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Emergency plasmapheresis for unstable angina in a patient with hyperviscosity syndrome.
Ovadia S, Lysyy L, Floru S.
Department of Internal Medicine C, E. Wolfson Medical Center, Halochamim 4 Holon, Israel. kovadia@hotmail.com
Publication Types:
PMID: 16182994 [PubMed - indexed for MEDLINE]
Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis.
Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA. jrichma1@jhmi.edu
Although most randomized clinical trials conclude that the addition of continuous peripheral nerve blockade (CPNB) decreases postoperative pain and opioid-related side effects when compared with opioids, studies have included relatively small numbers of patients and the majority failed to show statistical significance during all time periods for reduced pain or side effects. We identified studies primarily by searching Ovid Medline (1966-May 21, 2004) for terms related to postoperative analgesia with CPNB and opioids. Each article from the final search was reviewed and data were extracted from tables, text, or extrapolated from figures as needed. Nineteen articles, enrolling 603 patients, met all inclusion criteria. Inclusion criteria were a clearly defined anesthetic technique (combined general/regional anesthesia, general anesthesia alone, peripheral nerve block), randomized trial, adult patient population (> or =18 yr old), CPNB (or analgesia) used postoperatively (intrapleural catheters were deemed not to be classified as a peripheral nerve catheter), and opioids administered for postoperative analgesia in groups not receiving peripheral nerve block. Perineural analgesia provided better postoperative analgesia compared with opioids (P < 0.001). This effect was seen for all time periods measured for both mean visual analog scale and maximum visual analog scale at 24 h (P < 0.001), 48 h (P < 0.001), and 72 h (mean visual analog scale only) (P < 0.001) postoperatively. Perineural catheters provided superior analgesia to opioids for all catheter locations and time periods (P < 0.05). Nausea/vomiting, sedation, and pruritus all occurred more commonly with opioid analgesia (P < 0.001). A reduction in opioid use was noted with perineural analgesia (P < 0.001). CPNB analgesia, regardless of catheter location, provided superior postoperative analgesia and fewer opioid-related side effects when compared with opioid analgesia.
Publication Types:
PMID: 16368838 [PubMed - indexed for MEDLINE]
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Nonsteroidal antiinflammatory drugs suppress pain-related behaviors, but not referred hyperalgesia of visceral pain in mice.
Shin JW, Hwang KS, Kim YK, Leem JG, Lee C.
Department of Anesthesiology and Pain Medicine, Ulsan University College of Medicine, Seoul, Korea.
Visceral pain is characterized by spontaneous pain and referred hyperalgesia. After inducing visceral pain in mice using intracolonic mustard oil administration, we examined the effects of various nonsteroidal antiinflammatory drugs (NSAIDs) on pain-related behavior and on Evans blue dye extravasation. Animals were given one of the following: saline, ethanol, dimethylsulfoxide (DMSO), morphine, ketoprofen, ketorolac, or DFU (a cyclooxygenase-2 inhibitor). After drug treatment, mice underwent intracolonic administration of 50 microL 1.5% mustard oil. Spontaneous pain-related responses were assessed for the next 20 min. The frequency of withdrawal responses to the application of von Frey hairs to the abdomen, foot, and tail was determined. After completion of the behavioral tests, Evans blue was injected into the animals via the tail vein. Two hours later, the colon was removed postmortem and Evans blue content was measured. Spontaneous pain behaviors were significantly less in animals administered 3 and 10 mg/kg morphine, 50 mg/kg ketorolac, 100 mg/kg ketoprofen, and 20 mg/kg DFU (P < 0.05). Response frequencies to the application of von Frey hairs were lower in mice administered 3 and 10 mg/kg morphine (P < 0.05) but were not affected by ketorolac, ketoprofen, or DFU treatment. Colonic Evans blue content was smaller in mice given 100 mg/kg ketoprofen and 20 mg/kg DFU (P < 0.05). We concluded that NSAIDs reduced pain behavior and inflammation but had little effect on referred hyperalgesia.
PMID: 16368829 [PubMed - indexed for MEDLINE]
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An iontophoretic fentanyl patient-activated analgesic delivery system for postoperative pain: a double-blind, placebo-controlled trial.
Viscusi ER, Reynolds L, Tait S, Melson T, Atkinson LE.
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. eugene.viscusi@jefferson.edu
An iontophoretic fentanyl HCl patient-activated transdermal system (fentanyl HCl PATS) is under development for the treatment of acute postoperative pain. The fentanyl HCl PATS is a needle-free, credit card-sized, preprogrammed system that is applied to the patient's upper outer arm or chest. The fentanyl HCl PATS was demonstrated to be superior to placebo in a previous trial; however, the randomization scheme used and the lack of control of entry pain level may have contributed to the lack of robust findings. We compared the fentanyl HCl PATS with placebo for acute postoperative pain management in a larger trial that addressed the limitations of the previous study. Adult patients admitted to the postanesthesia care unit after major surgery were titrated to comfort with opioids and randomized 1:1 to receive the fentanyl HCl PATS 40 microg or placebo for 24 hours. Supplemental IV fentanyl was available to patients upon request in both treatment groups for the first 3 hours after enrollment. The primary efficacy end-point was the percentage of patients who discontinued participation in the study because of inadequate analgesia. Pain intensity scores, patient global assessments (PGA), and investigator global assessments (IGA) were collected. Four-hundred-eighty-four patients (PATS, n = 244; placebo, n = 240) were enrolled. Fewer patients receiving the fentanyl HCl PATS discontinued because of inadequate analgesia compared with placebo (28.7% versus 60.0%; P < 0.0001). Mean last pain intensity scores were 3.5 and 5.4 for the fentanyl HCl PATS and placebo groups, respectively. Patients (73.4%, PGA) and investigators (72.1%, IGA) considered the fentanyl HCl PATS a good or excellent method of pain control. Treatment-related adverse events were similar between groups. This study demonstrated the superiority of the iontophoretic fentanyl HCl PATS over placebo for acute postoperative pain management.
Publication Types:
PMID: 16368828 [PubMed - indexed for MEDLINE]
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Gabapentin: an alternative to the cyclooxygenase-2 inhibitors for perioperative pain management.
Turan A, White PF, Karamanlioglu B, Memis D, Tasdogan M, Pamukcu Z, Yavuz E.
Department of Anaesthesiology, Trakya University, Edirne, Turkey.
The cyclooxygenase-2 inhibitor, rofecoxib, was a popular analgesic adjuvant for improving perioperative pain management. We designed this placebo-controlled study to test the hypothesis that gabapentin could produce similar reductions in postoperative pain and opioid analgesic usage, thereby improving the recovery process. One hundred patients undergoing abdominal hysterectomy procedures were randomly assigned to one of four treatment groups: 1) control group received placebo capsules and pills before and for 2 days after surgery, 2) rofecoxib group received 50 mg/d PO and placebo capsules before and after surgery and, 3) gabapentin group received 1.2 g/d PO and placebo pills before and after surgery, and 4) combination group received rofecoxib 50 mg/d and gabapentin 1.2 g/d PO before and after surgery. The anesthetic technique was standardized and the postoperative assessments included verbal rating scales for pain and sedation, IV morphine usage, quality of recovery assessment, recovery of bowel function, resumption of normal activities, and patient satisfaction with their pain management. Postoperative pain scores were significantly reduced in all three analgesic treatment groups (versus control group). Compared with the control group, patient-controlled analgesia morphine usage was also significantly reduced in the 3 analgesic treatment groups at 1, 8, 24, and 30 h after surgery. Total PCA morphine usage was decreased by 43%, 24%, and 50% in groups 2, 3, and 4, respectively, compared with group 1. Oral analgesic consumption was also smaller in groups 2 and 4 when compared with the control group. The opioid-sparing effects of rofecoxib and gabapentin lead to a faster recovery of bowel function. Discharge eligibility scores in groups 2 and 4 were improved at 24 h when compared with group 1, and patient satisfaction with postoperative pain management was significantly higher at 24 h in all 3 analgesic treatment groups. At the 72 h follow-up, all of the patients in group 4 were completely satisfied with their pain management compared with only 32%, 64%, and 72% in groups 1, 2, and 3, respectively. Gabapentin (1.2 g/d PO) appears to be an acceptable alternative to rofecoxib (50 mg/d PO) for short-term use as an adjuvant to opioid analgesics in patients undergoing lower abdominal surgery.
Publication Types:
PMID: 16368826 [PubMed - indexed for MEDLINE]
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Comment on:
The combination of tramadol and morphine may be recommended for postoperative analgesia.
Webb A, Leong S.
Publication Types:
PMID: 16301283 [PubMed - indexed for MEDLINE]
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A prospective comparative study of two indirect methods for confirming the localization of an epidural catheter for postoperative analgesia.
de Medicis E, Tetrault JP, Martin R, Robichaud R, Laroche L.
Departement d'Anesthesiologie Centre Hospitalier Universitaire de Sherbrooke 3001, 12 E. Avenue Nord Sherbrooke, Quebec, Canada J1H 5N4. estria1@globetrotter.net
We prospectively evaluated, in randomized order, 2 indirect methods of confirming the localization of an epidural catheter for postoperative analgesia in 218 surgical patients: epidural stimulation test (EST) and epidural pressure waveform analysis (EPWA). The epidural space was localized by using a loss of resistance technique. All catheters were inserted 5 cm into the epidural space and primed with 5 mL of 0.9% normal saline. There were no differences between the methods: the positive predictive value and specificity were high (100% in both groups), but the sensitivity was moderate (80% for EST and 81% for EPWA) and the negative predictive value was low (16% for EST and 17% for EPWA). Combining both methods yielded better sensitivity (97%) and negative predictive value (57%) (P < 0.001). The sensitivity of EST was increased to 87% (P < 0.05) if sensory response was included as well as motor response for stimulation less than 10 mA. We suggest the inclusion of sensory response in the appropriate dermatome at a current <10 mA as a criterion for adequate epidural catheter localization for EST testing. EPWA sensitivity was significantly better with older patients: 94% for patients older than 80 yr compared with 63% for patients younger than 40, 73% for patients 40 to 60, and 85% for patients aged 60 to 80 yr (P = 0.03). We conclude that the two tests are comparable for confirming catheter placement.
Publication Types:
PMID: 16301268 [PubMed - indexed for MEDLINE]
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Continuous femoral nerve blockade or epidural analgesia after total knee replacement: a prospective randomized controlled trial.
Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P.
Department of Anesthesia, St. Vincent's Hospital, Melbourne, PO Box 2900 Fitzroy Victoria 3065 Australia. Michael.Barrington@svhm.org.au
Because postoperative pain after total knee replacement (TKR) can be severe, we compared the analgesic efficacy of continuous femoral nerve blockade (CFNB) and continuous epidural analgesia (CEA) after TKR in this prospective randomized trial. Patients undergoing TKR under spinal anesthesia were randomized to receive either a femoral infusion of bupivacaine 0.2% (median infusion rate 9.3 mL/h) (n = 53) or an epidural infusion of ropivacaine 0.2% with fentanyl 4 microg/mL (median infusion rate 7.6 mL/h) (n = 55). Adjuvant analgesics were oral rofecoxib and oxycodone and IV morphine. Pain, nausea and vomiting, hypotensive episodes, motor block, range of knee movement, and rehabilitation milestones were assessed postoperatively. There were equivalent pain scores, range of movement, and rehabilitation in both groups. There was significantly less nausea and vomiting in the CFNB group (P < 0.002). The CFNB group received more rofecoxib (P < 0.04) and oxycodone (P < 0.005) than the CEA group. The operative limb displayed more motor block than the nonoperative limb in both groups at the level of the hip and knee for up to 48 h (P < 0.05, Mann-Whitney U-test), but there was no difference between groups in the nonoperative limb. CFNB is an effective regional component of a multimodal analgesic strategy after TKR.
Publication Types:
PMID: 16301267 [PubMed - indexed for MEDLINE]
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The effects of diacerhein on mechanical allodynia in inflammatory and neuropathic models of nociception in mice.
Quintao NL, Medeiros R, Santos AR, Campos MM, Calixto JB.
Department of Pharmacology, Campus Universitario, Universidade Federal de Santa Catarina, 88049-900, Florianopolis SC, Brazil.
In this study we analyzed the systemic antiallodynic properties of diacerhein, a drug used to treat osteoarthritis, in inflammatory and neuropathic models of nociception in mice. The effects of diacerhein were compared with those of gabapentin, a drug used clinically for the management of neuropathic pain. Similar to gabapentin, diacerhein was able to significantly reverse the mechanical allodynia induced by carrageenan. A significant inhibition of carrageenan-induced nociception was also observed when diacerhein was administered by the intrathecal but not by the intraplantar route. The treatment with diacerhein or with gabapentin also inhibited the mechanical allodynia induced by complete Freund's adjuvant (CFA) or after the partial ligation of the sciatic nerve (PLSN). In the same range of doses, diacerhein or gabapentin did not affect the locomotor activity, motor coordination, or body temperature of the animals. The present results indicate that diacerhein produces marked antiallodynic effects in carrageenan and CFA nociception models and also inhibits the neuropathic pain after PLSN, with an efficacy similar to that observed for gabapentin. Diacerhein may be a potentially interesting tool for the management of inflammatory and neuropathic pain.
PMID: 16301256 [PubMed - indexed for MEDLINE]
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Inguinal herniorrhaphy under monitored anesthesia care with ilioinguinal-iliohypogastric block: the impact of adding clonidine to ropivacaine.
Beaussier M, Weickmans H, Abdelhalim Z, Lienhart A.
Departement d'Anesthesie Reanimation. Hopital St. Antoine. 184 rue du Fbg St-Antoine, 75012 Paris. France. marc.beaussier@sat.ap-hop-paris.fr
There is no information concerning the association of ropivacaine and clonidine for ilioinguinal-iliohypogastric block. In this prospective, double-blind study, we randomly assigned 40 adult patients scheduled for inguinal herniorrhaphy under monitored anesthesia care to receive either 225 mg ropivacaine (7.5 mg/mL) alone (control group) or combined with 75 mug clonidine (clonidine group) for preoperative ilioinguinal-iliohypogastric block. After completion of surgery, patients were transferred to the postanesthesia care unit and were asked to stand up and walk around at the second postoperative hour. After leaving the postanesthesia care unit, patients could take oral propacetamol (500 mg) and codeine (30 mg) on request. Pain intensity was assessed with a 100 mm visual analog scale. Time to first request of supplemental analgesics (median [95% confidence interval]) was 10 h (7.1-14.5 h) and 9 h (6.4->24 h) respectively in the clonidine and control groups (P = 0.83). Pain at rest did not differ between groups whereas pain at motion was reduced on the third postoperative day in the clonidine group. More patients who received clonidine experienced orthostatic hypotension upon standing up within the first postoperative hours (6 of 20 versus 1 of 20 in the control group; P < 0.05). In conclusion, the benefit of adding clonidine 75 mug to ropivacaine for ilioinguinal-iliohypogastric block for motion pain on the third postoperative day must be balanced with an increasing risk of orthostatic hypotension in the immediate postoperative period.
Publication Types:
PMID: 16301238 [PubMed - indexed for MEDLINE]
Comment in:
Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial.
Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA.
Group Health Cooperative and University of Washington, Seattle, Washington, USA. Sherman.k@ghc.org
BACKGROUND: Chronic low back pain is a common problem that has only modestly effective treatment options. OBJECTIVE: To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain. DESIGN: Randomized, controlled trial. SETTING: A nonprofit, integrated health care system. PATIENTS: 101 adults with chronic low back pain. INTERVENTION: 12-week sessions of yoga or conventional therapeutic exercise classes or a self-care book. MEASUREMENTS: Primary outcomes were back-related functional status (modified 24-point Roland Disability Scale) and "bothersomeness" of pain (11-point numerical scale). The primary time point was 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication use. RESULTS: After adjustment for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks (yoga vs. book: mean difference, -3.4 [95% CI, -5.1 to - 1.6] [P < 0.001]; yoga vs. exercise: mean difference, -1.8 [CI, -3.5 to - 0.1] [P = 0.034]). No significant differences in symptom bothersomeness were found between any 2 groups at 12 weeks; at 26 weeks, the yoga group was superior to the book group with respect to this measure (mean difference, -2.2 [CI, -3.2 to - 1.2]; P < 0.001). At 26 weeks, back-related function in the yoga group was superior to the book group (mean difference, -3.6 [CI, -5.4 to - 1.8]; P < 0.001). LIMITATIONS: Participants in this study were followed for only 26 weeks after randomization. Only 1 instructor delivered each intervention. CONCLUSIONS: Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.
Publication Types:
PMID: 16365466 [PubMed - indexed for MEDLINE]
Comment on:
Summaries for patients. Comparison of yoga, exercise, and education for the treatment of chronic low back pain.
[No authors listed]
Publication Types:
PMID: 16365464 [PubMed - indexed for MEDLINE]
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Comment in:
Summary for patients in:
Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial.
Wong SM, Hui AC, Tong PY, Poon DW, Yu E, Wong LK.
North District Hospital, The Chinese University of Hong Kong, and Prince of Wales Hospital, Hong Kong, China. jsmwong@hkstar.com
BACKGROUND: Lateral epicondylitis is a common condition for which botulinum toxin has been reported to have a therapeutic role in uncontrolled studies. OBJECTIVE: To determine if an injection of botulinum toxin is more effective than placebo for reducing pain in adults with lateral epicondylitis. DESIGN: Randomized, double-blind, placebo-controlled trial conducted from September 2002 to December 2004. SETTING: Outpatient clinics at a university hospital and a district hospital in Hong Kong. PARTICIPANTS: 60 patients with lateral epicondylitis. MEASUREMENTS: The primary outcome was change in subjective pain as measured by a 100-mm visual analogue scale (VAS) ranging from 0 (no pain) to 10 (worst pain ever) at 4 weeks and 12 weeks. All patients completed post-treatment follow-up. Interventions: A single injection of 60 units of botulinum toxin type A or normal saline placebo. RESULTS: Mean VAS scores for the botulinum group at baseline and at 4 weeks were 65.5 mm and 25.3 mm, respectively; respective scores for the placebo group were 66.2 mm and 50.5 mm (between-group difference of changes, 24.4 mm [95% CI, 13.0 to 35.8 mm]; P < 0.001). At week 12, mean VAS scores were 23.5 mm for the botulinum group and 43.5 mm for the placebo group (between-group difference of changes, 19.3 mm [CI, 5.6 to 32.9 mm]; P = 0.006). Grip strength was not statistically significantly different between groups at any time. Mild paresis of the fingers occurred in 4 patients in the botulinum group at 4 weeks. One patient's symptoms persisted until week 12, whereas none of the patients receiving placebo had the same complaint. At 4 weeks, 10 patients in the botulinum group and 6 patients in the placebo group experienced weak finger extension on the same side as the injection site. LIMITATIONS: The trial was small, and most participants were women. The blinding protocol may have been ineffective because the 4 participants who experienced paresis of the fingers could have correctly assumed that they received an active treatment. CONCLUSIONS: Botulinum toxin injection may improve pain over a 3-month period in some patients with lateral epicondylitis, but injections may be associated with digit paresis and weakness of finger extension.
Publication Types:
PMID: 16330790 [PubMed - indexed for MEDLINE]
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Original report in:
Summaries for patients. Botulinum toxin as a treatment for tennis elbow.
[No authors listed]
Publication Types:
PMID: 16330786 [PubMed - indexed for MEDLINE]
Comment on:
Pre-emptive analgesia with thoracic paravertebral blockade?
Lonnqvist PA.
Publication Types:
PMID: 16286347 [PubMed - indexed for MEDLINE]
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Analgesic and antacid properties of i.m. tramadol given before Caesarean section under general anaesthesia.
Elhakim M, Abd El-Megid W, Metry A, El-hennawy A, El-Queseny K.
Department of Anaesthesia, Faculty of Medicine, Ain-Sham University, Cairo, Egypt. mokhtar.elhakim@gmail.com
BACKGROUND: Intramuscular (i.m.) tramadol increases gastric pH during anaesthesia similar to famotidine. We investigated the antacid analgesic value of a single dose of i.m. tramadol given 1 h before elective Caesarean section performed under general anaesthesia. METHODS: Sixty ASA I parturients undergoing elective Caesarean section were included in a randomized double-blind study. The patients were randomly allocated to receive i.m. tramadol 100 mg (n=30) or famotidine 20 mg (n=30) 1 h before general anaesthesia. RESULTS: At the beginning and the end of anaesthesia, patients receiving tramadol had a median gastric fluid pH of 6.4, which was not significantly different from those treated with famotidine (median 6.3). The infant well-being, as judged by Apgar score, cord blood gas analysis, and neurobehavioural assessment showed no significant difference between the two groups. Nalbuphine consumption in the first 24 h after operation was reduced by 35% in the tramadol group. Pain intensity score on sitting and sedation were significantly greater in famotidine group up to 24 h after surgery. There was no significant difference in incidence and severity of nausea and vomiting between the two groups. CONCLUSION: A single i.m. dose of tramadol is useful pre-treatment to minimize the risk of acid aspiration during operation, and in improving pain relief during 24 h after surgery.
Publication Types:
PMID: 16227335 [PubMed - indexed for MEDLINE]
Nitric oxide and its modulators in chronic constriction injury-induced neuropathic pain in rats.
Naik AK, Tandan SK, Kumar D, Dudhgaonkar SP.
Division of Pharmacology and Toxicology, Indian Veterinary Research Institute, Izatnagar-243 122 (U.P.), India.
This study was conducted to examine the role of nitric oxide (NO) in peripheral neuropathy induced by chronic constriction injury of sciatic nerve of rats by using NO precursor, NO donors and nitric oxide synthase (NOS) inhibitors. Chronic constriction injury of sciatic nerve of rats resulted in peripheral neuropathy as confirmed by nociceptive behavioural tests using mechanical, thermal and cold allodynia. NO precursor, l-arginine and NO donors sodium nitroprusside, S-nitroso-N-acetylpenicillamine potentiated the hyperalgesia and allodynia significantly suggesting proalgesic effect in neuropathic rats. Intracerebroventricular (i.c.v.) administration of rats with NOS inhibitors such as l-N(G)-nitroarginine methyl ester, N-iminoethyl lysine and 7-nitroindazole did not show any effect but i.p. administration of NOS inhibitors aminoguanidine, l-N(G)-nitroarginine methyl ester and 7-nitroindazole caused alleviation of pain. The study confirms the involvement of endogenously synthesized and exogenously administered NO in chronic constriction injury-induced neuropathy in rats. Significant increase in the levels of nitrate and nitrite in ligated sciatic nerve suggest that local up regulation of NO in the production and maintenance of neuropathic pain. In conclusion, initial attempt to manipulate l-arginine: NO pathway is indicative of therapeutic potential of these interventions in the management of neuropathic pain.
PMID: 16364289 [PubMed - in process]
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Benfotiamine relieves inflammatory and neuropathic pain in rats.
Sanchez-Ramirez GM, Caram-Salas NL, Rocha-Gonzalez HI, Vidal-Cantu GC, Medina-Santillan R, Reyes-Garcia G, Granados-Soto V.
Departamento de Farmacobiologia, Centro de Investigacion y de Estudios Avanzados-Coapa, Calzada de los Tenorios 235, Colonia Granjas Coapa, 14330 Mexico, D.F., Mexico.
Benfotiamine has shown therapeutic efficacy in the treatment of painful diabetic neuropathy in human beings. However, so far there is no evidence about the efficacy of this drug in preclinical models of pain. The purpose of this study was to assess the possible antinociceptive and antiallodynic effect of benfotiamine in inflammatory and neuropathic pain models in the rat. Inflammatory pain was induced by injection of formalin in non-diabetic and diabetic (2 weeks) rats. Reduction of flinching behavior was considered as antinociception. Neuropathic pain was induced by either ligation of left L5/L6 spinal nerves or administration of streptozotocin (50 mg/kg, i.p.) in Wistar rats. Benfotiamine significantly reduced inflammatory (10-300 mg/kg) and neuropathic (75-300 mg/kg) nociception in non-diabetic and diabetic rats. Results indicate that oral administration of benfotiamine is able to reduce tactile allodynia from different origin in the rat and they suggest the use of this drug to reduce inflammatory and neuropathic pain in humans.
PMID: 16359659 [PubMed - in process]
Comment on:
Routine vs selective invasive strategies in acute coronary syndromes.
Carbajal EV.
Publication Types:
PMID: 16352788 [PubMed - indexed for MEDLINE]
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Comment on:
Routine vs selective invasive strategies in acute coronary syndromes.
Bavry AA, Kumbhani DJ.
Publication Types:
PMID: 16352787 [PubMed - indexed for MEDLINE]
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Lead poisoning--a differential diagnosis for abdominal pain.
Frith D, Yeung K, Thrush S, Hunt BJ, Hubbard JG.
Department of Surgery, St Thomas' Hospital, London SE1 7EH, UK. danielfrith@hotmail.com
Publication Types:
PMID: 16360796 [PubMed - indexed for MEDLINE]
Comment on:
Herpes zoster and the prevention of postherpetic neuralgia: beyond antiviral therapy.
Tenser RB, Dworkin RH.
Publication Types:
PMID: 16087894 [PubMed - indexed for MEDLINE]
A PET activation study of brush-evoked allodynia in patientswith nerve injury pain.
Witting N, Kupers RC, Svensson P, Jensen TS.
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark; CFIN, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Acute experimental brush-evoked allodynia induces a cortical activation pattern that differs from that typically seen during experimental nociceptive pain. In this study, we used positron emission tomography to measure changes in regional cerebral blood flow (rCBF) in patients with clinical allodynia. Nine patients with peripheral nerve injury were scanned during rest, brush-evoked allodynia, and brushing of normal contralateral skin. PET data were analyzed for the whole group and for single subjects. Allodynic stimulation activated the contralateral orbitofrontal cortex (BA 11) in every patient. Whereas normal brushing activated most strongly the contralateral insular cortex, allodynic brushing produced an ipsilateral activation in this area. Another important difference between normal and allodynic brushing was the absence of a contralateral primary somatosensory cortex (SI) activation during allodynic brushing. No thalamic activation was observed during allodynic or control brushing. Although no anterior cingulate cortex (ACC) activation could be demonstrated in the group analysis, single subject analysis revealed that four patients activated this region during brush-evoked allodynia. A direct post hoc comparison of brush -and allodynia-induced rCBF changes showed that allodynia was associated with significantly stronger activations in orbitofrontal cortex and ipsilateral insula whereas non-painful brushing more strongly activated SI and BA 5/7. These findings indicate that activity in the cortical network involved in the sensory-discriminative processing of nociceptive pain is downregulated in neuropathic pain. Instead, there is an upregulation of activity in the orbitofrontal and insular cortices, which is probably due to the stronger emotional load of neuropathic pain and higher computational demands of processing a mixed sensation of brush and pain.
PMID: 16368192 [PubMed - in process]
Neural correlates of individual differences in pain-related fear and anxiety.
Ochsner KN, Ludlow DH, Knierim K, Hanelin J, Ramachandran T, Glover GC, Mackey SC.
Department of Psychology, Columbia University, Schermerhorn Hall, 1190 Amsterdam Avenue, New York, NY 10027, USA.
Although individual differences in fear and anxiety modulate the pain response and may even cause more suffering than the initiating physical stimulus, little is known about the neural systems mediating this relationship. The present study provided the first examination of the neural correlates of individual differences in the tendency to (1) feel anxious about the potentially negative implications of physical sensations, as measured by the anxiety sensitivity index (ASI), and (2) fear various types of physical pain, as indexed by the fear of pain questionnaire (FPQ). In separate sessions, participants completed these questionnaires and experienced alternating blocks of noxious thermal stimulation (45-50 degrees C) and neutral thermal stimulation (38 degrees C) during the collection of whole-brain fMRI data. Regression analyses demonstrated that during the experience of pain, ASI scores predicted activation of a medial prefrontal region associated with self-focused attention, whereas FPQ scores predicted activation of a ventral lateral frontal region associated with response regulation and anterior and posterior cingulate regions associated with monitoring and evaluation of affective responses. These functional relationships cannot be wholly explained by generalized anxiety (indexed by STAI-T scores), which did not significantly correlate with activation of any regions. The present findings may help clarify both the impact of individual differences in emotion on the neural correlates of pain, and the roles in anxiety, fear, and pain processing played by medial and orbitofrontal systems.
PMID: 16364548 [PubMed - in process]
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The effects of noxious heat, auditory stimulation, a cognitive task, and time on task on pain perception and performance accuracy in healthy volunteers: A new experimental model.
Pud D, Sapir S.
Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, 31905 Haifa, Israel.
The effects of cognitive and competing sensory processing tasks on pain perception and as a function of time are only partially understood. To study these effects, we compared the simultaneous effects of noxious heat stimulation (HS), auditory stimulation (AS) (sinusoidally modulated speech-like signal, SMSLS), and a cognitive task (CT) (rate change detection of the SMSLS) on pain perception and task performance over repeated experimental runs. Sixty healthy paid volunteers were randomly assigned to four groups, one exposed to AS while performing the CT, one to HS (46 degrees C/6min), one to AS and HS, and one to AS and HS while performing the CT. Each group performed the experimental run four times, each run for 6min. Immediately after each run, the subjects rated pain intensity using a VAS (0-100). Two-way RM-ANOVA for analyzing pain intensities among the three heat pain groups demonstrated significant differences of VAS ratings (F(2,179)=4.57, P=0.019), being highest in the HS group (55+/-0.7SEM), followed by the AS+HS (39+/-6.8) and AS+HS+CT (33+/-0.7) groups. Post-hoc analyses revealed that group HS differed significantly from group AS+HS+CT and from group AS+HS (P<0.05, SNK), whereas group AS+HS did not differ significantly from group AS+HS+CT. Neither pain rating, nor rate of errors on the CT varied significantly across runs. These findings point to a significant influence of competing passive sensory processing on pain perception, with the cognitive task not necessarily adding to the perception of pain. Advantages and shortcomings of the present experimental model for future pain studies are discussed.
PMID: 16361060 [PubMed - in process]
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Unpleasant odors increase pain processing in a patient with neuropathic pain: Psychophysical and fMRI investigation.
Villemure C, Wassimi S, Bennett GJ, Shir Y, Bushnell MC.
McGill Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.
A 49-year old man with neuropathic pain in his right elbow, wrist and digits III-V of his hand reported that certain odors increased his pain by superimposing an electric shock-like pain to his already existing pain. Psychophysical testing revealed that the best predictor of pain exacerbation was odor unpleasantness. Functional magnetic resonance imaging (fMRI) showed increased activation following an unpleasant odor in pain related areas, including the thalamus, amygdala, insular and anterior cingulate cortices, with similar trends in primary somatosensory cortex hand/arm area. The increased pain and associated neural activations in response to unpleasant odors may be related to the phenomenon of synesthesia, to a rewiring of olfactory pathways onto pain pathways mimicking synesthesia or, to activation of the sympathetic nervous system.
PMID: 16361059 [PubMed - in process]
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Worrying about chronic pain. An examination of worry and problem solving in adults who identify as chronic pain sufferers.
De Vlieger P, Crombez G, Eccleston C.
Faculty of Psychology and Educational Sciences, Ghent University, Belgium; Research Institute for Psychology and Health, The Netherlands.
Worry is a common feature of chronic pain. The purpose of this study was to examine the extent of worry experienced by adults with chronic pain, and to explore features of problem solving associated with worry and chronic pain. A further purpose was to investigate whether there were differences in worry and problem solving for those presenting at a pain clinic for treatment, compared to those who identified as chronic pain sufferers but who were not presenting for treatment. A final purpose was to examine whether the extent of worry and problem solving attitudes helped to predict the primary clinical features of chronic pain such as intensity, disability and depressive mood. One hundred and eighty five adults with chronic pain provided completed questionnaires assessing worrying, problem solving, pain severity, disability, catastrophic thinking and depressive mood. Analyses showed that worry and problem solving approaches sampled in this study were not abnormal. Furthermore, no differences were found between the clinical and non-clinical sample for worrying and problem solving. In relation to the predictive value of worrying and problem solving, analyses revealed that only worrying had a unique contribution in explaining depressive mood. The results are discussed within a context of a model of worry and chronic pain, in which worry about chronic pain may be functioning to promote awareness of an insoluble problem.
PMID: 16360276 [PubMed - in process]
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Persistence of low back pain reporting among a cohort of employees in a metal corporation: A study with 5-, 10-, and 28-year follow-ups.
Kaaria S, Luukkonen R, Riihimaki H, Kirjonen J, Leino-Arjas P.
Department of Health Sciences, University of Jyvaskyla, Tietajankatu 28, 53100 Lappeenranta, Finland.
Low back pain (LBP) is a common symptom among adults but little is known about its persistence over time in defined populations. The aim of this study was to examine the persistence of LBP among a cohort of industrial employees studied in four successive surveys during a total of 28 years. Cross-tabulations and logistic regression was used to estimate the interdependence of LBP occurrence at the surveys. At baseline, 54% of the subjects reported local LBP and 25% LBP radiating to the lower limb(s). Persistent or recurrent LBP was common. Of those with LBP at baseline, 75, 73, and 88% reported it also at the 5-, 10- or 28-year follow-up, respectively. Of those with radiating pain, 66, 65, and 69% were symptomatic 5, 10, or 28 years later. The onset of reporting LBP increased during follow-up. Of those without local LBP at baseline, 33, 37 and 64% had pain at the 5-, 10-, or 28-year follow-up, respectively. Of those without radiating LBP, 17, 22, and 46% had pain at the 5-, 10-, or 28-year follow-up. The odds ratio of local LBP at the 5-, 10-, or 28-year follow-up for those with such pain at baseline vs. not were 6.0 (95% CI 4.3-8.3), 4.7 (3.3-6.6) and 4.0 (2.6-6.3), adjusted for age, gender and occupational class. The respective figures for radiating LBP were 8.5 (5.7-12.5), 6.7 (4.4-10.1) and 2.3 (1.5-3.6). We conclude that LBP is commonly recurrent.
PMID: 16360271 [PubMed - in process]
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GW274150, a novel and highly selective inhibitor of the inducible isoform of nitric oxide synthase (iNOS), shows analgesic effects in rat models of inflammatory and neuropathic pain.
De Alba J, Clayton NM, Collins SD, Colthup P, Chessell I, Knowles RG.
Department of Respiratory Pharmacology, RI CEDD GlaxoSmithKline Research and Development, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, UK.
Nitric oxide (NO), synthesised by different isoforms of nitric oxide synthase (NOS), has been linked with the development and maintenance of nociception. We studied the role of the inducible isoform, iNOS, in two different rat pain models with an inflammatory component. iNOS was immunohistochemically detected locally in the paw 6h after Freund's Complete Adjuvant (FCA) injection, showing a plateau at 24-72h and falling slowly in the following weeks. This correlated with the late phase of the hypersensitivity to pain revealed in the behavioural tests. A highly selective iNOS inhibitor GW274150 (1-30mg/kg orally, 24h after FCA) suppressed the accumulation of nitrite in the inflamed paw indicating substantial iNOS inhibition. At the same time it partially reversed FCA-induced hypersensitivity to pain and edema in a dose-dependent manner. After Chronic Constriction Injury (CCI) surgery to the sciatic nerve, iNOS presence was only detected locally in the region of the nerve (inflammatory cells). GW274150 (3-30mg/kg orally, 21 days after surgery) also reversed significantly the CCI-associated hypersensitivity to pain. No iNOS was detectable in dorsal root ganglia, spinal cord or brain in either model. This study demonstrates a role for peripherally-expressed iNOS in pain conditions with an inflammatory component and the potential value of iNOS inhibitors in such conditions.
PMID: 16360270 [PubMed - in process]
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Deep brain stimulation for chronic pain: Can it help?
Raslan AM.
Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Publication Types:
PMID: 16360268 [PubMed - in process]
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Increased taste intensity perception exhibited by patients with chronic back pain.
Small DM, Apkarian AV.
The John B Pierce Laboratory, Yale University, New Haven, CT, USA; Department of Surgery, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA.
There is overlap between brain regions involved in taste and pain perception, and cortical injuries may lead to increases as well as decreases in sensitivity to taste. Recently it was shown that chronic back pain (CBP) is associated with a specific pattern of brain atrophy. Since CBP is characterized by increased sensitivity to pain, we reasoned that the sense of taste might also be enhanced in CBP. Detection and recognition thresholds were established for a sour taste and ratings of both suprathreshold taste intensity and pleasantness-unpleasantness perception were collected for sweet, sour, salty and bitter stimuli in 11 CBP patients and 11 matched control subjects. As a control, ratings were also collected for visual assessment of degree of grayness. There was no difference between CBP and control subjects for visual grayness rating. On the other hand, CBP patients in comparison to control subjects rated gustatory stimuli as significantly more intense but no more or less pleasant and showed a trend towards a lower detection threshold (i.e. increased sensitivity). The selectivity of the taste disturbance suggests interaction between pain and taste at specific brain sites and provides further evidence that CBP involves specific brain abnormalities.
PMID: 16360267 [PubMed - in process]
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The role of developmental factors in predicting young children's use of a self-report scale for pain.
Stanford EA, Chambers CT, Craig KD.
Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4; Centre for Community Child Health Research, BC Research Institute for Children's and Women's Health, Vancouver, BC, Canada.
Accurate pain assessment is the foundation for effective pain management in children. At present, there is no clear consensus regarding the age at which young children are able to appropriately use self-report scales for pain. This study examined young children's ability to use the Faces Pain Scale-Revised; (FPS-R; [Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain 2001; 93: 173-83]) for pain in response to vignettes and investigated the role of developmental factors in predicting their ability to use the scale. One hundred and twelve healthy children (3-6 years old) were assessed for their ability to accurately use a common faces scale to rate pain in hypothetical vignettes depicting pain scenarios common in childhood. Accuracy was determined by considering whether children's judgements of pain severity matched the pain severity depicted in the various vignettes. Children were also administered measures of numerical reasoning, language, and overall cognitive development. Results indicated that 5- and 6-year-old children were significantly more accurate in their use of the FPS-R in response to the vignettes than 4-year-old children, who in turn were significantly more accurate than 3-year-old children. However, over half of the 6-year-olds demonstrated difficulties using the FPS-R in response to the vignettes. Child age was the only significant predictor of children's ability to use the scale in response to the vignettes. Thus, a substantial number of young children experienced difficulties using the FPS-R when rating pain in hypothetical vignettes, although the ability to use the scale did improve with age.
PMID: 16359800 [PubMed - in process]
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Referred pain and hyperalgesia in human tendon and muscle belly tissue.
Gibson W, Arendt-Nielsen L, Graven-Nielsen T.
Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D-3, DK-9220 Aalborg, Denmark.
The sensitivity of tendon and tendon-bone junction is not fully described although these tissues have high clinical impacts. This study assessed (1) pain intensity and referred pain caused by hypertonic saline injection to the proximal tendon-bone junction (PTBJ), tendon and muscle belly sites of tibialis anterior muscle and (2) pressure pain sensitivity, pre, during and post hypertonic saline injections. Eighteen subjects (14 males and 4 females) participated. Subjects also had constant mechanical stimulation for 120s at 130% of baseline pressure pain threshold (PPT) during which VAS parameters were recorded. VAS parameters after hypertonic saline for PTBJ (VAS area, VAS peak), and tendon sites (VAS area, duration and time to maximum VAS) were significantly (P<0.05) higher than muscle belly. During hypertonic saline pain all three sites displayed local and frequently enlarged and referred pain areas. Hypertonic saline pain at the PTBJ and tendon transiently increased pressure sensitivity at these sites (P<0.05). When referred pain was caused by mechanical stimulation it occurred predominantly at the PTBJ and tendon sites (86% cases). Constant mechanical stimulation caused steadily increasing pain (summation of pain) at all sites. Hypertonic saline pain at the tendon and PTBJ caused significantly higher (P<0.001) final VAS scores compared to the muscle belly site. The results indicate the PTBJ and tendon sites are more sensitive and susceptible to sensitisation by hypertonic saline than muscle belly. Furthermore, there may be site specific central changes reflected by the differences in the results regarding sensitivity and summation over time.
PMID: 16359798 [PubMed - in process]
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Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability.
Swinkels-Meewisse IE, Roelofs J, Oostendorp RA, Verbeek AL, Vlaeyen JW.
Department of Medical, Clinical, and Experimental Psychology, University of Maastricht, Maastricht, The Netherlands; Practice of Physical Therapy and Manual Therapy, Geldrop, The Netherlands.
Pain-related fear and pain catastrophizing are associated with disability and actual performance in chronic pain patients. In acute low back pain (LBP), little is known about the prediction of actual performance or perceived disability by pain-related fear and pain catastrophizing. This experimental, cross-sectional study aimed at examining whether pain-related fear and pain catastrophizing were associated with actual performance and perceived disability. Ninety six individuals with an episode of acute LBP performed a dynamic lifting task to measure actual performance. Total lifting time was used as outcome measure. The results show that pain-related fear, as measured with the Tampa Scale for Kinesiophobia, was the strongest predictor of this physical task. Using the Roland Disability Questionnaire as a measure of perceived disability, both pain-related fear and pain catastrophizing, as measured with the Pain Catastrophizing Scale, were significantly predictive of perceived disability and more strongly than pain intensity was. The results of the current study suggest that pain-related fear is an important factor influencing daily activities in individuals suffering an episode of acute LBP. The study results have important clinical implications, especially in the development of preventive strategies for chronic LBP.
PMID: 16359797 [PubMed - in process]
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Deep brain stimulation for the alleviation of post-stroke neuropathic pain.
Owen SL, Green AL, Stein JF, Aziz TZ.
University Laboratory of Physiology, University of Oxford, Oxford, UK.
Our aim was to asses the efficacy of deep brain stimulation in post-stroke neuropathic pain. Since 2000, 15 patients with post-stroke intractable neuropathic pain were treated with deep brain stimulation of the periventricular gray area (PVG), sensory thalamus (Ventroposterolateral nucleus-VPL) or both. Pain was assessed using both a visual analogue scale and the McGill's pain questionnaire. VAS scores show a mean improvement of 48.8% (SD 8.6%). However, there is a wide variation between patients. This study demonstrates that it is an effective treatment in 70% of such patients.
PMID: 16359796 [PubMed - in process]
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The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain.
Meredith PJ, Strong J, Feeney JA.
Division of Occupational Therapy, The University of Queensland, St Lucia Queensland, Brisbane, Queensland, 4072 Australia.
Although insecure attachment has been associated with a range of variables linked with problematic adjustment to chronic pain, the causal direction of these relationships remains unclear. Adult attachment style is, theoretically, developmentally antecedent to cognitions, emotions and behaviours (and might therefore be expected to contribute to maladjustment). It can also be argued, however, that the experience of chronic pain increases attachment insecurity. This project examined this issue by determining associations between adult attachment characteristics, collected prior to an acute (coldpressor) pain experience, and a range of emotional, cognitive, pain tolerance, intensity and threshold variables collected during and after the coldpressor task. A convenience sample of 58 participants with no history of chronic pain was recruited. Results demonstrated that attachment anxiety was associated with lower pain thresholds; more stress, depression, and catastrophizing; diminished perceptions of control over pain; and diminished ability to decrease pain. Conversely, secure attachment was linked with lower levels of depression and catastrophizing, and more control over pain. Of particular interest were findings that attachment style moderated the effects of pain intensity on the tendency to catastrophize, such that insecurely attached individuals were more likely to catastrophize when reporting high pain intensity. This is the first study to link attachment with perceptions of pain in a pain-free sample. These findings cast anxious attachment as a vulnerability factor for chronic pain following acute episodes of pain, while secure attachment may provide more resilience.
PMID: 16359795 [PubMed - in process]
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Chronobiological characteristics of painful diabetic neuropathy and postherpetic neuralgia: Diurnal pain variation and effects of analgesic therapy.
Odrcich M, Bailey JM, Cahill CM, Gilron I.
Department of Anesthesiology, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, Canada K7L 2V7.
Clinical impressions suggest that neuropathic pain is often worse at night and significantly impairs sleep. However, the temporal pattern of neuropathic pain during waking hours has not been clearly characterized. Using clinical trial data, we have evaluated the diurnal variation of pain intensity before and during analgesic treatment in patients with diabetic neuropathy (DN) and postherpetic neuralgia (PHN). Pain intensity (0-10) measures throughout the day from a placebo-controlled trial of around-the-clock administration of gabapentin, morphine and a gabapentin-morphine combination in neuropathic pain patients were examined. Baseline data in untreated patients revealed no effect of day of week but a significant effect of time of day in both DN (P<0.001) and PHN (P<0.001) such that pain intensity progressively increases throughout the day. This temporal pattern is essentially preserved during treatment with gabapentin, morphine and their combination. Neuropathic pain intensity progressively increases throughout the day and this temporal profile appears to be unaffected by treatment with gabapentin and/or morphine. Advancing our understanding of the chronobiology of neuropathic pain may shed new light on various neurohormonal and neurophysiologic influences and lead to the identification of novel therapeutic targets. Furthermore, recognizing diurnal pain patterns may guide treatment strategies such as the targeted timing of analgesic therapies.
PMID: 16359793 [PubMed - in process]
Promoting science in a pragmatic world: not (yet) time for partial opioid rotation.
Strasser F.
Publication Types:
PMID: 16010530 [PubMed - indexed for MEDLINE]
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