Ultimo Aggiornamento: Febbraio 2004

1: Anesth Analg. 2004 Feb;98(2):557-558.

Local Anesthetic Switching for Intrathecal Tachyphylaxis in Cancer Patients with
Pain.

Yang CP, Yeh CC, Wong CS, Wu CT.

Division of Anesthesiology, Armed Forces Taoyuan General Hospital, Department of
Anesthesiology, Tri-Service General Hospital, National Defense Medical Center,
Taipei, Taiwan. Department of Anesthesiology, Tri-Service General Hospital,
National Defense Medical Center, Taipei, Taiwan. Anesthesia and Intensive Care
Unit and Pain Relief and Palliative Care Unit, La Maddalena, Cancer Center,
Palermo, Italy.

PMID: 14742416 [PubMed - as supplied by publisher]

2: Anesth Analg. 2004 Feb;98(2):408-413.

A Placebo-Controlled Randomized Crossover Trial of the N-Methyl-D-Aspartic Acid
Receptor Antagonist, Memantine, in Patients with Chronic Phantom Limb Pain.

Wiech K, Kiefer RT, Topfner S, Preissl H, Braun C, Unertl K, Flor H, Birbaumer
N.

Institute of Medical Psychology and Behavioral Neurobiology and the. Department
of Anesthesiology and Intensive Care Medicine, University of Tubingen, Tubingen,
Germany, the. Department of Neuropsychology, University of Heidelberg, Central
Institute of Mental Health, Mannheim, Germany, and the. Center for Cognitive
Neuroscience, University of Trento, Trento, Italy.

In the present study we investigated the effect of the N-methyl-D-aspartic acid
(NMDA) receptor antagonist memantine (30 mg/d) on the intensity of chronic
phantom limb pain (PLP) and cortical reorganization. In 8 patients with chronic
PLP, memantine was tested in a placebo-controlled double-blinded crossover trial
of 4 wk duration per trial. The intensity of PLP was rated hourly by the
patients on a visual analog scale during baseline and both treatment periods. At
the same time points, the functional organization of the primary somatosensory
cortex (SI) was determined by neuromagnetic source imaging. In comparison to
baseline and placebo, the NMDA receptor antagonist had no effect on the
intensity of chronic PLP. In none of the periods were significant changes in the
functional organization of SI observed. Although the conclusions regarding the
clinical effect are limited because of the small sample size, the data indicate
that in the studied dosage the NMDA receptor antagonist memantine is ineffective
in the treatment of chronic PLP and is also ineffective for the reduction of
associated neural plasticity in the primary SI. IMPLICATIONS: NMDA receptors
play a substantial role in central nervous system changes underlying neuropathic
pain. In a placebo-controlled double-blinded study we tested the effect of 30 mg
memantine on chronic phantom limb pain and pain-associated cortical
reorganization.

PMID: 14742379 [PubMed - as supplied by publisher]

3: Anesth Analg. 2004 Feb;98(2):401-7.

The effects of remifentanil and gabapentin on hyperalgesia in a new extended
inflammatory skin pain model in healthy volunteers.

Gustorff B, Hoechtl K, Sycha T, Felouzis E, Lehr S, Kress HG.

Department of Anesthesia and General Intensive Care Medicine (B), University of
Vienna, Vienna, Austria.

We tested the responsiveness of measures of hyperalgesia in a model of
UVB-induced inflammatory hyperalgesia with remifentanil, gabapentin, and the
combination of both drugs in a double-blinded, active placebo-controlled,
4-way-crossover design in 16 volunteers. A circular skin area was irradiated
with UVB-light 20 h before the application of gabapentin (600 mg) and 2 h later
remifentanil (0.08 micro g. kg(-1). min(-1), 40 min). In the sunburn spots we
observed stable decreases of the heat pain perception thresholds (HPPT, mean
difference, 4.45 degrees C; 95% confidence interval [CI], 3.32 degrees -5.59
degrees ) and heat pain tolerance thresholds (HPTT; mean difference, 5.43
degrees C; 95% CI, 4.50 degrees -6.35 degrees ) compared with normal skin.
Further, large areas of mechanical hyperalgesia to pinprick adjacent to the
erythema spots developed in all subjects. Overall remifentanil increased the
HPPT (mean increase, 2.47 degrees C; 95% CI, 1.86 degrees -3.09 degrees, P <
0.001) and HPTT (mean increase, 3.18 degrees C; 95% CI, 2.65 degrees -3.71
degrees, P < 0.001) and reduced the area of secondary hyperalgesia by 59% (mean
decrease, 5326 mm(2); 95% CI, 4233-6419 mm(2), P < 0.001) compared with placebo.
In the sunburn remifentanil markedly increased the HPTT by 86% compared with
normal skin (additional increase, 2.57 degrees C; 95% CI, 1.71 degrees -3.43
degrees ). This different effect was not seen in the HPPT. With the exception of
a small increase of HPTT in the sunburn (P = 0.02) gabapentin had no noticeable
effect on either hyperalgesia. In conclusion, opioid analgesia was reliably
demonstrated in this new extended pain model. IMPLICATIONS: Opioid analgesia was
reliably demonstrated in a new inflammatory model of primary and secondary
hyperalgesia. Gabapentin showed no antihyperalgesic and no opioid-enhancing
effect in this model.

PMID: 14742378 [PubMed - in process]

4: Anesth Analg. 2004 Feb;98(2):395-400.

The median effective dose of nefopam and morphine administered intravenously for
postoperative pain after minor surgery: a prospective randomized double-blinded
isobolographic study of their analgesic action.

Beloeil H, Delage N, Negre I, Mazoit JX, Benhamou D.

Department of Anesthesiology, Hopital Bicetre, Assistance Publique-Hopitaux de
Paris and the Anesthesia Laboratory UPRES EA 3540, Faculte de Medecine du
Kremlin-Bicetre Universite de Paris-Sud, Le Kremlin-Bicetre, France.

The aim of this study was to characterize the nature of analgesic interaction
between nefopam and morphine administered IV for postoperative pain after minor
surgery. To do so, we defined the median effective analgesic dose (ED(50)) for
each drug and also the median ED(50) of their combination and compared them
using the isobolographic method. Determination of median effective doses was
performed by the up-and-down sequential drug administration in a two-stage
study. First, in a prospective, randomized, double-blinded study, we enrolled 60
patients with mild to moderate pain after minor surgery; this was followed by an
open study enrolling 30 patients. The end-point was a pain score less than 3 on
a Numerical Pain Scale (0-10). Initial doses were 16 mg in group N, 5 mg in
group M, and 7.5 mg of N combined with 2.5 mg of M in group N+M. The testing
interval was 2 mg in group N, 1 mg in group M, and 1.5 mg of N combined with 0.5
mg of M in group N+M. ED(50) (95% confidence interval) was 5 mg (4-6 mg) for
morphine, 18 mg (16-18 mg) for nefopam, and 4 mg (3.5-4.5 mg) with 12 mg
(10.5-13.5 mg) for the combination of morphine and nefopam administered at a 3:1
dose ratio. Isobolographic analysis demonstrated a significant infra-additive
interaction. The incidence of side effects did not differ significantly among
morphine, nefopam, and their combination. These findings suggest that the
combination of nefopam and morphine does not offer any advantage compared to
each drug administered IV or alone after minor surgery. This study is the first
to define the ED(50) of nefopam and morphine in postoperative patients. In
conclusion, the addition of nefopam has a morphine-sparing effect, but the
combination is infra-additive. IMPLICATIONS: Pharmacologic interaction between
nefopam and morphine shows infra-additivity but their combination may be
clinically useful as morphine consumption is decreased in postoperative
patients.

PMID: 14742377 [PubMed - in process]

5: Anesth Analg. 2004 Feb;98(2):343-5.

Reducing venipuncture pain by a cough trick: a randomized crossover volunteer
study.

Usichenko TI, Pavlovic D, Foellner S, Wendt M.

Department of Anesthesiology and Intensive Care Medicine, Ernst-Moritz-Arndt
University, Greifswald, Germany.

We tested the effectiveness of the cough trick (CT) as a method of pain relief
during peripheral venipuncture (VP) in a crossover study. Twenty healthy
volunteers were punctured twice in the same hand vein within an interval of 3
wk, once with the CT procedure and once without it. The intensity of pain, hand
withdrawal, palm sweating, blood pressure, heart rate, and serum glucose
concentration were recorded. The intensity of pain during VP with the CT
procedure was less than without it, whereas the other variables changed
insignificantly. The easily performed CT was effective in pain reduction during
VP, although the mechanism remains unclear. IMPLICATIONS: The effectiveness of a
cough trick for pain reduction during peripheral venipuncture was tested in a
volunteer study in which each subject served as his own control. The easily
performed cough-trick procedure was effective for pain reduction, although the
mechanism remains unclear.

PMID: 14742367 [PubMed - in process]

6: Anesth Analg. 2004 Feb;98(2):336-42.

Effective Treatment of Laparoscopic Cholecystectomy Pain with Intravenous
Followed by Oral COX-2 Specific Inhibitor.

Joshi GP, Viscusi ER, Gan TJ, Minkowitz H, Cippolle M, Schuller R, Cheung RY,
Fort JG.

Department of Anesthesiology and Pain Management, University of Texas
Southwestern Medical Center, Dallas, Texas.

In this multicenter, double-blinded, randomized, placebo-controlled study we
evaluated the analgesic and opioid-sparing efficacy of a preoperative dose of IV
parecoxib followed by oral valdecoxib in treating pain associated with elective
laparoscopic cholecystectomy. Patients were randomized to receive a single IV
dose of parecoxib 40 mg (n = 134) or placebo (n = 129) 30-45 min before
induction of anesthesia. Six to 12 h after the IV dose, the parecoxib group
received a single oral dose of valdecoxib 40 mg, followed by valdecoxib 40 mg qd
on postoperative days 1-4, then 40 mg qd prn days 5-7. The placebo IV group
received oral placebo on an identical schedule. All patients were allowed
supplemental IV fentanyl as needed during the first 4 h postoperatively (T0-240
min) followed by hydrocodone 5 mg/acetaminophen 500 mg (Vicodin(R); 1-2 tablets
orally every 4-6 h as needed). Patients taking parecoxib used 21% less fentanyl
than those receiving placebo (P = 0.011). The mean area under the curve of pain
intensity (PI) scores over time from T0-240 min was 55.2 for parecoxib and 61.2
for placebo (P = 0.083). At T180 and T240 min, mean PI score was 7.0 and 7.6
points lower in the parecoxib group, respectively (P < 0.02). Fewer patients on
valdecoxib required supplemental analgesics (P < 0.05) after discharge. At T240
min and at day 7, Patient's and Physician's/Nurse's Global Evaluations were
significantly better in the parecoxib/valdecoxib group (P < 0.05). Incidences of
adverse events, adverse events causing withdrawal, and serious adverse events
were less for parecoxib/valdecoxib than for placebo. The authors conclude that
preoperative parecoxib is a valuable opioid-sparing adjunct to the standard of
care for treating pain after laparoscopic cholecystectomy, and subsequent
treatment with oral valdecoxib extends this clinical benefit. IMPLICATIONS:
Parecoxib 40 mg IV, 30-45 min preoperatively followed by oral valdecoxib 40 mg
qd reduced opioid requirements and provided superior pain relief as well as
improved patient global evaluation after laparoscopic cholecystectomy.

PMID: 14742366 [PubMed - in process]

7: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar
devices are comparably effective.

Forouzanfar T, Kemler MA, Weber WE, Kessels AG, Van Kleef M.

Pain Management and Research Centre, Department of Anaesthesiology, University
Hospital Maastricht, Maastricht, The Netherlands.

BACKGROUND: Spinal cord stimulation (SCS) has been used since 1967 for the
treatment of patients with chronic pain. However, long-term effects of this
treatment have not been reported. The present study investigated the long-term
effects of cervical and lumbar SCS in patients with complex regional pain
syndrome type I. METHODS: Thirty-six patients with a definitive implant were
included in this study. A pain diary was obtained from all patients before
treatment and 6 months and 1 and 2 years after implantation. All patients were
asked to complete a seven-point Global Perceived Effect (GPE) scale and the
Euroqol-5D (EQ-5D) at each post-implant assessment point. RESULTS: The pain
intensity was reduced at 6 months, 1 and 2 years after implantation (P<0.05).
However, the repeated measures ANOVA showed a statistically significant, linear
increase in the visual analogue scale score (P=0.03). According to the GPE, at
least 42% of the cervical SCS patients and 47% of the lumbar SCS patients
reported at least 'much improvement'. The health status of the patients, as
measured on the EQ-5D, was improved after treatment (P<0.05). This improvement
was noted both from the social and from the patients' perspective. Complications
and adverse effects occurred in 64% of the patients and consisted mainly of
technical defects. There were no differences between cervical and lumbar groups
with regard to outcome measures. CONCLUSION: SCS reduced the pain intensity and
improves health status in the majority of the CRPS I patients in this study.
There was no difference in pain relief and complications between cervical and
lumbar SCS.

PMID: 14742334 [PubMed - as supplied by publisher]

8: Br J Anaesth. 2004 Jan;92(1):153; author reply 153.

Comment on:
Br J Anaesth. 2003 Mar;90(3):300-3.Intrathecal morphine for coronary bypass grafting.

Singh B, Tempe DK, Gupta M, Dutt V.

Publication Types:
Comment
LetterPMID: 14665575 [PubMed - indexed for MEDLINE]

9: Br J Anaesth. 2004 Jan;92(1):4-6.

Does epidural analgesia improve surgical outcome?

Ballantyne JC.

PMID: 14665544 [PubMed - indexed for MEDLINE]

10: Eur J Pharmacol. 2004 Jan 26;484(2-3):217-23.

Decrease in serotonin concentration in raphe magnus nucleus and attenuation of
morphine analgesia in two mice models of neuropathic pain.

Sounvoravong S, Nakashima MN, Wada M, Nakashima K.

Division of Analytical Research for Pharmacoinformatics, Department of Clinical
Pharmacy, Graduate School of Pharmaceutical Sciences, Nagasaki University, 1-14
Bunkyo-machi, 852-8521, Nagasaki, Japan

The alleviation of neuropathic pain cannot be satisfactorily achieved by
treatment with opioids. There is much evidence to indicate that the active site
of morphine for inducing effective analgesia is in the raphe magnus nucleus,
where serotonin (5-HT, 5-hydroxytryptamine) acts as a primary transmitter.
Therefore, we developed the hypothesis that 5-HT released in the raphe magnus
nucleus could be related to the effectiveness of morphine in two mice models of
neuropathic pain, diabetic (DM)-induced neuropathy and sciatic nerve ligation
(SL). Two weeks after a single administration of streptozotocin, or 10 days
after sciatic nerve ligation, mice were subcutaneously (s.c.) injected with
morphine at 3, 5 and 10 mg/kg. The antinociceptive effect of morphine was
estimated in the tail-pinch test; 5-HT content was measured after induction of
neuropathic pain by microdialysis followed by high-performance liquid
chromatography with electrochemical detection (HPLC-ECD). Morphine produced as
insufficient antinociceptive effect in SL mice at all doses compared with that
in sham-operated mice, while in DM mice, morphine given s.c. at 5 and 10 mg/kg
produced antinociceptive effects compared with those in non-diabetic mice, but
not at 3 mg/kg. The 5-HT content of dialysates, expressed as AUC for 75 min, in
SL and DM mice was less than that in control mice. However, morphine given s.c.
at 5 mg/kg did not significantly affect 5-HT levels in both mice models compared
to their controls. These results suggest that the decrease in 5-HT levels in the
raphe magnus nucleus may be related to attenuation of the analgesic effect of
morphine caused by the abnormal pain state found in diabetes and partial
peripheral nerve injury.

PMID: 14744606 [PubMed - in process]

11: J Pain Symptom Manage. 2003 Dec;26(6):1070; author reply 1071.

Comment on:
J Pain Symptom Manage. 2003 Jul;26(1):655-67.Re: definitions related to the medical use of opioids.

Brown RL.

Publication Types:
Comment
LetterPMID: 14654255 [PubMed - indexed for MEDLINE]

12: JAMA. 2004 Jan 28;291(4):435-41.

Prognostic value of placental growth factor in patients with acute chest pain.

Heeschen C, Dimmeler S, Fichtlscherer S, Hamm CW, Berger J, Simoons ML, Zeiher
AM.

Department of Cardiology, Johann Wolfgang Goethe University, Frankfurt, Germany.

CONTEXT: Experimental data suggest that placental growth factor (PlGF), a member
of the vascular endothelial growth factor family, acts as a primary inflammatory
instigator of atherosclerotic plaque instability and thus may be useful as a
risk-predicting biomarker in patients with acute coronary syndromes (ACS).
OBJECTIVE: To determine whether blood levels of PlGF predict risk for death or
nonfatal myocardial infarction in patients with acute chest pain.Design,
Setting, and PATIENTS: Measurement of PlGF levels as well as levels of markers
of myocardial necrosis (troponin T [TnT]), platelet activation (soluble CD40
ligand [sCD40L]), and inflammation (high-sensitivity C-reactive protein [hsCRP])
in an inception cohort of 547 patients with angiographically validated ACS
participating in the CAPTURE (c7E3 Fab Anti-Platelet Therapy in Unstable
Refractory Angina) trial and in a heterogeneous cohort of 626 patients
presenting with acute chest pain to an emergency department in Germany between
December 1996 and March 1999. MAIN OUTCOME MEASURE: Risk for death or nonfatal
myocardial infarction after 30 days. RESULTS: In patients with ACS, elevated
PlGF levels (>27.0 ng/L; 40.8% of patients) indicated a markedly increased risk
of events at 30 days (14.8% vs 4.9%; unadjusted hazard ratio [HR], 3.34; 95%
confidence interval [CI], 1.79-6.24; P<.001). In a multivariable model, elevated
levels of TnT (HR, 1.83; 95% CI, 1.05-3.86; P =.03), sCD40L (HR, 2.65; 95% CI,
1.41-4.99; P =.002), and PlGF (HR, 3.03; 95% CI, 1.54-5.95; P<.001) were
independent predictors, while elevated hsCRP level was not (HR, 0.98; 95% CI,
0.53-1.98; P =.94). In patients with acute chest pain, elevated levels of PlGF
predicted risk (21.2% vs 5.3%) (unadjusted: HR, 4.80; 95% CI, 2.81-8.21; P<.001;
adjusted: HR, 3.00; 95% CI, 1.68-5.38; P<.001). Patients negative for all 3
markers (TnT, sCD40L, and PlGF) were at very low cardiac risk (7 days: no event;
30 days: 2.1% event rate). CONCLUSIONS: Plasma PlGF levels may be an independent
biomarker of adverse outcome in patients with suspected ACS. A single initial
measurement of plasma PlGF appears to extend the predictive and prognostic
information gained from traditional inflammatory markers.

PMID: 14747500 [PubMed - in process]

13: JAMA. 2004 Jan 28;291(4):415.

Back Pain Is a Money Drain.

Hampton T.

PMID: 14747485 [PubMed - as supplied by publisher]

14: JAMA. 2004 Jan 21;291(3):365-7.

Comment on:
JAMA. 2004 Jan 21;291(3):309-16.Ranolazine and other antianginal therapies in the era of the drug-eluting stent.

Berger P.

Publication Types:
Comment
EditorialPMID: 14734600 [PubMed - indexed for MEDLINE]

15: JAMA. 2004 Jan 21;291(3):309-16.

Comment in:
JAMA. 2004 Jan 21;291(3):365-7.Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise
tolerance and angina frequency in patients with severe chronic angina: a
randomized controlled trial.

Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J, Wang W,
Skettino SL, Wolff AA; Combination Assessment of Ranolazine In Stable Angina
(CARISA) Investigators.

Department of Medicine, Division of Cardiology, St Louis University School of
Medicine, St Louis, Mo, USA. chaitman@slu.edu

CONTEXT: Many patients with chronic angina experience anginal episodes despite
revascularization and antianginal medications. In a previous trial, antianginal
monotherapy with ranolazine, a drug believed to partially inhibit fatty acid
oxidation, increased treadmill exercise performance; however, its long-term
efficacy and safety have not been studied in combination with beta-blockers or
calcium antagonists in a large patient population with severe chronic angina.
OBJECTIVES: To determine whether, at trough levels, ranolazine improves the
total exercise time of patients who have symptoms of chronic angina and who
experience angina and ischemia at low workloads despite taking standard doses of
atenolol, amlodipine, or diltiazem and to determine times to angina onset and to
electrocardiographic evidence of myocardial ischemia, effect on angina attacks
and nitroglycerin use, and effect on long-term survival in an open-label
observational study extension. DESIGN, SETTING, AND PATIENTS: A randomized,
3-group parallel, double-blind, placebo-controlled trial of 823 eligible adults
with symptomatic chronic angina who were randomly assigned to receive placebo or
1 of 2 doses of ranolazine. Patients treated at the 118 participating ambulatory
outpatient settings in several countries were enrolled in the Combination
Assessment of Ranolazine In Stable Angina (CARISA) trial from July 1999 to
August 2001 and followed up through October 31, 2002. INTERVENTION: Patients
received twice-daily placebo or 750 mg or 1000 mg of ranolazine. Treadmill
exercise 12 hours (trough) and 4 hours (peak) after dosing was assessed after 2,
6 (trough only), and 12 weeks of treatment. MAIN OUTCOME MEASURES: Change in
exercise duration, time to onset of angina, time to onset of ischemia,
nitroglycerin use, and number of angina attacks. RESULTS: Trough exercise
duration increased by 115.6 seconds from baseline in both ranolazine groups
(pooled) vs 91.7 seconds in the placebo group (P =.01). The times to angina and
to electrocardiographic ischemia also increased in the ranolazine groups, at
peak more than at trough. The increases did not depend on changes in blood
pressure, heart rate, or background antianginal therapy and persisted throughout
12 weeks. Ranolazine reduced angina attacks and nitroglycerin use by about 1 per
week vs placebo (P<.02). Survival of 750 patients taking ranolazine during the
CARISA trial or its associated long-term open-label study was 98.4% in the first
year and 95.9% in the second year. CONCLUSION: Twice-daily doses of ranolazine
increased exercise capacity and provided additional antianginal relief to
symptomatic patients with severe chronic angina taking standard doses of
atenolol, amlodipine, or diltiazem, without evident adverse, long-term survival
consequences over 1 to 2 years of therapy.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled TrialPMID: 14734593 [PubMed - indexed for MEDLINE]

16: N Engl J Med. 2004 Jan 29;350(5):520-1; discussion 520-1.

Case 5-2003: a 16-year-old girl with a rash and chest pain.

Schur PH.

Publication Types:
Comment
LetterPMID: 14749466 [PubMed - in process]

17: N Engl J Med. 2004 Jan 29;350(5):516-8; author reply 516-8.

Prognostic value of myeloperoxidase in patients with chest pain.

Cayley WE Jr.

Publication Types:
Comment
LetterPMID: 14749463 [PubMed - in process]

18: Neurology. 2004 Jan 27;62(2):285-8.

Valproic acid has no effect on pain in polyneuropathy: a randomized, controlled
trial.

Otto M, Bach FW, Jensen TS, Sindrup SH.

Department of Neurology, Odense University Hospital, Denmark.
maritotto@dadlnet.dk

The aim of this randomized, double-blind, placebo-controlled cross-over study
was to test whether valproic acid relieves painful polyneuropathy. Thirty-one
patients completed two treatment phases of 4 weeks' duration with valproic acid
(1,500 mg daily) and placebo. There was no significant difference between
valproic acid and placebo in the rating of total pain (median, 5 in the valproic
acid period vs 6 in the placebo period; p = 0.24) or in individual pain ratings.

PMID: 14745070 [PubMed - in process]

19: Neurology. 2004 Jan 27;62(2):218-25.

Systemic lidocaine in pain due to peripheral nerve injury and predictors of
response.

Attal N, Rouaud J, Brasseur L, Chauvin M, Bouhassira D.

INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Hopital
Ambroise Pare, AP-HP, and Universite Versailles-Saint-Quentin, France.

OBJECTIVE: To investigate the effects of IV lidocaine on spontaneous and evoked
pain (allodynia and hyperalgesia) due to peripheral nerve injury (postherpetic
neuralgia or nerve trauma) using quantitative sensory testing. METHOD: The
authors randomized 22 patients to receive lidocaine 5 mg/kg IV during 30 minutes
or placebo in a double-blind crossover design and 16 patients subsequently
received mexiletine on an open basis titrated from 400 to 1,000 mg per day (mean
737 mg/day). RESULTS: Lidocaine induced a significant decrease in ongoing pain
for up to 6 hours with a peak effect 60 to 120 minutes postinjection. The drug
also decreased mechanical dynamic allodynia and static (punctate) mechanical
allodynia/hyperalgesia, but not thermal allodynia and hyperalgesia. The effects
of lidocaine and mexiletine on spontaneous pain intensity were significantly
higher in patients with concomitant mechanical allodynia in comparison with
those without allodynia. CONCLUSIONS: These data indicate modality-specific
antihyperalgesic effects of IV lidocaine in patients with peripheral nerve
injury. Patients with mechanical allodynia may be good candidates for treatment
with local anesthetic-like drugs and possibly with other sodium-channel
blockers.

PMID: 14745057 [PubMed - in process]

20: Neurology. 2004 Jan 27;62(2):212-7.

Painful stimuli evoke itch in patients with chronic pruritus: central
sensitization for itch.

Ikoma A, Fartasch M, Heyer G, Miyachi Y, Handwerker H, Schmelz M.

Department of Dermatology, Kyoto University, Japan.

BACKGROUND: Central sensitization for pain is important for patients with
chronic pain. The authors investigated a possible role of central sensitization
for itch in patients with chronic pruritus. METHODS: Noxious stimuli were
applied in lesional and visually nonlesional skin areas of 25 patients with
atopic dermatitis, in lesional skin areas of 9 patients with psoriasis vulgaris,
and in 20 healthy subjects. The stimuli included mechanical pinpricks,
electrical stimuli, contact heat, and injection of low-pH solution. Intensities
of itch and pain were assessed separately on a numeric rating scale. RESULTS:
All the noxious stimuli primarily evoked pain in control subjects and patients
with psoriasis vulgaris. In patients with atopic dermatitis, however, itch was
evoked instead of burning pain. In their lesional skin, itch was the predominant
sensation. Chemical stimuli evoked intense itch in lesional and visually healthy
skin areas (the area under the curve of itch rating compared with the control,
mean +/- SEM, 668 +/- 166 and 625 +/- 192 vs 38 +/- 23; p < 0.001; p < 0.01).
Chemically induced itch also was observed in healthy subjects after a
conditioning histamine stimulus of 15 minutes, but not after a conditioning
histamine stimulus of 2 minutes. CONCLUSION: The chronic barrage of pruriceptive
input may elicit central sensitization for itch so that nociceptive input no
longer inhibits itch but on the contrary is perceived as itch. In contrast to
the well-known A-fiber-mediated alloknesis and hyperknesis, this type of central
sensitization appears to be elicited by C-nociceptors.

PMID: 14745056 [PubMed - in process]

21: Neurology. 2003 Aug 26;61(4):577-8.

Response to sumatriptan in headache of MELAS syndrome.

Iizuka T, Sakai F, Endo M, Suzuki N.

Department of Medicine (Neurology), School of Medicine, Kitasato University,
Kanagawa, Japan. takahiro@med.kitasato-u.ac.jp

Publication Types:
Case ReportsPMID: 12939448 [PubMed - indexed for MEDLINE]

22: Neurology. 2003 May 27;60(10):E8-9.

Comment on:
Neurology. 2003 May 27;60(10):1684-7.Patient pages. Daily headaches due to medication overuse.

Eross E.

Publication Types:
Comment
Patient Education HandoutPMID: 12771288 [PubMed - indexed for MEDLINE]

23: Neurology. 2003 Feb 25;60(4):729-30; author reply 729-30.

Comment on:
Neurology. 2002 May 14;58(9):1404-7.Safety, tolerability, and efficacy of orally administered cannabinoids in MS.

Russo EB.

Publication Types:
Comment
LetterPMID: 12601130 [PubMed - indexed for MEDLINE]

24: Spine. 2003 Jun 15;28(12):1350-1.

Comment on:
Spine. 2002 Nov 15;27(22):2614-9; discussion 2620.Chronic pain of spinal origin.

Chrubasik S, Roufogalis BD.

Publication Types:
Comment
LetterPMID: 12811283 [PubMed - indexed for MEDLINE]

25: Spine. 2003 Jun 15;28(12):1347-8; author reply 1348-50.

Comment on:
Spine. 2001 Apr 15;26(8):E165-9.Side of symptomatic annular tear and site of low back pain: is there a
correlation?

Aprill C, Laslett M, McDonald B.

Publication Types:
Comment
LetterPMID: 12811282 [PubMed - indexed for MEDLINE]

26: Spine. 2003 Jun 15;28(12):1290-9.

Updated method guidelines for systematic reviews in the cochrane collaboration
back review group.

van Tulder M, Furlan A, Bombardier C, Bouter L; Editorial Board of the Cochrane
Collaboration Back Review Group.

Institute for Research in Extramural Medicine, Department of Clinical
Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the
Netherlands. mw.van_tulder.emgo@med.vu.nl

STUDY DESIGN: Descriptive method guidelines. OBJECTIVES: To help reviewers
design, conduct, and report reviews of trials in the field of back and neck
pain. SUMMARY OF BACKGROUND DATA: In 1997, the Cochrane Collaboration Back
Review Group published method guidelines for systematic reviews. Since its
publication, new methodologic evidence emerged and more experience was acquired
in conducting reviews. METHODS: All reviews and protocols of the Back Review
Group were assessed for compliance with the 1997 method guidelines. Also, the
most recent version of the Cochrane Handbook (4.1) was checked for new
recommendations. In addition, some important topics that were not addressed in
the 1997 method guidelines were included (e.g., methods for qualitative
analysis, reporting of conclusions, and discussion of clinical relevance of the
results). In May 2002, preliminary results were presented and discussed in a
workshop. In two rounds, a list of all possible recommendations and the final
draft were circulated for comments among the editors of the Back Review Group.
RESULTS: The recommendations are divided in five categories: literature search,
inclusion criteria, methodologic quality assessment, data extraction, and data
analysis. Each recommendation is classified in minimum criteria and further
guidance. Additional recommendations are included regarding assessment of
clinical relevance, and reporting of results and conclusions. CONCLUSIONS:
Systematic reviews need to be conducted as carefully as the trials they report
and, to achieve full impact, systematic reviews need to meet high methodologic
standards.

PMID: 12811274 [PubMed - indexed for MEDLINE]

27: Spine. 2003 Jun 15;28(12):1215-8.

Cochrane back review group.

Bouter LM, Pennick V, Bombardier C; Editorial Board of the Back Review Group.

Publication Types:
EditorialPMID: 12811262 [PubMed - indexed for MEDLINE]