136, 156 Masticatory, 3, 4, 5, 7, 18, 22, 23, 25, 28, 33, 39, 41, 43, 44, 46, 50, 65, 67, 136 Maxillary, 4, 136, 142 Maxillary Sinus, 4, 136 Meatus, 136 Medial, 113, 136, 155 Mediator, 136, 151 Medical Records, 137, 149 Medicament, 137, 153 MEDLINE, 79, 137 Membrane, 19, 21, 121, 122, 127, 134, 137, 138, 143, 152 Memory, 113, 123, 124, 137 Meninges, 119, 123, 125, 137 Meningitis, 72, 137 Menopause, 85, 95, 137, 145 Menstrual Cycle, 12, 137, 146 Menstruation, 125, 137, 146 Mental, iv, 6, 16, 23, 26, 78, 80, 99, 120, 121, 123, 124, 127, 132, 137, 147, 150, 157 Mentors, 7, 137 Mesenchymal, 40, 137 Mesolimbic, 115, 137 MI, 109, 137 Microcirculation, 26, 137 Microtubules, 137, 142 Mineralization, 137, 141 Mineralocorticoids, 111, 123, 137 Modification, 113, 137, 148 Molecular, 16, 79, 81, 116, 122, 134, 137, 148, 155

Molecule, 114, 116, 118, 121, 125, 129, 137, 142, 144, 148 Monitor, 5, 138, 141 Monoclonal, 138, 148 Mononuclear, 66, 138 Morphine, 40, 138, 139, 141 Morphology, 44, 138 Motility, 11, 128, 138, 151 Motion Sickness, 138, 139 Motor Activity, 4, 11, 24, 122, 138 Motor nerve, 138 Movement Disorders, 115, 138 Mucinous, 128, 138 Mucosa, 136, 138 Multiple sclerosis, 6, 138 Muscle Contraction, 59, 138 Muscle Fibers, 8, 55, 58, 60, 84, 138, 139 Muscle relaxant, 24, 138, 140, 143, 148, 153 Muscle Relaxation, 138, 153 Muscle Spindles, 11, 55, 60, 138, 143 Muscle tension, 138 Muscular Dystrophies, 125, 139 Musculature, 58, 65, 139, 152 Myalgia, 4, 139 Myasthenia, 139, 140, 147 Myelin, 138, 139, 151 Myelitis, 65, 139 Myocardial infarction, 32, 85, 86, 95, 99, 123, 137, 139 Myocardium, 137, 139 Myofascial Pain Syndromes, 5, 139 Myopathy, 48, 139 Myosin, 138, 139 Myositis, 4, 45, 67, 84, 139 N Naive, 16, 139 Naproxen, 56, 139 Narcotic, 127, 138, 139 Nasociliary, 139, 152 Nausea, 88, 114, 115, 139, 156 Neck Muscles, 72, 139 Need, 3, 4, 55, 56, 60, 64, 70, 72, 102, 111, 129, 139, 155 Neoplasia, 5, 139, 140 Neoplasm, 140, 156 Neoplastic, 65, 140 Neostigmine, 140, 147 Nephropathy, 134, 140 Nerve, 17, 18, 24, 28, 31, 35, 37, 38, 45, 50, 65, 72, 111, 113, 119, 120, 124, 125, 128, 133, 136, 138, 139, 140, 141, 142, 145, 146, 147, 150, 152, 153, 156, 157

Index 165

Nerve Endings, 140, 141 Nervous System, 14, 65, 112, 119, 136, 140, 143 Neural, 7, 11, 13, 14, 46, 112, 140 Neuralgia, 59, 140 Neurogenic, 5, 140 Neuroleptic, 112, 115, 140 Neurologic, 38, 65, 66, 140 Neuroma, 71, 72, 140 Neuromuscular, 35, 36, 41, 54, 55, 58, 60, 111, 140 Neuronal, 7, 15, 140 Neurons, 7, 9, 11, 13, 14, 71, 124, 128, 138, 140, 152, 153, 157 Neuropathy, 140, 150 Neurophysiology, 13, 20, 24, 25, 31, 33, 42, 46, 140 Neurotransmitter, 111, 113, 117, 124, 129, 131, 134, 140, 141, 150 Neutrons, 112, 140, 148 Nitrogen, 112, 113, 128, 141, 156 Nociceptors, 13, 14, 71, 141 Nonverbal Communication, 141, 147 Norepinephrine, 111, 124, 140, 141 Nuclear, 116, 128, 141 Nuclei, 112, 140, 141, 147, 157 Nucleic acid, 132, 141 Nucleus, 7, 11, 120, 123, 126, 128, 134, 136, 138, 140, 141, 147, 157 O Oncogenic, 40, 141, 147 Ophthalmologic, 66, 141 Ophthalmology, 128, 141 Opiate, 138, 141 Opium, 138, 141 Orofacial, 4, 5, 7, 11, 18, 19, 21, 24, 67, 141 Orthostatic, 115, 141 Osteoarthritis, 9, 54, 86, 92, 96, 97, 134, 141, 144 Osteomalacia, 31, 35, 40, 141 Osteoporosis, 57, 95, 141 Outpatient, 35, 36, 37, 142 Ovaries, 142, 156 Oxidation, 111, 135, 142 Oxygen Consumption, 127, 142, 149 P Pachymeningitis, 137, 142 Paclitaxel, 26, 142 Pain Threshold, 17, 18, 26, 30, 142 Palliative, 18, 94, 142, 154 Palpation, 13, 58, 142 Palsies, 65, 142

Pancreas, 111, 133, 142 Pancreatic, 119, 142 Paralysis, 123, 142, 147 Paranasal Sinuses, 136, 142 Parietal, 33, 142 Parietal Lobe, 142 Parkinsonism, 115, 142 Patch, 16, 59, 142, 156 Pathogenesis, 10, 47, 66, 142 Pathologic, 8, 40, 116, 122, 131, 143 Pathophysiology, 5, 6, 7, 58, 143 Patient Education, 84, 104, 106, 109, 143 Pelvic, 84, 143, 146 Pelvis, 111, 136, 142, 143, 157 Peptide, 113, 143, 146, 154 Perception, 37, 67, 143 Pericarditis, 33, 143 Pericardium, 143, 154 Peripheral Nervous System, 140, 142, 143, 150 Peripheral Vascular Disease, 143 Peroral, 20, 40, 143 Pharmacologic, 5, 88, 113, 130, 143, 155 Phenoxybenzamine, 5, 58, 143 Phentolamine, 5, 143 Phenytoin, 31, 143 Phospholipids, 114, 118, 127, 135, 143 Phosphorus, 118, 144 Phosphorylase, 38, 144 Phosphorylase b, 38, 144 Phosphorylase Kinase, 144 Phosphorylated, 15, 144 Phosphorylates, 15, 144 Phosphorylation, 15, 144 Physical Examination, 7, 144 Physical Therapy, 14, 15, 50, 55, 144 Physiologic, 22, 130, 137, 144, 148, 156 Physiology, 8, 14, 21, 22, 29, 30, 36, 37, 39, 41, 43, 46, 48, 126, 140, 144 Pilot study, 17, 33, 34, 144 Piroxicam, 56, 144 Pituitary Gland, 123, 144 Plants, 59, 112, 118, 120, 124, 129, 138, 141, 144, 149, 155 Platinum, 135, 144 Pneumonia, 122, 145 Poisoning, 123, 128, 139, 145 Polymyalgia Rheumatica, 66, 100, 145 Pons, 117, 145 Popliteal, 14, 145 Porphyria, 19, 145 Porphyrins, 145

166

Muscle Pain

Posterior, 6, 113, 116, 125, 139, 142, 145, 150 Postmenopausal, 95, 142, 145 Postoperative, 31, 65, 90, 144, 145 Postural, 28, 45, 145 Potassium, 41, 137, 145 Practice Guidelines, 80, 85, 86, 90, 98, 145 Precursor, 120, 124, 125, 126, 141, 145, 156 Prednisolone, 145 Prednisone, 84, 145 Premenstrual, 13, 146 Preoperative, 65, 146 Prevalence, 7, 12, 66, 146 Probe, 10, 146 Procaine, 135, 146 Progesterone, 146, 153 Progression, 56, 67, 146 Progressive, 41, 71, 124, 125, 130, 139, 141, 146, 149, 156 Projection, 7, 141, 146 Proline, 121, 131, 146 Prone, 12, 146 Prophylaxis, 57, 146 Propofol, 35, 146 Proprioception, 11, 24, 25, 146 Prostate, 146 Prostate gland, 146 Prostatic Hyperplasia, 89, 146 Protein C, 39, 135, 146 Protein S, 15, 116, 146 Proteins, 113, 114, 120, 121, 138, 141, 143, 146, 147, 148, 151 Protocol, 92, 147 Protons, 16, 112, 131, 147, 148 Proto-Oncogene Proteins, 142, 147 Proto-Oncogene Proteins c-mos, 142, 147 Protraction, 33, 147 Proximal, 124, 145, 147 Psychiatric, 6, 147 Psychiatry, 20, 23, 39, 128, 147 Psychic, 137, 147, 150 Psychogenic, 5, 147 Psychosis, 115, 147 Psychotherapy, 67, 147 Ptosis, 58, 147 Public Policy, 79, 147 Pulmonary, 66, 116, 127, 147 Pulmonary Artery, 116, 147 Pulse, 126, 138, 147 Pyloric Stenosis, 92, 147 Pyridostigmine Bromide, 12, 147

Q Quality of Life, 9, 12, 72, 148 Quaternary, 148, 153 R Radiation, 88, 126, 127, 128, 134, 147, 148, 158 Radiation therapy, 88, 127, 134, 148 Radicular, 65, 148 Radioactive, 130, 131, 132, 133, 141, 148 Radiolabeled, 148 Radiotherapy, 117, 148 Randomized, 9, 11, 12, 16, 18, 47, 125, 148 Randomized clinical trial, 12, 18, 148 Randomized Controlled Trials, 16, 148 Receptor, 13, 15, 50, 114, 120, 125, 130, 148, 151 Receptors, Serotonin, 148, 151 Rectum, 113, 115, 128, 133, 146, 148 Recur, 57, 148 Reductase, 32, 48, 149 Refer, 1, 58, 117, 121, 124, 128, 135, 139, 140, 147, 149, 155, 157 Reflex, 20, 28, 46, 90, 98, 138, 149 Refraction, 149, 152 Regimen, 125, 149 Relaxant, 143, 149, 153 Renal failure, 48, 123, 149 Respiration, 120, 123, 138, 149 Restoration, 144, 149 Retreatment, 41, 149 Retrospective, 34, 44, 149 Retrospective study, 44, 149 Rheumatic Diseases, 19, 20, 32, 65, 66, 149 Rheumatism, 19, 26, 33, 132, 149 Rheumatoid, 9, 54, 96, 134, 139, 144, 149 Rheumatoid arthritis, 9, 54, 96, 134, 139, 144, 149 Rigidity, 134, 142, 144, 149 Risk factor, 89, 149 Rod, 120, 149 S S-1, 9, 149 Saliva, 149 Salivary, 5, 149 Saponins, 149, 153 Schizophrenia, 126, 150, 157 Schwannoma, 72, 150 Sciatica, 94, 150 Sclerosis, 97, 138, 150 Screening, 89, 120, 150 Second Messenger Systems, 150 Secretion, 123, 131, 132, 133, 137, 150

Index 167

Sedimentation, 145, 150 Segmental, 11, 33, 71, 150, 152 Segmentation, 150 Seizures, 67, 123, 143, 150 Semisynthetic, 118, 150 Senile, 142, 150 Sensibility, 11, 42, 43, 131, 150 Sensitization, 12, 71, 150 Sensory loss, 65, 139, 151 Serine, 144, 147, 151 Serotonin, 28, 115, 130, 140, 148, 151, 156 Serum, 21, 41, 121, 132, 136, 137, 151 Shock, 67, 151, 156 Side effect, 57, 59, 73, 111, 112, 115, 144, 149, 151, 155 Signs and Symptoms, 4, 151 Skeletal, 5, 8, 9, 13, 39, 58, 84, 113, 120, 123, 138, 139, 151, 152, 153 Skeleton, 111, 134, 151, 155 Skull, 72, 123, 134, 151, 154 Sleep Bruxism, 34, 151 Small intestine, 131, 134, 151 Smooth muscle, 112, 117, 122, 131, 138, 151, 152 Social Environment, 148, 151 Social Security, 148, 151 Sodium, 15, 56, 59, 124, 129, 137, 139, 151 Soft tissue, 5, 117, 151 Soma, 152 Somatic, 12, 143, 152 Spasm, 42, 57, 58, 59, 152 Spatial disorientation, 124, 152 Specialist, 16, 101, 124, 152 Species, 59, 118, 123, 126, 138, 152, 153, 156 Spectrum, 45, 152 Spheno, 47, 152 Sphenoidal, 152 Spike, 5, 152 Spinal cord, 6, 15, 65, 97, 117, 119, 120, 125, 126, 128, 137, 139, 140, 142, 143, 149, 152, 153 Spinal Cord Vascular Diseases, 139, 152 Spinal Nerve Roots, 150, 152 Spondylolisthesis, 98, 152 Sprains and Strains, 84, 135, 152 Sprue, 87, 152 Stabilization, 143, 152 Stasis, 59, 152 Steel, 120, 152 Stenosis, 95, 153 Steroid, 66, 118, 123, 150, 153

Stimulant, 99, 117, 131, 134, 153 Stimulus, 4, 13, 24, 29, 44, 112, 122, 125, 126, 133, 134, 135, 149, 153, 154 Stomach, 111, 126, 128, 129, 131, 139, 151, 153 Stress, 13, 72, 128, 139, 149, 153 Stricture, 153 Stroke, 15, 78, 94, 153 Subarachnoid, 130, 153 Subclinical, 45, 133, 150, 153 Subspecies, 152, 153 Succinylcholine, 17, 31, 37, 41, 48, 153 Supplementation, 15, 112, 153 Suppression, 34, 59, 66, 123, 153 Symptomatic, 6, 66, 153 Synapse, 111, 153, 156 Synergist, 11, 153 Synergistic, 56, 153 Syringomyelia, 6, 153 Systemic, 4, 65, 66, 74, 84, 114, 117, 123, 126, 133, 134, 145, 148, 153, 156 Systemic lupus erythematosus, 65, 84, 114, 153 Systolic, 131, 154 T Talus, 113, 154, 155 Tardive, 115, 154 Temporal, 32, 33, 66, 71, 130, 136, 145, 154 Tendinitis, 84, 154 Tendon, 13, 117, 121, 128, 154 Tendonitis, 4, 154 Testosterone, 149, 154 Therapeutics, 32, 38, 47, 74, 90, 154 Thermal, 29, 48, 140, 154 Thoracic, 116, 154, 157 Threshold, 4, 43, 67, 127, 131, 154 Thrombin, 146, 154 Thromboembolism, 97, 154 Thrombomodulin, 146, 154 Thrombopenia, 114, 154 Thromboses, 115, 154 Thrombosis, 146, 153, 154 Thrombus, 122, 133, 154, 157 Thymus, 132, 136, 154 Thyroid, 85, 132, 154, 155 Thyrotropin, 132, 154 Tibia, 113, 127, 155 Tin, 58, 144, 155 Tinnitus, 67, 155, 157 Tolerance, 12, 30, 129, 155 Tomography, 20, 155 Tone, 47, 48, 155

168

Muscle Pain

Tonic, 24, 25, 31, 33, 40, 118, 155 Tonicity, 125, 155 Tonus, 155 Tooth Injuries, 151, 155 Toothache, 67, 155 Topical, 20, 26, 40, 47, 56, 131, 155 Torsion, 133, 155 Toxic, iv, 116, 118, 123, 124, 140, 155 Toxicity, 125, 155 Toxicology, 80, 155 Toxin, 155 Trace element, 155, 156 Trachea, 117, 154, 156 Traction, 120, 156 Transdermal, 56, 156 Transfection, 116, 156 Transfer Factor, 132, 156 Translation, 113, 156 Transmitter, 111, 124, 134, 136, 141, 156 Transplantation, 132, 156 Trauma, 8, 67, 86, 123, 156 Tremor, 23, 142, 156 Trigeminal, 7, 11, 156 Trigger zone, 115, 156 Tryptophan, 121, 151, 156 Tubal ligation, 35, 156 Tumour, 128, 156 Type 2 diabetes, 95, 156 U Ulcer, 156 Ulceration, 56, 156 Unconscious, 132, 156 Uremia, 149, 156

Uterus, 111, 120, 126, 137, 142, 146, 156, 157 V Vaccine, 74, 99, 147, 157 Vascular, 5, 14, 66, 112, 124, 130, 133, 137, 152, 154, 157 Vasoconstriction, 58, 126, 157 Vasodilator, 117, 125, 131, 143, 157 VE, 9, 157 Vein, 115, 134, 141, 157 Venous, 91, 115, 130, 146, 157 Venous Thrombosis, 91, 157 Ventricles, 119, 157 Venules, 117, 118, 137, 157 Verapamil, 17, 18, 23, 157 Vertebrae, 134, 152, 157 Vestibular, 72, 157 Vestibule, 157 Vestibulocochlear Nerve, 155, 157 Vestibulocochlear Nerve Diseases, 155, 157 Veterinary Medicine, 79, 157 Viral, 141, 157 Visceral, 12, 16, 71, 157 Visceral Afferents, 71, 157 Vivo, 157 W Weight Gain, 41, 57, 157 Windpipe, 154, 157 Withdrawal, 123, 143, 157 X X-ray, 128, 141, 148, 158 Z Zymogen, 146, 158

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