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Items 1 - 47 of 47 |
One page. |
Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads.
Liem EB, Joiner TV, Tsueda K, Sessler DI.
Outcomes Research Institute and Department of Anesthesiology and Perioperative Medicine, Louisville, Kentucky 40202, USA.
BACKGROUND: Anesthetic requirement in redheads is exaggerated, suggesting that redheads may be especially sensitive to pain. Therefore, the authors tested the hypotheses that women with natural red hair are more sensitive to pain and that redheads are resistant to topical and subcutaneous lidocaine. METHODS: The authors evaluated pain sensitivity in red-haired (n = 30) or dark-haired (n = 30) women by determining the electrical current perception threshold, pain perception, and maximum pain tolerance with a Neurometer CPT/C (Neurotron, Inc., Baltimore, MD). They evaluated the analogous warm and cold temperature thresholds with the TSA-II Neurosensory Analyzer (Medoc Ltd., Minneapolis, MN). Volunteers were tested with both devices at baseline and with the Neurometer after 1-h exposure to 4% liposomal lidocaine and after subcutaneous injection of 1% lidocaine. Data are presented as medians (interquartile ranges). RESULTS: Current perception, pain perception, and pain tolerance thresholds were similar in the red-haired and dark-haired women at 2,000, 250, and 5 Hz. In contrast, redheads were more sensitive to cold pain perception (22.6 [15.1-26.1] vs. 12.6 [0-20] degrees C; P = 0.004), cold pain tolerance (6.0 [0-9.7] vs. 0.0 [0.0-2.0] degrees C; P = 0.001), and heat pain (46.3 [45.7-47.5] vs. 47.7 [46.6-48.7] degrees C; P = 0.009). Subcutaneous lidocaine was significantly less effective in redheads (e.g., pain tolerance threshold at 2,000-Hz stimulation in redheads was 11.0 [8.5-16.5] vs. > 20.0 (14.5 to > 20) mA in others; P = 0.005). CONCLUSION: Red hair is the phenotype for mutations of the melanocortin-1 receptor. Results indicate that redheads are more sensitive to thermal pain and are resistant to the analgesic effects of subcutaneous lidocaine. Mutations of the melanocortin-1 receptor, or a consequence thereof, thus modulate pain sensitivity.
PMID: 15731586 [PubMed - in process]
 
The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial [ISRCTN87413556].
Das DA, Grimmer KA, Sparnon AL, McRae SE, Thomas BH.
Centre of Allied Health Evidence, University of South Australia, Adelaide, Australia. debashish.das@unisa.edu.au <debashish.das@unisa.edu.au>
BACKGROUND: The management of burn injuries is reported as painful, distressing and a cause of anxiety in children and their parents. Child's and parents' pain and anxiety, often contributes to extended time required for burns management procedures, in particular the process of changing dressings. The traditional method of pharmacologic analgesia is often insufficient to cover the burnt child's pain, and it can have deleterious side effects 12. Intervention with Virtual Reality (VR) games is based on distraction or interruption in the way current thoughts, including pain, are processed by the brain. Research on adults supports the hypothesis that virtual reality has a positive influence on burns pain modulation. METHODS: This study investigates whether playing a virtual reality game, decreases procedural pain in children aged 5-18 years with acute burn injuries. The paper reports on the findings of a pilot study, a randomised trial, in which seven children acted as their own controls though a series of 11 trials. Outcomes were pain measured using the self-report Faces Scale and findings of interviews with parent/carer and nurses. RESULTS: The average pain scores (from the Faces Scale) for pharmacological analgesia only was, 4.1 (SD 2.9), while VR coupled with pharmacological analgesia, the average pain score was 1.3 (SD 1.8) CONCLUSION: The study provides strong evidence supporting VR based games in providing analgesia with minimal side effects and little impact on the physical hospital environment, as well as its reusability and versatility, suggesting another option in the management of children's acute pain.
PMID: 15745448 [PubMed - in process]
Recent developments in pain in dementia.
Scherder E, Oosterman J, Swaab D, Herr K, Ooms M, Ribbe M, Sergeant J, Pickering G, Benedetti F.
Centre of Human Movement Sciences, Rijksuniversiteit Groningen, A Deusinglaan 1, 9713 AV Groningen, Netherlands. eja.scherder@psy.vu.nl
Publication Types:
PMID: 15731144 [PubMed - indexed for MEDLINE]
Comment on:
Biomedical models and healthcare systems: new model will be useful if it alters allocation of resources.
Wright ES.
Publication Types:
PMID: 15718551 [PubMed - indexed for MEDLINE]
Comment on:
Epiduroscopy for lumbar spinal stenosis.
Nash TP.
Publication Types:
PMID: 15629909 [PubMed - indexed for MEDLINE]
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Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children.
Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H.
Department of Anesthesiology, Nara Medical University, Nara, Japan. ne6n-ssok@asahi-net.or.jp
BACKGROUND: Ilioinguinal and iliohypogastric (IG-IH) nerve block has been widely used in children undergoing inguinal hernia repair. This technique may provide insufficient analgesia for intraoperative management as the inguinal region may receive sensory innervation from genitofemoral nerve. We proposed that addition of a genitofemoral nerve block might improve the quality of analgesia. METHODS: Ninety-eight children undergoing inguinal hernia repair were assigned randomly to receive either IG-IH nerve block (Group I) or IG-IH and genitofemoral nerve blocks (Group II). Systolic arterial pressure (SAP) and heart rate (HR) were recorded before surgery (control), after skin incision, at sac traction and at the end of surgery. Postoperative analgesic requirements and incidence of complications were recorded until discharge. RESULTS: At sac traction, SAP and HR were significantly higher in Group I (P<0.05), and the incidence of episodes of increased HR was also significantly higher in Group II (29 vs 12%, respectively, P<0.05). There were no significant differences in SAP and HR at other time points, postoperative analgesic requirements or incidence of complications between the groups. CONCLUSIONS: The benefit of the additional genitofemoral nerve block to IG-IH nerve block was limited only to the time of sac traction without any postoperative effect. This suggests there is little clinical benefit in the addition of a genitofemoral nerve block.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15567812 [PubMed - indexed for MEDLINE]
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Chronic knee pain in a 21-year-old woman.
Alqueza AB, Dicaprio MR, Lindskog DM, Reith J, Scarborough MT.
College of Medicine, University of Florida, Gainesville, FL, USA.
Publication Types:
PMID: 15738832 [PubMed - in process]
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Lower body positive-pressure exercise after knee surgery.
Eastlack RK, Hargens AR, Groppo ER, Steinbach GC, White KK, Pedowitz RA.
Department of Orthopaedic Surgery, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA.
Lower body positive pressure allows unloading of the lower extremities during exercise in a pressurized treadmill chamber. This study assessed the preliminary feasibility of lower body positive pressure exercise as a rehabilitation technique by examining its effects on gait mechanics and pain, postoperatively. Fifteen patients who had arthroscopic meniscectomy or anterior cruciate ligament reconstruction participated in this study. Patients exercised for 5 minutes at 2.0 mph under three body weight conditions (normal body weight, 60% body weight, and 20% body weight) in random order. Bilateral ground reaction force, electromyographs, and dynamic knee range of motion were collected, and pain was assessed using a visual analog scale. Ground reaction forces for surgically treated and contralateral extremities were reduced 42% and 79% from normal body weight conditions when ambulating at 60% and 20% body weight, respectively. After meniscectomy, ambulatory knee range of motion decreased only at 20% body weight (37 degrees), compared with normal body weight conditions (49 degrees). Peak electromyographic activity of the biceps was maintained at all body weight conditions, whereas that of the vastus medialis was reduced at 20% body weight. Pain relief was significant with lower body positive pressure ambulation after anterior cruciate ligament reconstruction. This study showed that lower body positive pressure exercise is effective at reducing ground reaction forces, while safely facilitating gait postoperatively.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15685078 [PubMed - indexed for MEDLINE]
Testing the sequential model of pain processing in irritable bowel syndrome: a structural equation modeling analysis.
Lackner JM, Jaccard J, Blanchard EB.
Behavioral Medicine Clinic, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, State University of New York, ECMC, 462 Grider Street, Buffalo, NY 14215, USA.
Pain, the cardinal feature of irritable bowel syndrome (IBS), is a multidimensional phenomenon with sensory and affective dimensions. Price's [Psychological Mechanisms of Pain and Analgesia, 1999] pain processing model was used to delineate four a priori sequentially related stages (pain sensation intensity, immediate pain unpleasantness, long-term suffering, and pain-related behavior). Although prior research with both healthy individuals and somatic pain patients supports the model in general, its applicability to IBS is unclear. Our goal was to extend the scope of the sequential model and test its fundamental tenets using structural equation modeling (SEM) with data obtained from 168 Rome II diagnosed IBS patients (19% male, 81% female). A secondary goal was to assess the relationship between a set of contextual factors associated with IBS (age, gender, trait anxiety) and the four pain stages. Results were consistent with a successive order of pain processing such that the pain sensation directly impacts pain unpleasantness, which, in turn, leads to suffering and illness behaviors. However, contrary to a model with strictly successive stages, pain sensation had independent effects on illness behaviors over and above pain affect. The effect of anxiety on illness behavior was mediated by suffering, while psychopathology directly influenced pain sensation and pain unpleasantness but not later stages. Age was related to pain sensation and illness behaviors but not pain affect. Gender tended to be more strongly associated with more distal pain stages (e.g., pain affect) vis-a-vis its effects on pain sensation. These data are generally supportive of a four-stage pain processing model.
PMID: 15737813 [PubMed - in process]
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Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms.
Svendsen KB, Andersen S, Arnason S, Arner S, Breivik H, Heiskanen T, Kalso E, Kongsgaard UE, Sjogren P, Strang P, Bach FW, Jensen TS.
Danish Pain Research Center, University Hospital of Aarhus, Noerrebrogade 44, Building 1A, 8000 Aarhus, Denmark.
Breakthrough pain or transient worsening of pain in patients with an ongoing steady pain is a well known feature in cancer pain patients, but it is also seen in non-malignant pain conditions with involvement of nerves, muscles, bones or viscera. Continuous and intermittent pain seems to be a general feature of these different pain conditions, and this raises the possibility of one or several common mechanisms underlying breakthrough pain in malignant and non-malignant disorders. Although the mechanisms of spontaneous ongoing pain and intermittent flares of pain (BTP) may be difficult to separate, we suggest that peripheral and/or central sensitization (hyperexcitability) may play a major role in many causes of BTP. Mechanical stimuli (e.g. micro-fractures) changes in chemical environments and release of tumour growth factors may initiate sensitization both peripherally and centrally. It is suggested that sensitization could be the common denominator of BTP in malignant and non-malignant pain.
PMID: 15737812 [PubMed - in process]
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Brain processing of tonic muscle pain induced by infusion of hypertonic saline.
Thunberg J, Lyskov E, Korotkov A, Ljubisavljevic M, Pakhomov S, Katayeva G, Radovanovic S, Medvedev S, Johansson H.
Center for Musculoskeletal Research, University of Gavle, P.O. Box 7629, S-907 12, Umea, Sweden.
Most of the previous studies on the effects of pain on Regional Cerebral Blood Flow (rCBF) had been done with brief cutaneous or intramuscular painful stimuli. The aim of the present study was to investigate the effect on rCBF of long lasting tonic experimental muscle pain. To this end we performed PET investigations of rCBF following tonic experimental low back pain induced by continuous intramuscular infusion of hypertonic (5%) saline (HS) with computer controlled infusion pump into the right erector spinae on L(3) level in 19 healthy volunteers. Changes in rCBF were measured with the use of (15)O labelled water during four conditions: Baseline (before start of infusion), Early Pain (4 min after start of infusion), Late Pain (20 min after start of infusion) and Post-Pain ( [Formula: see text] 15 min after stop of infusion) conditions. Results of SPM analysis showed relative rCBF increase in the right insula and bilateral decrease in the temporo-parieto-occipital cortex during initial phase of painful stimulation (Early Pain) followed by activation of the medial prefrontal region and bilateral inhibition of insula, anterior cingulate and dorso-lateral prefrontal cortex mainly in ipsilateral hemisphere during Late Pain conditions. The results show that longer lasting tonic experimental muscle pain elicited by i.m infusion of HS results in decreases rather than increases in rCBF. Possible explanations for differences found in rCBF during tonic hypertonic saline-induced experimental muscle pain as compared with previous findings are discussed.
PMID: 15737811 [PubMed - in process]
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Health care providers' orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity.
Houben RM, Ostelo RW, Vlaeyen JW, Wolters PM, Peters M, Stomp-van den Berg SG.
Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) differentiates between a biomedical versus a biopsychosocial treatment orientation with regard to common low back pain. This study re-examined the factor structure and psychometric properties of the PABS-PT, along with the relationship between PABS-PT scores and the perceived harmfulness of physical activities and treatment recommendations for common low back pain. Two hundred and ninety-seven paramedical therapists completed the PABS-PT and questionnaires measuring related concepts, rated the perceived harmfulness of 41 daily physical activities depicted in photographs and gave recommendations for return to normal activity for three patients with low back pain. Analysis revealed two factors labelled `biomedical' and `biopsychosocial treatment orientation'. Furthermore, scores on both factors of the PABS-PT were related to measures of related concepts (statistically significant Pearson correlation coefficients between 0.30 and 0.65) such as the HC-PAIRS and a therapist version of the TSK. Regression analyses revealed that both factors were consistent predictors of judgements of the harmfulness of physical activities (PHODA) and of recommendations for return to work and normal activity.
PMID: 15737810 [PubMed - as supplied by publisher]
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Imaging of acute versus pathological pain in humans.
Lorenz J, Casey KL.
Institute of Neurophysiology and Pathophysiology, University Clinic Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Pain subserves different functions. Acute pain from the intact body alerts the victim to immediately react and withdraw from the bodily threat, ideally before an injury happens. However, during manifest injury and tissue inflammation, withdrawal and flight are no longer adaptive. Instead, sparing the affected body part to promote healing requires heightened awareness and avoidance behaviour over longer periods of time. Quality and time scales of behavioural adaptations are therefore substantially different between pain during normal compared to abnormal tissue states. Given these functional differences we postulated that the two phenomena also recruit different forebrain systems. We used positron emission tomography (PET) and subtracted scans obtained during painful heating of normal skin from scans during equally intense but normally non-painful heating of capsaicin-treated skin. This comparison reveals the specific activation of a medial thalamic pathway to limbic forebrain structures such as anterior insula, perigenual anterior cingulate, ventral striatum, and prefrontal cortex during pain originating in the chemically sensitised skin. It is possible that the unique forebrain recruitment by pain under a patho-physiological tissue status is caused by a significantly greater facilitation of the multi-synaptic projections from the spino-parabrachial tract of the superficial dorsal horn to the medial thalamus compared to deeper and direct lateral thalamic projections from the spino-thalamic tract.
PMID: 15737808 [PubMed - in process]
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Can opioids prevent post-operative chronic pain?
Stubhaug A.
Department of Anaesthesiology, Rikshospitalet University Hospital, 0027 Oslo, Norway.
Chronic post-operative pain is a major source of suffering and disability. Better standardisation for assessing and reporting chronic post-operative pain is needed. Peripheral and central nervous plasticity seem to play a major role in the development of chronic post-injury pain. Complex mechanisms, including several receptor systems and messenger systems are involved. Thus, it is unlikely that one single agent will solve the problem. Opioids have proven effect both in animal models, experimental human models, and in some clinical models. Timing and dose seem to be of importance. However, it is likely that polypharmacy and multi-modal treatment is necessary to further improve the preventive strategy.
PMID: 15737806 [PubMed - in process]
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Opioids in chronic non-cancer pain, indications and controversies.
Breivik H.
Professor, Department of Anaesthesiology, Rikshospitalet University Hospital, N-0027 Oslo, Norway.
The use of opioid analgesics for long term management of chronic non-cancer pain is now an accepted, although still a controversial medical practice. In some well selected patients with long-lasting or recurrent pain, severe enough to markedly reduce their quality of life, and for whom no other more effective and less risky therapy is available, opioid analgesics may reduce intensity of pain, increase functioning and improve quality of life for prolonged periods. The type of pain and pain history of the patients do not predict reliably the chance of long term success or risk of complications from opioid therapy. However, the outlook for successful long term opioid therapy is better in a patient with a stable psychosocial situation having nociceptive type pain that is markedly relieved by a moderate dose of a long lasting oral or transdermal opioid, than a patient from a complex and unstable psychosocial background having neuropathic type pain that is relieved only partly by a higher dose of a potent opioid. When a patient is managed by a multidisciplinary team, the compliance is better and risk of loss of control and complications are less than when a single doctor is managing the patient. The evidence base for this type of pain management is meagre because the needed randomized controlled trials, which ideally should last for several years, have not been performed. Therefore a number of national and international guidelines are being published, recommending experts' opinion on appropriate use and responsible follow-up of long term treatment with opioids for chronic non-cancer pain.
PMID: 15737800 [PubMed - in process]
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Intravenous opioid testing in patients with chronic non-cancer pain.
Gustorff B.
Department of Anaesthesia and General Intensive Care Medicine (B), Medical University of Vienna, Wahringer Gurtel 18-20, A1090 Vienna, Austria.
The clinical use of an intravenous opioid testing can help to predict whether opioids will be beneficial. The determination of individual opioid responsiveness justifies subsequent long-term opioid treatment and is generally recommended. An overview over current testing procedures is given with particular regard to choice of opioid, maximum dose, determination of endpoints and duration of testing and recovery. Remifentanil testing is a new approch and is studied in a randomized placebo-controlled cross-over study in 24 patients suffering from severe non-cancer pain. An ascending infusion of remifentanil and placebo respectively was titrated against endpoints. The testing allowed a disctinction between 11 opioid-responders and 13 non-responders. Complete recovery after end of infusion was rapid with a reach of baseline conditions after 25 min in all patients. Thus the complete remifentanil testing procedure required at utmost 1 h. In conclusion, remifentanil testing offers a more rapid procedure allowing the routine use in an ambulatory setting.
PMID: 15737799 [PubMed - in process]
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Opioids in neuropathic pain: clues from animal studies.
Dickenson AH, Suzuki R.
Department of Pharmacology, University College, Gower Street, London WC1E 6BT, UK.
For many years the clinical consensus was that opioids were ineffective in neuropathic pain. However this view is changing and here we discuss the mechanisms of opioid analgesia in terms of the changes that can occur in preclinical models of nerve injury. We argue that opioid mechanisms can be perturbed by neuropathy but in most cases these negative influences can be overcome by dose-escalation.
PMID: 15737797 [PubMed - in process]
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Opioids for chronic nonmalignant and neuropathic pain.
Sandkuhler J, Kress HG.
Center of Brain Research, Department of Neurophysiology, Medical University of Vienna, A-1090 Vienna, Austria.
Publication Types:
PMID: 15737793 [PubMed - in process]
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The antinociceptive effect of Delta9-tetrahydrocannabinol in the arthritic rat.
Cox ML, Welch SP.
Virginia Commonwealth University, Department of Pharmacology and Toxicology, Medical College of Virginia, P.O. Box 980613, MCV Station, Richmond, VA 23298-0613, USA.
Our study addressed the hypothesis that spinal release of endogenous opioids underlies Delta9-tetrahydrocannabinol (Delta9-THC)-induced antinociception in Freund's adjuvant-induced arthritic and nonarthritic rats. The paw-pressure test was used to assess the antinociceptive effects of Delta9-THC versus those of morphine, and opioid and cannabinoid receptor-selective antagonists were used to characterize the involved receptors. Cerebrospinal fluid was collected after Delta9-THC injection (i.p.) for the measurement of endogenous opioid peptides. Our results indicate that morphine or Delta9-THC is equally potent and efficacious in both nonarthritic and arthritic rats. Delta9-THC-induced antinociception is attenuated by the kappa opioid receptor antagonist, nor-binaltorphimine, in arthritic rats only. Delta9-THC induces increased immunoreactive dynorphin A (idyn A) levels in nonarthritic rats while decreasing idyn A in arthritic rats. We hypothesize that the elevated idyn A level in arthritic rats contributes to hyperalgesia by interaction with N-methyl-D-aspartate receptors, and that Delta9-THC induces antinociception by decreasing idyn A release. Copyright 2004 Elsevier B.V.
PMID: 15189765 [PubMed - indexed for MEDLINE]
Comment on:
Acetaminophen in cancer pain.
Hardy J, Reymond E, Charles M.
Publication Types:
PMID: 15735139 [PubMed - indexed for MEDLINE]
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The "pain pen" for breakthrough cancer pain: a promising treatment.
Enting RH, Mucchiano C, Oldenmenger WH, Fritzon M, Wallen A, Goslinga-van der Gaag S, Sillevis Smitt PA, Delhaas E.
Daniel den Hoed Cancer Center, Erasmus Medical Center, Rotterdam, The Netherlands.
Breakthrough pain has been recognized as a challenging pain phenomenon in cancer. Oral transmucosal fentanyl citrate (OTFC) recently has been recommended as treatment, but OTFC is not widely available. Therefore, alternatives are needed. In two separate pilot studies, 58 patients were instructed to self-administer subcutaneous (SC) rescue opioids (hydromorphone (n=43), morphine (n=11), or sufentanil (n=4), using a standard injection-pen for breakthrough pain. Patients were asked to rate the overall efficacy of SC rescue opioids on a 3-point scale (not noticeable, moderate, or good). The efficacy was rated as good in 49 patients (84%, 95% CI: 73-91%), moderate in 8 patients (14%), and not noticeable in 1 patient (2%). The median dose per injection was equianalgesic to 25 mg of SC morphine (range: 4-150 mg). Twenty-nine patients (50%) were treated until death (n=26) or were on ongoing treatment (n=3). Patients were treated for a median of 6 weeks (1 day-41 months).
PMID: 15733812 [PubMed - in process]
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Morphine in intrasite gel applied topically to painful ulcers.
Zeppetella G, Ribeiro MD.
Publication Types:
PMID: 15733803 [PubMed - in process]
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Re: Use of strong opioids in advanced cancer pain.
Hanks GW, Reid C, Forbes K.
Publication Types:
PMID: 15733798 [PubMed - in process]
Comment in:
Changes in the proportion and volume of care provided to children by generalists and subspecialists.
Freed GL, Nahra TA, Venus PJ, Schech SD, Wheeler JR.
Division of General Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA. gfreed@med.umich.edu
OBJECTIVE: To assess whether primary care physicians, via referrals or other mechanisms, are now providing proportionally less care for children with specific common diagnoses, thus driving greater demand for specialist services. STUDY DESIGN: Secondary data analysis (1993-2001) from one of the largest commercial healthcare organizations in the United States. Evaluation and management (E/M) common procedural terminology (CPT) visit codes and International Classification of Diseases (ICD) codes pertaining to asthma, constipation, headache, and heart murmurs were selected. Visits were then assigned to the specialty of physician providing care. Significant differences between and among categories of physicians were tested using logistic regression. RESULTS: Overall, pediatrician generalists and specialists provided a greater proportion of E/M visits to children in 2001 than in 1993, compared with nonpediatrician providers. However, although the absolute increase in the proportion of all E/M visits by children <18 years of age to pediatrician generalists was greater than that of pediatrician subspecialists (4.77% vs 0.69%; P <.0001), the relative increase was much smaller for the generalists (8.9% vs 19.7%; P <.0001). Findings were consistent for most of the specific diagnoses examined. CONCLUSIONS: The increases in both the proportion and number of visits made to specialists has not been accompanied by a decrease in visits to generalists.
PMID: 15644815 [PubMed - indexed for MEDLINE]
Corticosteroids, ibuprofen, and acetaminophen for IFNbeta-1a flu symptoms in MS: a randomized trial.
Rio J, Nos C, Bonaventura I, Arroyo R, Genis D, Sureda B, Ara JR, Brieva L, Martin J, Saiz A, Sanchez Lopez F, Prieto JM, Roquer J, Dorado JF, Montalban X.
Centres H. Vall d'Hebron, Barcelona, Spain. jrio@vhebron.net
OBJECTIVE: To compare the efficacy of acetaminophen, ibuprofen, and prednisone in the treatment of interferon beta-1a (IFNbeta-1a) flu-like syndrome (FLS). METHODS: Patients with relapsing-remitting multiple sclerosis initiating treatment with IM IFNbeta-1a were randomized in a multicenter, randomized, double-blind, controlled trial to receive acetaminophen 500 mg before and 6 and 12 hours after each injection, ibuprofen 400 mg before and 6 and 12 hours after each injection, or prednisone 60 mg daily for 1 week, plus tapering. Patients were instructed to keep a daily diary of fever severity, myalgia, chills, headache, and asthenia for 27 days. The sum of the scores of individual symptoms was used to obtain a daily FLS index. The primary outcome was the FLS index area under the curve (AUC) corrected by the number of measurement days. RESULTS: Eighty-four patients were randomized at 11 hospitals: acetaminophen (n = 28), ibuprofen (n = 28), and corticosteroids (n = 28). No differences were detected between treatments in the mean AUC of the FLS index. With limitation of the analysis to the days of IM IFNbeta-1a injection, differences favoring ibuprofen were observed in the mean FLS index (p = 0.0007). CONCLUSIONS: No prophylactic treatment for flu-like syndrome seems to be superior to another in terms of overall well-being during the first month of IM IFNbeta-1a therapy. However, ibuprofen confers better control of symptoms immediately following IM IFNbeta-1a injection.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15304586 [PubMed - indexed for MEDLINE]
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Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition.
Julien N, Goffaux P, Arsenault P, Marchand S.
Departement des Sciences de la Sante, Universite du Quebec en Abitibi-Temiscamingue, Rouyn-Noranda, Que., Canada.
A deficit of endogenous pain inhibitory systems has been suggested to contribute to some chronic pain conditions, one of them being fibromyalgia. The aim of the investigation was to test whether endogenous pain inhibitory systems were activated by a spatial summation procedure in 30 fibromyalgia, 30 chronic low back pain, and 30 healthy volunteers who participated in a cross-over trial (two sessions). Each session consisted of visual analog scale ratings of pain during the immersion of different surfaces of the arm in circulating noxious cold (12 degrees C) water. The arm was arbitrarily divided into eight segments from the fingertips to the shoulder. One session was ascending (from the fingertips to the shoulder) and the other was descending (from the shoulder to the fingertips); they included eight consecutive 2-min immersions separated by 5-min resting periods. For healthy and low back pain subjects, pain was perceived differently during the ascending and descending sessions (P=0.0001). The descending session resulted in lower pain intensity and unpleasantness. This lowering of the perception curve seems to be due to a full recruitment of inhibitory systems at the beginning of the descending session as opposed to a gradual recruitment during the ascending session. For fibromyalgia subjects, no significant differences were found between the increasing and decreasing sessions (P>0.05). These data support a deficit of endogenous pain inhibitory systems in fibromyalgia but not in chronic low back pain. The treatments proposed to fibromyalgia patients should aim at stimulating the activity of those endogenous systems.
PMID: 15733656 [PubMed - in process]
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A normative analysis of the development of pain-related vocabulary in children.
Stanford EA, Chambers CT, Craig KD.
Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4. eajob@interchange.ubc.ca
Effective verbalization of pain requires progressive cognitive development and acquisition of social communication skills. Use of self-report in pediatric pain assessment assumes children have acquired a capacity to understand and use common words to describe pain. The current investigation documented the language most commonly used by young children to describe pain and the age of onset of use of these words. Two complementary research methodologies were employed. Study 1 used the CHILDES database, an aggregated transcript database of multiple research studies examining spontaneous speech development across childhood. Transcripts of 14 randomly selected studies, yielding a total of 245 child participants ranging in age from 1 to 9 years, were searched for seven English primary pain word-stems: 'ache', 'boo-boo', 'hurt', 'ouch', 'ow', 'pain', and 'sore'. Study 2 surveyed 111 parents of children aged 3 to 6 years old concerning words the children commonly used for pain. Parents rated their children's frequency and age of first use of the seven pain word-stems. Both studies indicated that the most frequently used word-stems were 'hurt', 'ouch', and 'ow'. These words first emerged in children's vocabularies as early as 18 months of age. The word-stem 'pain' was used relatively infrequently and gradually emerged in children's vocabularies. The findings indicate that young children rely on a select number of words to describe pain, with these words appearing in children's vocabularies at an early age. These results have implications for developmentally appropriate pain assessment in young children.
PMID: 15733654 [PubMed - in process]
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Lack of estrogen increases pain in the trigeminal formalin model: a behavioural and immunocytochemical study of transgenic ArKO mice.
Multon S, Pardutz A, Mosen J, Hua MT, Defays C, Honda S, Harada N, Bohotin C, Franzen R, Schoenen J.
Research Center for Cellular and Molecular Neurobiology, Neuroanatomy Laboratory, University of Liege, 4020 Liege, Belgium. s.multon@ulg.ac.be
In order to examine the effect of estrogen on facial pain, we first compared the face-rubbing evoked by a formalin injection in the lip of aromatase-knockout (ArKO) mice, lacking endogenous estrogen production, 17 beta-estradiol-treated ArKO mice (ArKO-E2) and wild-type (WT) littermates. During the 'acute' phase of pain the time spent rubbing was similar in the three groups, whereas during the following 'interphase' and the second phase of pain, grooming was increased in ArKO mice. Estradiol-treatment restored a behaviour similar to WT group. To better understand estrogens modulation on pain processes, we examined changes in 5-HT and CGRP innervations of trigeminal nucleus caudalis (TNC) in ArKO, ArKO-E2 and WT groups sacrificed during the interphase. Whereas serotonin and CGRP immunoreactivities were comparable in WT and ArKO non-injected control groups, our data showed that 9 min after formalin injection, the density of serotoninergic terminals increased significantly in WT, but not in ArKO mice, while that of CGRP-immunoreactive fibers was lower in WT than in ArKO mice on the injected side. Estradiol-treatment only partially reversed these changes in ArKO-E2 mice. We conclude that estrogen deprivation in ArKO mice can be responsible for increased nociceptive response and that it is accompanied by transmitter changes favouring pro- over anti-nociceptive mechanisms in TNC during interphase of the formalin model. That estradiol-treatment completely reverses the behavioural abnormality suggests that estrogens absence produces chiefly functional activation-dependent changes. However, the fact that the immunohistochemical abnormalities were not totally normalized by estradiol-treatment suggested that some permanent developmental alterations may occur in ArKO mice.
PMID: 15733652 [PubMed - in process]
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Dot-probe evaluation of selective attentional processing of pain cues in patients with chronic headaches.
Asmundson GJ, Carleton RN, Ekong J.
Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, Saskatchewan, Canada S4S 0A2. gordon.asmundson@uregina.ca
Evidence supporting the notion that patients with chronic pain are characterized by attentional biases for sensory and affect pain words, and that such biases are mediated by fear of pain, is mixed. The present investigation was an attempt to replicate and extend initial findings obtained with the dot-probe task. Thirty patients with chronic headache and 19 healthy controls were tested using a dot-probe task including affect pain, sensory pain, and neutral words. Individual difference variables, including fear of pain measures, were assessed and considered in analyses. Selective attention was denoted using the bias index, congruency index, and incongruency index. There were no significant between-group differences or interactions between group and word type observed for any of the indices of selective attention. Across groups there was evidence for a significant association between anxiety sensitivity and the bias index for sensory pain words, and between affective description of current pain and the incongruency index for affect pain words. These results do not provide convincing evidence that patients with chronic headache selectively attend to affect or sensory pain cues when compared to healthy controls. The significant cross-groups associations between anxiety sensitivity and current pain description and indices of selective attention are consistent with the notion that attentional biases may be influenced by fear propensity and current concerns. Implications of the findings and future research directions are discussed.
PMID: 15733651 [PubMed - in process]
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Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology.
Giamberardino MA, Affaitati G, Lerza R, Lapenna D, Costantini R, Vecchiet L.
Ce.S.I., G. D'Annunzio Foundation, G. D'Annunzio University of Chieti, Pescara, Italy. mag@unich.it
The relationship was investigated between algogenic potential of gallbladder pathology and occurrence/extent of sensory and trophic changes in the referred area. Five groups of subjects were studied, with: symptomatic gallbladder calculosis (3-20 colics); asymptomatic calculosis; symptomatic gallbladder shape abnormality (8-18 colics); asymptomatic shape abnormality; normal gallbladder/no symptoms. At the cystic point (CP) and contralaterally, all underwent measurement of: pain thresholds to electrical stimulation of skin, subcutis and muscle; thickness of subcutis and muscle via ultrasounds. Contralaterally to CP, all thresholds were not significantly different in the five groups. At CP, subcutis and muscle thresholds were significantly lower in symptomatic vs asymptomatic patients and/or normals (0.0001<P< 0.05). In symptomatic cases, at CP compared to contralaterally, subcutis and muscle thresholds were significantly lower (0.0001<P<0.02), subcutis thickness was significantly higher and muscle thickness significantly lower (0.006<P<0.02). Subcutis and muscle thresholds at CP in symptomatic patients were significantly and inversely correlated linearly to the number of colics (P<0.0004; P<0.0001). Patients with symptomatic calculosis were re-evaluated after 6 months; those not presenting further colics showed a significant increase in subcutis and muscle thresholds at CP, while those who continued presenting colics showed a further significant threshold decrease (0.01<P<0.05); tissue thickness did not vary. Referred hyperalgesia and altered trophism from the gallbladder only occur in painful pathology, their extent being modulated by the amount of perceived pain. The results suggest different mechanisms by which visceral nociceptive inputs trigger sensory vs trophic changes in the referred area.
PMID: 15733650 [PubMed - in process]
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Change of dorsal horn neurochemistry in a mouse model of neuropathic cancer pain.
Shimoyama M, Tatsuoka H, Ohtori S, Tanaka K, Shimoyama N.
Department of Autonomic Physiology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba-ken 260-8670, Japan. shimoyama@faculty.chiba-u.jp
We investigated some neurochemical changes that take place in the spinal cord dorsal horn in a mouse model of neuropathic cancer pain. The model was produced by inoculation of Meth-A sarcoma cells to the vicinity of the sciatic nerve, which resulted in growth of a tumor mass embedding the nerve. Hind paw-lifting, a behavioral sign of spontaneous pain, was at maximum on Day 18, but decreased thereafter. The decrease was likely caused by progression of motor paralysis. On Day 18, thermal and mechanical pain thresholds of the affected paw were significantly increased. Histologically, the sciatic nerve presented damages to both unmyelinated and myelinated fibers on Day 18, which were more pronounced on Day 25. In the spinal cord, c-Fos-positive cells were significantly increased in the superficial and deep layers on Day 18. The number of c-Fos-positive cells in the superficial layer correlated with the duration of paw-lifting. The increase in c-Fos-positive cells was still present on Day 25 despite decreased paw-lifting. Substance P and calcitonin gene-related peptide were up-regulated on Day 18 but down-regulated on Day 25. A marked up-regulation of dynorphin A (DynA) was present on Day 18 and persisted through Day 25. Our model caused progressive damage to the sciatic nerve and presented spontaneous pain-behavior while the paw became hyposensitive to mechanical and thermal stimuli. Since the up-regulation of DynA in the dorsal horn persisted and paralleled the increase in c-Fos-positive cells, the release of DynA may be associated with spontaneous pain in our model.
PMID: 15733648 [PubMed - in process]
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Role of central and peripheral mGluR5 receptors in post-operative pain in rats.
Zhu CZ, Hsieh G, Ei-Kouhen O, Wilson SG, Mikusa JP, Hollingsworth PR, Chang R, Moreland RB, Brioni J, Decker MW, Honore P.
Neuroscience Research, Global Pharmaceutical Research and Development, Abbott Laboratories, Abbott Park, IL 60064-3500, USA. chang.z.zhu@abbott.com
Metabotropic glutamate receptors (mGluRs) have previously been shown to play a role in pain transmission during inflammatory or neuropathic pain states. However, the role of mGluR5 in post-operative pain remains to be fully investigated. The present study was conducted to characterize analgesic activity of 2-methyl-6-(phenylethynyl)-pyridine (MPEP) in the skin-incision-induced post-operative pain model in rats. MPEP is a potent and selective mGluR5 antagonist with high affinity (K(i)=6.3+/-0.9 nM) in rat cortex using [(3)H]-MPEP as a radioligand, while not competing with the mGluR1-selective radioligand [(3)H]-R214127 (K(i)>10,000 nM) in rat cerebellum. Post-operative pain was examined 2 h following surgery using weight-bearing (WB) difference between injured and uninjured paws as a measure of non-evoked pain. In this model, MPEP, as morphine, showed dose-dependent effects and full efficacy after systemic administration (ED(50)=15 mg/kg, i.p. for MPEP, ED(50)=1.3 mg/kg, s.c. for morphine). In addition, intrathecal (i.t.) and intracerebroventricular (i.c.v.) MPEP reduced WB difference (ED(50)=65 microg/rat i.t. and ED(50)=200 microg/rat i.c.v.). Interestingly, intraplantar (i.pl.) injection of MPEP either before or after surgery induced a similar reduction in WB difference (ED(50)=90 microg/rat, i.pl.) while contralateral i.pl. MPEP injection did not produce any effect. These results demonstrate that both peripheral and central mGluR5 receptors play a role in nociceptive transmission observed during post-operative pain. In addition, the data suggest that mGluR5 antagonists could offer a new therapeutic approach to the treatment of post-operative pain.
PMID: 15733645 [PubMed - in process]
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Investigation of the paradoxical painful sensation ('illusion of pain') produced by a thermal grill.
Bouhassira D, Kern D, Rouaud J, Pelle-Lancien E, Morain F.
INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Hopital Ambroise Pare, AP-HP, Boulogne and Universite Versailles-Saint-Quentin, 92100 Boulogne-Billancourt, France. dodoer.bouhassira@apr.ap-hop-paris.fr
A paradoxical painful sensation can be elicited by the simultaneous application of innocuous warm and cold stimuli to the skin. In the present study, we analyzed the conditions of production of this unique experimental illusion of pain in 52 healthy volunteers (27 men, 25 women). The stimuli were produced by a thermode composed of six bars whose temperature was controlled by Peltier elements. The temperature of alternate (even- and odd-numbered) bars could be controlled independently to produce various patterns of the 'thermal grill'. After measuring the cold and heat pain thresholds, a series of combinations of warm and cold stimuli, whose distance to the thermal pain threshold was at least 4 degrees C, were applied on the palmar surface of the right hand during 30s. After each stimulus, the subjects had to describe and rate their sensations on visual analog scales. Paradoxical painful sensations, mostly described as burning, were reported by all the subjects but three. However, the phenomenon was less frequent in approximately one third of ('low responder') volunteers. The frequency and intensity of such painful sensations were directly related to the magnitude (i.e. 5-25 degrees C) of the difference of the temperature between the warm and cold bars of the grill. The combination of increasingly colder temperature to a given warm temperature induces similar effects as combining increasingly warmer temperature to a given cold temperature. These results suggest that pain can be the result of a simple addition of non-noxious warm and cold signals.
PMID: 15733641 [PubMed - in process]
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ERK is sequentially activated in neurons, microglia, and astrocytes by spinal nerve ligation and contributes to mechanical allodynia in this neuropathic pain model.
Zhuang ZY, Gerner P, Woolf CJ, Ji RR.
Pain Research Center, Department of Anesthesiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Activation of extracellular signal-regulated kinase (ERK), a mitogen activated-protein kinase (MAPK), in dorsal horn neurons contributes to inflammatory pain by transcription-dependent and -independent means. We have now investigated if ERK is activated in the spinal cord after a spinal nerve ligation (SNL) and if this contributes to the neuropathic pain-like behavior generated in this model. An L5 SNL induces an immediate (<10 min) but transient (<6 h) induction of phosphoERK (pERK) restricted to neurons in the superficial dorsal horn. This is followed by a widespread induction of pERK in spinal microglia that peaks between 1 and 3 days post-surgery. On Day 10, pERK is expressed both in astrocytes and microglia, but by Day 21 predominantly in astrocytes in the dorsal horn. In the L5 DRG SNL transiently induces pERK in neurons at 10 min, and in satellite cells on Day 10 and 21. Intrathecal injection of the MEK (ERK kinase) inhibitor PD98059 on Day 2, 10 or 21 reduces SNL-induced mechanical allodynia. Our results suggest that ERK activation in the dorsal horn, as well as in the DRG, mediates pain through different mechanisms operating in different cells at different times. The sequential activation of ERK in dorsal horn microglia and then in astrocytes might reflect distinct roles for these two subtypes of glia in the temporal evolution of neuropathic pain.
PMID: 15733640 [PubMed - in process]
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Sensory and motor effects of experimental muscle pain in patients with lateral epicondylalgia and controls with delayed onset muscle soreness.
Slater H, Arendt-Nielsen L, Wright A, Graven-Nielsen T.
Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7D, 9220 Aalborg E, Denmark.
This study compares the effect of experimental muscle pain on deep tissue sensitivity and force attenuation in the wrist extensors of patients with lateral epicondylalgia (n=20), and healthy controls (n=20) with experimentally induced sensori-motor characteristics simulating lateral epicondylalgia. Delayed onset muscle soreness (DOMS) in wrist extensors of healthy controls was induced by eccentric exercise in one arm 24h prior to injection (Day 0). Saline-induced pain intensity (visual analogue scale, VAS), distribution, and quality were assessed quantitatively in both arms for both groups. Pressure pain thresholds (PPT) were assessed at three different sites in the wrist extensors. Maximal grip force and wrist extension force were recorded. In response to saline-induced pain in the extensor carpi radialis brevis, regardless of arm, the patient group demonstrated a significantly quicker pain onset (P<0.01), mapped larger pain areas and more referred pain areas, compared to healthy controls (P<0.03). Pain persisted significantly longer in the sore arm of the patient group, compared with all other arms (P<0.02). Patients demonstrated significant bilateral hyperalgesia at extensor carpi radialis brevis during and post saline-induced pain compared to pre-injection and healthy controls (P<0.04). The sore arm in patients and the DOMS arms in healthy subjects showed significantly reduced maximal force (P<0.0001), at all Day 1 times compared with the control arms. In patients, the bilateral increase in deep tissue sensitivity and enlarged referred pain areas during saline-induced pain might suggest involvement of central sensitisation.
PMID: 15733637 [PubMed - in process]
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Brain processing during mechanical hyperalgesia in complex regional pain syndrome: a functional MRI study.
Maihofner C, Forster C, Birklein F, Neundorfer B, Handwerker HO.
Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany. maihoefner@physiologie1.uni-erlangen.de
Complex Regional Pain Syndromes (CRPS) are characterized by a triad of sensory, motor and autonomic dysfunctions of still unknown origin. Pain and mechanical hyperalgesia are hallmarks of CRPS. There are several lines of evidence that central nervous system (CNS) changes are crucial for the development and maintenance of mechanical hyperalgesia. However, little is known about the cortical structures associated with the processing of hyperalgesia in pain patients. This study describes the use of functional magnetic resonance imaging (fMRI) to delineate brain activations during pin-prick hyperalgesia in CRPS. Twelve patients, in whom previous quantitative sensory testing revealed the presence of hyperalgesia to punctuate mechanical stimuli (i.e. pin-prick hyperalgesia), were included in the study. Pin-prick-hyperalgesia was elicited by von-Frey filaments at the affected limb. For control, the identical stimulation was performed on the unaffected limb. fMRI was used to explore the corresponding cortical activations. Mechanical stimulation at the unaffected limb was non-painful and mainly led to an activation of the contralateral primary somatosensory cortex (S1), insula and bilateral secondary somatosensory cortices (S2). The stimulation of the affected limb was painful (mechanical hyperalgesia) and led to a significantly increased activation of the S1 cortex (contralateral), S2 (bilateral), insula (bilateral), associative-somatosensory cortices (contralateral), frontal cortices and parts of the anterior cingulate cortex. The results of our study indicate a complex cortical network activated during pin-prick hyperalgesia in CRPS. The underlying neuronal matrix comprises areas not only involved in nociceptive, but also in cognitive and motor processing.
PMID: 15733635 [PubMed - in process]
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Is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb? A randomised clinical trial.
Moseley GL.
School of Physiotherapy, The University of Sydney, Lidcombe, Sydney, NSW 1825, Australia. l.moseley@fhs.usyd.edu.au
In complex regional pain syndrome (CRPS1) initiated by wrist fracture, a motor imagery program (MIP), consisting of hand laterality recognition followed by imagined movements and then mirror movements, reduces pain and disability, but the mechanism of effect is unclear. Possibilities include sustained attention to the affected limb, in which case the order of MIP components would not alter the effect, and sequential activation of cortical motor networks, in which case it would. Twenty subjects with chronic CRPS1 initiated by wrist fracture and who satisfied stringent inclusion criteria, were randomly allocated to one of three groups: hand laterality recognition, imagined movements, mirror movements (RecImMir, MIP); imagined movements, recognition, imagined movements (ImRecIm); recognition, mirror movements, recognition (RecMirRec). At 6 and 18 weeks, reduced pain and disability were greater for the RecImMir group than for the other groups (P<0.05). Hand laterality recognition imparted a consistent reduction in pain and disability across groups, however, this effect was limited in magnitude. Imagined movements imparted a further reduction in pain and disability, but only if they followed hand laterality recognition. Mirror movements also imparted a reduction in pain and disability, but only when they followed imagined movements. The effect of the MIP seems to be dependent on the order of components, which suggests that it is not due to sustained attention to the affected limb, but is consistent with sequential activation of cortical motor networks.
PMID: 15733631 [PubMed - in process]
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Do men and women differ in their response to interdisciplinary chronic pain management?
Keogh E, McCracken LM, Eccleston C.
Pain Management Unit, Royal National Hospital for Rheumatic Disease and University of Bath, Bath BA2 7AY, UK. e.m.keogh@bath.ac.uk
Women report more pain than men. It also seems that gender may moderate responses to pharmacological agents used to combat pain, suggesting that men and women differ in treatment efficacy. Recent research suggests that gender differences may also exist in response to interdisciplinary pain management interventions. We, therefore, report data from a treatment-outcome program at a UK Pain Management Unit. The sample consisted of 98 chronic pain patients (33 males; 65 females) who completed a series of measures relating to pain and distress at three different time points: immediately prior, on completion, and 3 months following an interdisciplinary pain management intervention. The pain management intervention consisted of a 3- or 4-week residential program that aimed to enhance daily functioning, and which involved physiotherapists, occupational therapists, a nurse, physicians, and clinical psychologists. Analyses revealed that the pain management intervention produced improvements in a range of domains of outcome for both men and women, and that such effects were sustained at 3 months following treatment. However, although both men and women exhibited significant post-treatment reduction in measures of current pain intensity and with one measure of pain-related distress, at 3 months following treatment men showed similar reductions as at post-treatment, whereas for women there were no significant differences from pre-treatment scores. This suggests that gender may play a role in reports of pain and distress following interdisciplinary chronic pain management. However, the current results are different from those previously reported. We discuss potential reasons for such differences.
PMID: 15733629 [PubMed - in process]
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Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lanteri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E.
INSERM E-332, AP-HP Hopital Ambroise Pare, Boulogne and Universite Versailles-Saint-Quentin, France. didier.bouhassira@apr.ap-hop-paris.fr
Few studies have directly compared the clinical features of neuropathic and non-neuropathic pains. For this purpose, the French Neuropathic Pain Group developed a clinician-administered questionnaire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination. This questionnaire was used in a prospective study of 160 patients presenting with pain associated with a definite neurological or somatic lesion. The most common aetiologies of nervous lesions (n=89) were traumatic nerve injury, post herpetic neuralgia and post stroke pain. Non-neurological lesions (n=71) were represented by osteoarthritis, inflammatory arthropathies and mechanical low back pain. Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non-neuropathic pain. The prevalence of pain descriptors and sensory dysfunctions were systematically compared in the two groups of patients. The analysis of the psychometric properties of the DN4 questionnaire included: face validity, inter-rater reliability, factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain. We found that a relatively small number of items are sufficient to discriminate neuropathic pain. The 10-item questionnaire developed in the present study constitutes a new diagnostic instrument, which might be helpful both in clinical research and daily practice.
PMID: 15733628 [PubMed - in process]
Chronic abdominal pain in children.
American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain.
Children and adolescents with chronic abdominal pain pose unique challenges to their caregivers. Affected children and their families experience distress and anxiety that can interfere with their ability to perform regular daily activities. Although chronic abdominal pain in children is usually attributable to a functional disorder rather than organic disease, numerous misconceptions, insufficient knowledge among health care professionals, and inadequate application of knowledge may contribute to a lack of effective management. This clinical report accompanies a technical report (see page e370 in this issue) on childhood chronic abdominal pain and provides guidance for the clinician in the evaluation and treatment of children with chronic abdominal pain. The recommendations are based on the evidence reviewed in the technical report and on consensus achieved among subcommittee members.
PMID: 15741394 [PubMed - in process]
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Evaluation and management of pain in patients with Klippel-Trenaunay syndrome: a review.
Lee A, Driscoll D, Gloviczki P, Clay R, Shaughnessy W, Stans A.
Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Gonda Vascular Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Klippel-Trenaunay syndrome (KTS) is a rare disorder that consists of a triad of capillary vascular malformation, venous malformations and/or varicose veins, and soft tissue and/or bony hypertrophy. Pain is a real and debilitating problem in these patients. We have observed 9 common causes of pain in KTS: (1) chronic venous insufficiency, (2) cellulitis, (3) superficial thrombophlebitis, (4) deep vein thrombosis, (5) calcification of vascular malformations, (6) growing pains, (7) intraosseous vascular malformation, (8) arthritis, and (9) neuropathic pain. The management of pain in patients with KTS depends on its cause. These patients are best evaluated initially in a center with an experienced multidisciplinary team that includes a primary health care provider, surgeons, and ancillary staff. The ongoing care of a patient with KTS often depends on a local provider who is more readily accessible to the patient but may not have the expertise of a large center to manage the complications of KTS. The purpose of this communication is to review the common causes of pain in these patients to provide local health care providers and patients and their families with appropriate management strategies.
PMID: 15741381 [PubMed - in process]
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Chronic abdominal pain in children.
American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain; North American Society for Pediatric Gastroenterology Hepatology, and Nutrition.
Chronic abdominal pain, defined as long-lasting intermittent or constant abdominal pain, is a common pediatric problem encountered by primary care physicians, medical subspecialists, and surgical specialists. Chronic abdominal pain in children is usually functional, that is, without objective evidence of an underlying organic disorder. The Subcommittee on Chronic Abdominal Pain of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition has prepared this report based on a comprehensive, systematic review and rating of the medical literature. This report accompanies a clinical report based on the literature review and expert opinion. The subcommittee examined the diagnostic and therapeutic value of a medical and psychological history, diagnostic tests, and pharmacologic and behavioral therapy. The presence of alarm symptoms or signs (such as weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea, and significant vomiting) is associated with a higher prevalence of organic disease. There was insufficient evidence to state that the nature of the abdominal pain or the presence of associated symptoms (such as anorexia, nausea, headache, and joint pain) can discriminate between functional and organic disorders. Although children with chronic abdominal pain and their parents are more often anxious or depressed, the presence of anxiety, depression, behavior problems, or recent negative life events does not distinguish between functional and organic abdominal pain. Most children who are brought to the primary care physician's office for chronic abdominal pain are unlikely to require diagnostic testing. Pediatric studies of therapeutic interventions were examined and found to be limited or inconclusive.
PMID: 15741363 [PubMed - in process]
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Early Patterns of Care for Occupational Back Pain.
Cote P, Baldwin ML, Johnson WG.
From the *Institute for Work & Health and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada, daggerSchool of Health Management and Policy, W. P. Carey School of Business, Arizona State University, Tempe, AZ, and double daggerSchool of Health Administration and Policy and Department of Economics, W. P. Carey School of Business, Arizona State University, Tempe, AZ.
STUDY DESIGN.: Cross-sectional analysis. OBJECTIVES.: To describe the early health care utilization for occupational back pain. To identify factors associated with health care seeking and provider choice among persons with occupational back pain. SUMMARY OF BACKGROUND DATA.: Back pain is the most prevalent work-related injury, yet little is known about patterns of care for occupational back pain. MATERIALS AND METHODS.: The sample includes 1104 workers with incident episodes of low back pain. Outcomes measures include whether or not workers received care and the types of providers seen. Predictors of outcomes include demographics, injury severity, history of back pain, occupation, and employer. RESULTS.: Eight percent of workers did not receive care in the first 4 to 16 weeks after filing a workers' compensation claim. Injury severity, gender, occupation, and employer were significant predictors of the decision to seek care. Almost 90% of workers who received care were treated by medical physicians, often in combination with physical therapists or chiropractors. Age, occupation, injury severity, and whether the employer or worker chose the initial health care provider were associated with the choice of provider. Employers selected providers for 78% of injured workers who received care. Medical physicians were the providers most often chosen by both employers and workers, but workers were more likely than employers to select chiropractors. CONCLUSIONS.: A small but significant number of injured workers do not seek care for their back pain. Medical physicians treat all but a small fraction of the workers who receive care. The decision to seek care and the choice of providers is associated with injury severity, occupation, and employer actions.
PMID: 15738794 [PubMed - as supplied by publisher]
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Early Disability Risk Factors for Low Back Pain Assessed at Outpatient Occupational Health Clinics.
Shaw WS, Pransky G, Patterson W, Winters T.
From the *Liberty Mutual Center for Disability Research, Hopkinton, Massachusetts, daggerDepartment of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, double daggerOccupational Health + Rehabilitation Inc, Hingham, Massachusetts, and section signOccupational and Environmental Health Network, Waltham, Massachusetts.
STUDY DESIGN.: Inception cohort (</=14 days after pain onset) with 1-month follow-up. OBJECTIVE.: To determine whether disability risk factors provided by patients and clinicians at a first medical visit for acute occupational low back pain predict outcomes. SUMMARY OF BACKGROUND DATA.: Improving health and work outcomes for patients with occupational low back pain may require early identification of risk factors for persistent pain and disability. Previous studies of back pain prognosis have not assessed patients at the time of initial provider contact, and many have not differentiated between occupational and nonoccupational injuries. METHOD.: Patients (183 female, 385 male) presenting to occupational health clinics with recent onset occupational low back pain (</=14 days duration) completed a 16-item survey of potential disability risks including demographic, injury, workplace, psychosocial, and symptom factors. After the initial visit, clinicians completed an additional 10-item questionnaire of symptoms and initial prognosis. Outcome variables of functional limitation and work status were assessed 1 month after pain onset. RESULTS.: In multivariate analyses, functional improvement and return to work were more strongly predicted by employer factors (job tenure, physical work demands, availability of modified duty, earlier reporting to employer) and self-ratings of pain and mood than by health history or physical examination. A logistic regression model had a sensitivity of 74.3% to predict those remaining out of work and a specificity of 70.1%. CONCLUSIONS.: Early screening for disability risk factors may be helpful to identify those patients at greatest risk for delayed recovery from occupational low back pain. Intervention strategies for high-risk patients might be improved by focusing on job factors, pain coping strategies, and expectations for recovery.
PMID: 15738793 [PubMed - as supplied by publisher]
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Acute Low Back Pain: Diagnostic and Therapeutic Practices Reported by Brazilian Rheumatologists.
Margarido MD, Kowalski SC, Natour J, Ferraz MB.
From *Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Department of Medicine, Division of Rheumatology; and daggerPaulista Centre for Health Economics, Sao Paulo, Brazil.
STUDY DESIGN.: A cross-sectional study. OBJECTIVES.: To assess resource utilization in the diagnosis, management, and hospitalization of patients with low back pain (LBP) as prescribed by Brazilian rheumatologists. SUMMARY OF BACKGROUND DATA.: LBP is an important cause of disability, suffering, and social costs. Two to five percent of patients miss workdays because of LBP; it is the second highest cause of physician visits and absenteeism. METHODS.: Rheumatologists taking part in a national rheumatology medical congress answered a questionnaire to assess management of patients with LBP. It consisted of two hypothetical scenarios describing patients with acute LBP (scenario 1) and sciatica (scenario 2). There were 29 questions mainly related to education, protective measures, rest, and medication. RESULTS.: A total of 207 questionnaires were returned. In scenario 1, 70% of the participants ordered some diagnostic test at first visit; lumbar radiograph was the most ordered (92%), while more than 80% prescribed rest and 100% at least one drug. Nonsteroidal anti-inflammatory drugs were prescribed by 69% of the participants. In scenario 2, 93% of the physicians ordered diagnostic tests at first visit, with computed tomography being the most ordered test (69%). Rest was prescribed by 90% (average 18 days) of the participants and physical therapy was counseled by 84%. CONCLUSIONS.: Considering the hypothetical scenarios, participants overused diagnostic and therapeutic procedures. A dissemination of guidelines for optimizing resource use in LBP diagnosis and management is needed.
PMID: 15738792 [PubMed - as supplied by publisher]
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Predicting Health-Related Quality of Life in Patients With Low Back Pain.
Horng YS, Hwang YH, Wu HC, Liang HW, Mhe YJ, Twu FC, Wang JD.
From the *Department of Physical Medicine and Rehabilitation, En Chu Kong Hospital, Taipei, Taiwan, daggerInstitute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan, double daggerDepartment of Public Health, National Taiwan University, Taipei, Taiwan, section signDepartment of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ||School of Occupational Therapy, National Taiwan University, Taipei, Taiwan, paragraph signDepartment of Physical Medicine and Rehabilitation, Ton-Yen General Hospital, Hsin Chu, Taiwan, and #Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
STUDY DESIGN.: Cross-sectional surveys of health-related quality of life (HRQOL) in patients with low back pain at ambulatory clinics plus 8 weeks of follow-up. OBJECTIVE.: The objective of this study is to predict the HRQOL in patients with low back pain. SUMMARY OF BACKGROUND DATA.: There is disagreement on the relative contribution of pain, physical impairment, functional status, and psychological factors on the disability and HRQOL in patients with low back pain. METHODS.: Data were collected from 232 patients with low back pain who were consecutively recruited from several clinics of physical medicine and rehabilitation. Every patient received physical examination and completed a set of questionnaire, including the Taiwan version of the Brief Questionnaire of the World Health Organization on quality of life (WHOQOL-BREF), Modified Roland and Morris Disability Questionnaire, and visual analogue scale for pain intensity and for HRQOL. These patients were observed with a mail questionnaire 8 weeks later. The results of WHOQOL-BREF were also compared to those obtained from another 213 healthy volunteers who were accompanied persons with patients, volunteer workers in hospitals, and hospital employees. RESULTS.: Results showed that there were significant correlations of HRQOL with pain intensity, disability scale, and disability days. Among the results of physical examination, lumbosacral radiculopathy was the only factor with moderate correlation with HRQOL. The significant predictors for HRQOL included physical domain, psychological domain, pain intensity, and family income. Among all the 232 study patients, 100 of them responded to thefollow-up questionnaire. Changes in environmental domain, disability days, educational level, receiving herb drugs, and physiotherapy were the significant predictors for the changes of HRQOL. CONCLUSIONS.: The HRQOL of patients with low back pain depended on functional status and psychological factors more than simple physical impairment. Future intervention may need to put more emphasis on improving functional status and psychological stress for these patients.
PMID: 15738789 [PubMed - as supplied by publisher]
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The Updated Cochrane Review of Bed Rest for Low Back Pain and Sciatica.
Hagen KB, Jamtvedt G, Hilde G, Winnem MF.
From the *National Resource Centre for Rehabilitation in Rheumatology, Oslo, Norway, daggerNorwegian Health Services Research Centre, Oslo, Norway, double dagger38 Patterson Close SW, Calgary, Canada, and section signGlaxoSmithKlein, Oslo, Norway.
STUDY DESIGN.: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES.: To report the main results from the updated version of the Cochrane Review on bed rest for low back pain. SUMMARY OF BACKGROUND DATA.: There has been a growing amount of evidence showing that bed rest is not beneficial for people with low back pain. However, existing systematic reviews are unclear regarding the effects of bed rest for different types of low back pain. METHODS.: All randomized studies available in systematic searches up to March 2003 were included. Two reviewers independently selected trials for inclusion assessed the validity of included trials and extracted data. Investigators were contacted to obtain missing information. RESULTS.: Two new trials comparing advice to rest in bed with advice to stay active were included. There is high quality evidence that people with acute low back pain who are advised to rest in bed have a little more pain (standardized mean difference 0.22, 95% confidence interval: 0.02-0.41) and a little less functional recovery (standardized mean difference 0.29, 95% confidence interval: 0.05-0.45) than those advised to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain (standardized mean difference -0.03, 95% confidence interval: -0.24-0.18) or functional status (standardized mean difference 0.19, 95% confidence interval: -0.02-0.41) between bed rest and staying active. CONCLUSION.: For people with acute low back pain, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active.
PMID: 15738787 [PubMed - as supplied by publisher]
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