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Ann Intern Med 2003 Apr 15;138(8):685
Edmonton, Alberta T5H 2L8, Canada.
[Medline record in process]
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PMID: 12693897, UI: 22580392
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Ann Intern Med 2003 Apr 15;138(8):685-6
Cabrini Medical Centre; 3144 Victoria, Australia.
PMID: 12693896, UI: 22580391
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BMJ 2003 Apr 5;326(7392):748-50
Pain Management Clinic, Bristol Royal Infirmary, Bristol BS2 8HW, University of Rochester Medical Centre, New York, USA.
PMID: 12676845, UI: 22562760
Cephalalgia 2003 May;23 Suppl 1:43-8
Physiologisches Institut, Christian-Albrechts-Universitat zu Kiel, Germany.
Involvement of the (efferent) autonomic nervous system in the generation of pain is ongoing matter of debate. Based on clinical and experimental observations, there are good arguments that the sympathetic nervous system may be involved in pain following trauma, with and without nerve lesion, at an extremity, such as in complex regional pain syndrome type I and II. However, the mechanisms involved are in many cases still unclear. In various types of headache there is no convicing evidence that the sympathetic nervous system is involved in the generation of pain, although these pains may be accompanied by considerable autonomic reactions which are dependent on activity in sympatheitc neurons. Migraine and headaches with autonomic symptoms are accompanied by autonomic reactions which are dependent on activity in cranial parasympathetic neurons. Whether parasympathetic neurons innervating cranial blood vessels are involved in activation or sensitization of trigemino-vascular afferents is discussed and needs experimental verification.
PMID: 12699458, UI: 22585991
Cephalalgia 2003 May;23 Suppl 1:1-4
IRCCS Neuromed, Pozzilli, Laboratory of Pathophysiology of Integrative Autonomic Systems, University Center for the Study of Adaptive Disorders and Headache (UCADH), IRCCS Neurological Institute C. Mondino Foundation, Pavia, and Chair of Neurology, Department of Clinical Neurology and Otolaryngology, La Sapienza University, Rome, Italy.
[Record supplied by publisher]
EEG-studies in migraine in the last decade has contributed modestly to the understanding of headache pathogenesis. Headache patient groups seem to have increased EEG responses to photic stimulation, but a useful biological marker for migraine in single patients has not been found. In future EEG and QEEG studies we recommend to use follow-up designs and record several EEGs across the migraine cycle. It is also important to use a blinded study design in order to avoid selection bias. A clinical EEG should be performed in patients with acute headache attacks when either epilepsy, basilar migraine, migraine with prolonged aura or alternating hemiplegia is suspected. Unequivocal epileptiform abnormalities usually suggest a diagnosis of epilepsy. In children with occipital spike-wave activity the probable diagnosis is childhood epilepsy with occipital paroxysms (CEOP). The final diagnosis of either an epilepsy syndrome or migraine must be mainly based on a clinical judgement.
PMID: 12699454
J Pain Symptom Manage 2003 May;25(5 Suppl):S31-5
Neuroscience, Clinical Development and Medical Affairs, Novartis Pharmaceuticals, East Hanover, NJ, USA
Oxcarbazepine is a second-generation antiepileptic drug (AED) with proven efficacy in managing partial epileptic seizures, with or without secondary generalization, in adults and children. The overlap between the underlying pathophysiologic mechanisms of some epilepsy models and neuropathic pain models supports the rationale for using certain AEDs in the treatment of neuropathic pain. Several AEDs have reportedly produced analgesia in a range of neuropathic pains, including painful diabetic neuropathy (PDN) and post-herpetic neuralgia. Increasing evidence suggests that oxcarbazepine can provide significant analgesia in several neuropathic pain conditions, including trigeminal neuralgia and PDN, and is also may be effective in treating neuropathic pain refractory to other AEDs, such as carbamazepine and gabapentin. The analgesic effects of oxcarbazepine, and its generally improved safety and tolerability profile compared with other standard AEDs, suggests that oxcarbazepine will be an important addition to the neuropathic pain armamentarium. The rationale and evidence to support the efficacy of oxcarbazepine are presented here.
PMID: 12694990, UI: 22581890
J Pain Symptom Manage 2003 May;25(5 Suppl):S12-7
Rehabilitation Institute of Chicago, Chicago, IL, USA
Neuropathic pain is a challenging condition to treat. It is heterogeneous in nature and largely resistant to treatment with commonly prescribed analgesics. Current management strategies fail to achieve adequate or satisfactory pain relief in a high proportion of patients. The four main reasons that treatments for neuropathic pain fail are: inadequate diagnosis and a lack of appreciation of the mechanisms involved; insufficient management of comorbid conditions; incorrect understanding or selection of treatment options; and the use of inappropriate outcomes measures. These unmet needs in the current management of neuropathic pain are reviewed in this article. The review focuses on the need for a methodical and mechanistic approach to diagnosis, and a flexible, interdisciplinary approach to treatment of neuropathic pain conditions, in order to improve pain relief and quality of life in patients with neuropathic pain.
PMID: 12694988, UI: 22581888
J Pain Symptom Manage 2003 May;25(5 Suppl):S4-S11
Department of Neurology, King's College Hospital, London, and The Medway Hospital, Gillingham, Kent, UK
Currently, no consensus on the optimal management of neuropathic pain exists and practices vary greatly worldwide. Possible explanations for this include difficulties in developing agreed diagnostic protocols and the coexistence of neuropathic, nociceptive and, occasionally, idiopathic pain in the same patient. Also, neuropathic pain has historically been classified according to its etiology (e.g., painful diabetic neuropathy, trigeminal neuralgia, spinal cord injury) without regard for the presumed mechanism(s) underlying the specific symptoms. A combined etiologic/mechanistic classification might improve neuropathic pain management. The treatment of neuropathic pain is largely empirical, often relying heavily on data from small, generally poorly-designed clinical trials or anecdotal evidence. Consequently, diverse treatments are used, including non-invasive drug therapies (antidepressants, antiepileptic drugs and membrane stabilizing drugs), invasive therapies (nerve blocks, ablative surgery), and alternative therapies (e.g., acupuncture). This article reviews the current and historical practices in the diagnosis and treatment of neuropathic pain, and focuses on the USA, Europe and Japan.
PMID: 12694987, UI: 22581887
Lancet 2003 Apr 12;361(9365):1247-51
Department of Surgery, Groene Hart Hospital, Gouda, Netherlands. djswank@XS4all.nl <djswank@XS4all.nl>
BACKGROUND: Laparoscopic adhesiolysis for chronic abdominal pain is controversial and is not evidence based. We aimed to test our hypothesis that laparoscopic adhesiolysis leads to substantial pain relief and improvement in quality of life in patients with adhesions and chronic abdominal pain. METHODS: Patients had diagnostic laparoscopy for chronic abdominal pain attributed to adhesions; other causes for their pain had been excluded. If adhesions were confirmed during diagnostic laparoscopy, patients were randomly assigned either to laparoscopic adhesiolysis or no treatment. Treatment allocation was concealed from patients, and assessors were unaware of patients' treatment and outcome. Pain was assessed for 1 year by visual analogue score (VAS) score (scale 0-100), pain change score, use of analgesics, and quality of life score. Analysis was by intention to treat. FINDINGS: Of 116 patients enrolled for diagnostic laparoscopy, 100 were randomly allocated either laparoscopic adhesiolysis (52) or no treatment (48). Both groups reported substantial pain relief and a significantly improved quality of life, but there was no difference between the groups (mean change from baseline of VAS score at 12 months: difference 3 points, p=0.53; 95% CI -7 to 13). INTERPRETATION: Although laparoscopic adhesiolysis relieves chronic abdominal pain, it is not more beneficial than diagnostic laparoscopy alone. Therefore, laparoscopic adhesiolysis cannot be recommended as a treatment for adhesions in patients with chronic abdominal pain.
PMID: 12699951, UI: 22586649
Spine 2003 Apr 15;28(8):E146-7
*Department of Dermatology.
STUDY DESIGNA case of chronic low back pain caused by a glomus tumor that persisted more than 30 years is presented.OBJECTIVETo emphasize the need to consider skin tumors in the differential diagnosis of low back pain.SUMMARY OF BACKGROUND DATAChronic low back pain can be caused by a myriad of factors. There are six relatively common skin tumors, which present as painful lesions. As seen in the reported case, if they occur in the lumbar region, they can cause low back pain.METHODSA subject with low back pain underwent an excision biopsy of a localized area of tenderness where his symptoms were reproduced when light pressure was applied.RESULTSHistology confirmed that a glomus tumor accounted for the subject's pain.CONCLUSIONSPainful skin tumors may cause low back pain and need to be considered in the differential diagnosis of chronic low back pain.
PMID: 12698131, UI: 22584479
Spine 2003 Apr 15;28(8):842-848
*Department of Physical and Rehabilitation Medicine, dagger Physiology, double dagger Neurosurgery, and section sign Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland; and the parallel DBC International Ltd., and Haaga Neurological Research Center, Helsinki, Finland. From the *Department of Physical and Rehabilitation Medicine, dagger Physiology, double dagger Neurosurgery, and section sign Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland; and the parallel DBC International Ltd., and Haaga Neurological Research Center, Helsinki, Finland.
STUDY DESIGNA follow-up study evaluating postural control, lumbar movement perception, and paraspinal muscle reflexes in disc herniation-related chronic low back pain (LBP) before and after discectomy.OBJECTIVESTo assess the effect of discectomy on postural control, lumbar perception, and reflex activation of paraspinal muscles during sudden upper limb loading.SUMMARY OF BACKGROUND DATAImpaired muscle function, postural control, and lumbar proprioception have been observed in LBP. However, they have not been studied in sciatica patients after surgery.METHODSThe study included 20 patients selected for an operation for chronic LBP caused by disc herniation and 15 controls without chronic LBP. The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface electromyography. The ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The postural control was measured with a vertical force platform. Pain, disability, and depression scores were recorded.RESULTSPatients had poorer lumbar perception (P = 0.012) and postural control (P < 0.05) than did healthy controls. The postural control remained unchanged, but lumbar perception (P = 0.054) and the lumbar feed-forward control (P = 0.043) improved after the surgery.CONCLUSIONSThe results demonstrate impaired lumbar proprioception and postural control in sciatica patients. During short-term follow-up after operative treatment, postural control does not seem to change, but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover.
PMID: 12698130
Spine 2003 Apr 15;28(8):834-41
*Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
STUDY DESIGNA comparative study of trunk muscle recruitment patterns in healthy control subjects and patients with chronic low back pain was conducted.OBJECTIVETo assess trunk muscle recruitment in patients with low back pain.SUMMARY OF BACKGROUND DATAConflicting evidence has been reported on the level and pattern of trunk muscle recruitment in patients with low back pain. The disparities can be explained partly by methodologic differences. It was hypothesized that trunk muscle recruitment patterns may be altered in patients with low back pain to compensate for reduced spinal stability.METHODSFor this study, 16 patients with low back pain and 16 matched control subjects performed slow trunk motions about the neutral posture and isometric ramp contractions while seated upright. Ratios of electromyographic amplitudes and estimated moment contributions of antagonist over agonist muscles and of segmentally inserting muscles over muscles inserting on the thorax and pelvis only were calculated. In addition, model simulations were performed to assess the effect of changes in muscle recruitment on spinal stability.RESULTSThe ratios of antagonist over agonist, and of lumbar over thoracic erector spinae electromyographic amplitude and estimated moment contributions were greater in the patients than in the control subjects. The simulation model predicted that these changes would effectively increase spinal stability.CONCLUSIONSTrunk muscle recruitment patterns in patients with low back pain are different from those in healthy control subjects. The differences are likely to be functional with respect to enhancement of spinal stability in the patients.
PMID: 12698129, UI: 22584477
Spine 2003 Apr 15;28(8):828-833
*Biomechanics Laboratory and the dagger Department of Physiotherapy, National Hospital Orthopaedic Department, University of Oslo, Oslo, Norway, and the double dagger Norwegian University of Sport and Physical Education, Norway. From the *Biomechanics Laboratory and the dagger Department of Physiotherapy, National Hospital Orthopaedic Department, University of Oslo, Oslo, Norway, and the double dagger Norwegian University of Sport and Physical Education, Norway.
STUDY DESIGNA reliability study was performed.OBJECTIVESTo evaluate the test-retest reliability of self-reported functional status and pain in chronic low back pain patients by postal questionnaires.SUMMARY OF BACKGROUND DATAEvaluation tools focusing on the patients' self-reported physical function are recommended in studies on low back pain. Postal questionnaires are inexpensive and should be considered to assess long-term results. The reliability of a postal questionnaire has not been assessed in patients with chronic low back pain.METHODSForty-two patients with chronic low back pain (15 men, 27 women; mean age, 40 years; range, 20-61 years) agreed to participate in the study. The mean duration of symptoms was 8.9 years (range, 1-40 years). A postal questionnaire was sent to the patients twice within a 2-week interval. The questionnaire included the following items: work, back satisfaction, General Function Score (GFS), Oswestry Disability Index (ODI), pain, fear-avoidance beliefs, life satisfaction and pain medication.RESULTSThirty-seven patients (88%) returned both questionnaires. Except for lumbar pain, there were no statistical differences between the answers from the two questionnaires. The intraclass coefficient values ranged from 0.70 (lumbar pain) to 0.94 (ODI). The repeatability or absolute size of measurement error was 11.9 for the ODI and 28.6 and 34.2 for lumbar and leg pain, respectively. The kappa values for work, back satisfaction, and pain medication were 0.94 and 0.61, 0.62, and 0.64, respectively. The kappa values for the separate items in the GFS ranged from 0.41 to 0.79. The correlations between ODI and the GFS, lumbar pain, life satisfaction, and back satisfaction were 0.35, -0.72, -0.76, and 0.76, respectively.CONCLUSIONThe ODI was highly reliable. The questions about work, back satisfaction, and pain medication showed good agreement. The GFS, pain intensity, fear-avoidance beliefs, and life satisfaction appeared to lack sufficient reliability to be recommended in postal questionnaires.
PMID: 12698128