Sympathetic nervous system and pain: A clinical reappraisal

1997 ◽  
Vol 20 (3) ◽  
pp. 426-434 ◽  
Author(s):  
Helmut Blumberg ◽  
Ulrike Hoffmann ◽  
Mohsen Mohadjer ◽  
Rudolf Scheremet
Keyword(s):  
Spontaneous Pain ◽  
Sympathetic Block ◽  
Technical Success ◽  
Sympathetically Maintained Pain ◽  
Sympathetic Function ◽  
Target Article ◽  
Autonomic Motor ◽  
The Relationship ◽  
Generalized Distribution ◽  
Sympathetic Blocks

The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called “reflex sympathetic dystrophy” (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In a second group, called “sympathetically maintained pain” (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic–sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied.

Lumbar Sympathetic Block: Fluoroscopy

2016 ◽  
Author(s):  
Samer N. Narouze
Keyword(s):  
Pain Syndrome ◽  
Diagnostic Value ◽  
Lateral Approach ◽  
Direct Result ◽  
Sympathetic Blockade ◽  
Sympathetic Block ◽  
Sympathetically Maintained Pain ◽  
Therapeutic Value ◽  
Classic Approach ◽  
Sympathetic Blocks

Lumbar sympathetic blocks (LSB) result in the interruption of the sympathetic efferent fibers to the lower extremities with sparing of the somatic nerves, thus providing a diagnostic value as to the relative sympathetic contribution to the patient’s pain syndrome. In those patients with significant sympathetically maintained pain, repeated blocks may provide a therapeutic value and help facilitate physical therapy. The original described technique is the paramedian or “classic” approach described by Mandl in 1926. A more lateral approach was later developed by Reid and colleagues. The incidence of complications related to lumbar sympathetic blockade is minimal. The complications result either from insertion and manipulation of the needle or as a direct result of the injected solution.

Choosing a Markov blanket

2020 ◽  
Vol 43 ◽  
Author(s):  
Thomas Parr
Keyword(s):  
Markov Blanket ◽  
Target Article ◽  
The Relationship

Abstract This commentary focuses upon the relationship between two themes in the target article: the ways in which a Markov blanket may be defined and the role of precision and salience in mediating the interactions between what is internal and external to a system. These each rest upon the different perspectives we might take while “choosing” a Markov blanket.

scholarly journals The Influence of Pre-Procedural Imaging and Cystic Duct Cholangiography on Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1286
Author(s):  
Junya Sato ◽  
Kazunari Nakahara ◽  
Yosuke Michikawa ◽  
Ryo Morita ◽  
Keigo Suetani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Cholecystitis ◽  
Cystic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Procedure Time ◽  
Technical Success ◽  
Factors Affecting ◽  
Gallbladder Drainage ◽  
Procedural Evaluation ◽  
The Relationship

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis is challenging. We evaluated the influence of pre-procedural imaging and cystic duct cholangiography on ETGBD. Patients who underwent ETGBD for acute cholecystitis were retrospectively examined. The rate of gallbladder contrast on cholangiography, the accuracy of cystic duct direction and location by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and the relationship between pre-procedural imaging and the technical success of ETGBD were investigated. A total of 145 patients were enrolled in this study. Gallbladder contrast on cholangiography was observed in 29 patients. The accuracy of cystic duct direction and location (proximal or distal, right or left, and cranial or caudal) by CT were, respectively, 79%, 60%, and 58% by CT and 68%, 55%, and 58% by MRCP. Patients showing gallbladder contrast on cholangiography underwent ETGBD with a significantly shorter procedure time and a lower rate of cystic duct injury. No other factors affecting procedure time, technical success, and cystic duct injury were identified. Pre-procedural evaluation of cystic duct direction and location by CT or MRCP was difficult in patients with acute cholecystitis. Patients who showed gallbladder contrast on cholangiography showed a shorter procedure time and a lower rate of cystic duct injury.

Symptoms as latent variables

2010 ◽  
Vol 33 (2-3) ◽  
pp. 165-166 ◽  
Author(s):  
Dennis J. McFarland ◽  
Loretta S. Malta
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Latent Variables ◽  
Diagnosis And Treatment ◽  
Diagnostic Classification ◽  
Generalized Anxiety ◽  
Diagnostic Categories ◽  
Target Article ◽  
The Relationship

AbstractIn the target article, Cramer et al. suggest that diagnostic classification is improved by modeling the relationship between manifest variables (i.e., symptoms) rather than modeling unobservable latent variables (i.e., diagnostic categories such as Generalized Anxiety Disorder). This commentary discusses whether symptoms represent manifest or latent variables and the implications of this distinction for diagnosis and treatment.

scholarly journals The relationship between object manipulation and language development in Broca's area: A connectionist simulation of Greenfield's hypothesis

2002 ◽  
Vol 25 (1) ◽  
pp. 145-153 ◽  
Author(s):  
Ronan G. Reilly
Keyword(s):  
Language Development ◽  
Motor Coordination ◽  
Dual Function ◽  
Broca’S Area ◽  
Broca's Area ◽  
Main Thrust ◽  
Target Article ◽  
Brain Sciences ◽  
Developmental Differentiation ◽  
The Relationship

In her Behavioral and Brain Sciences target article, Greenfield (1991) proposed that early in a child's development Broca's area may serve the dual function of coordinating object assembly and organizing the production of structured utterances. As development progresses, the upper and lower regions of Broca's area become increasingly specialized for motor coordination and speech, respectively. This commentary presents a connectionist simulation of aspects of this proposal. The results of the simulation confirm the main thrust of Greenfield's argument and suggest that an important impetus for the developmental differentiation in Broca's area may be the increasing complexity of the computational demands made upon it.

Sympathetic contribution to pain – need for clarification

1997 ◽  
Vol 20 (3) ◽  
pp. 487-489
Author(s):  
Helmut Blumberg ◽  
Ulrike Hoffman ◽  
Mohsen Mohadjer ◽  
Rudolf Scheremet
Keyword(s):  
Sympathetic System ◽  
Discharge Pattern ◽  
Sympathetic Block ◽  
Organ Function ◽  
Pain Syndromes ◽  
Regional Pain Syndromes ◽  
Complex Regional Pain Syndromes ◽  
Definition Of ◽  
The Relationship

Certain patients with a possible contribution of the sympathetic system to pain may not fit the definition of complex regional pain syndromes (CRPS), which raises the question of terminology for those patients. To further clarify the relationship between the sympathetic system and pain, apart from the need for placebo studies, there remains an urgent need for a satisfactory definition of the criteria for a complete sympathetic block. It also remains uncertain whether a change in the discharge pattern of sympathetic fibres underlies the changes in sympathetic organ function, often found in patients with CRPS.

Deconstructing RTK: How to explicate a theory of implicit knowledge

1999 ◽  
Vol 22 (5) ◽  
pp. 790-801 ◽  
Author(s):  
Josef Perner ◽  
Zoltan Dienes
Keyword(s):  
Executive Control ◽  
First Principles ◽  
Explicit Knowledge ◽  
Implicit Knowledge ◽  
Theory Of Knowledge ◽  
Memory Development ◽  
Target Article ◽  
Linguistic Representations ◽  
Implicit And Explicit ◽  
The Relationship

In this response, we start from first principles, building up our theory to show more precisely what assumptions we do and do not make about the representational nature of implicit and explicit knowledge (in contrast to the target article, where we started our exposition with a description of a fully fledged representational theory of knowledge (RTK). Along the way, we indicate how our analysis does not rely on linguistic representations but it implies that implicit knowledge is causally efficacious; we discuss the relationship between property structure implicitness and conceptual and nonconceptual content; then we consider the factual, fictional, and functional uses of representations and how we go from there to consciousness. Having shown how the basic theory deals with foundational criticisms, we indicate how the theory can elucidate issues that commentators raised in the particular application areas of explicitation, voluntary control, visual perception, memory, development (with discussion on infancy, theory of mind [TOM] and executive control, gestures), and finally models of learning.

How we know our own minds: The relationship between mindreading and metacognition

2009 ◽  
Vol 32 (2) ◽  
pp. 121-138 ◽  
Author(s):  
Peter Carruthers
Keyword(s):  
Propositional Attitudes ◽  
Childhood Development ◽  
Prior Model ◽  
Section 8 ◽  
Target Article ◽  
Third Person ◽  
System 2 ◽  
Human Thinking ◽  
Mental Events ◽  
The Relationship

AbstractFour different accounts of the relationship between third-person mindreading and first-person metacognition are compared and evaluated. While three of them endorse the existence of introspection for propositional attitudes, the fourth (defended here) claims that our knowledge of our own attitudes results from turning our mindreading capacities upon ourselves. Section 1 of this target article introduces the four accounts. Section 2 develops the “mindreading is prior” model in more detail, showing how it predicts introspection for perceptual and quasi-perceptual (e.g., imagistic) mental events while claiming that metacognitive access to our own attitudes always results from swift unconscious self-interpretation. This section also considers the model's relationship to the expression of attitudes in speech. Section 3 argues that the commonsense belief in the existence of introspection should be given no weight. Section 4 argues briefly that data from childhood development are of no help in resolving this debate. Section 5 considers the evolutionary claims to which the different accounts are committed, and argues that the three introspective views make predictions that are not borne out by the data. Section 6 examines the extensive evidence that people often confabulate when self-attributing attitudes. Section 7 considers “two systems” accounts of human thinking and reasoning, arguing that although there are introspectableeventswithin System 2, there are no introspectableattitudes. Section 8 examines alleged evidence of “unsymbolized thinking”. Section 9 considers the claim that schizophrenia exhibits a dissociation between mindreading and metacognition. Finally, section 10 evaluates the claim that autism presents a dissociation in the opposite direction, of metacognition without mindreading.

Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women 

1999 ◽  
Vol 90 (4) ◽  
pp. 1039-1046 ◽  
Author(s):  
Barbara L. Leighton ◽  
Stephen H. Halpern ◽  
Donna B. Wilson
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Delivery Mode ◽  
Sympathetic Block ◽  
Cervical Dilation ◽  
Induced Labor ◽  
Second Stage ◽  
Vaginal Deliveries ◽  
Epidural Catheters ◽  
Sympathetic Blocks

Background Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. Methods At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. Results Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. Conclusions Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

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