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A role for endothelin in neuropathic pain after chronic constriction injury of the sciatic nerve.
Klass M, Hord A, Wilcox M, Denson D, Csete M.
Department of Anesthesiology, Emory Anesthesiology University School of Medicine, Atlanta, Georgia 30322, USA.
The purpose of this study was to explore the role of endothelin in neuropathic pain. Endothelins (ET) are a family (ET-1, ET-2, ET-3) of ubiquitously expressed peptides involved in control of vascular tone. Injected ET-1 causes intense pain via activation of ETA receptors, modulated by analgesic signals initiated by ETB receptor activation. Using a rat model of chronic constriction injury of the sciatic nerve, we found that pharmacologic ETA receptor antagonism acutely and significantly reduced thermal and mechanical hyperalgesic responses 5 days after injury. Furthermore, ET-1 and the ETA receptor are locally upregulated at the site of chronic constriction injury at both the message and the protein levels, suggesting that ET-1 may be involved in establishing pain after the injury. These data point to ET-1 as an important mediator of pain in general and suggest that ETA antagonism deserves study as a potential novel therapy for neuropathic pain.
PMID: 16301255 [PubMed - in process]
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Systemic administration of local anesthetics to relieve neuropathic pain: a systematic review and meta-analysis.
Tremont-Lukats IW, Challapalli V, McNicol ED, Lau J, Carr DB.
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
We reviewed randomized controlled trials to determine the efficacy and safety of systemically administered local anesthetics compared with placebo or active drugs. Of 41 retrieved studies, 27 trials of diverse quality were included in the systematic review. Ten lidocaine and nine mexiletine trials had data suitable for meta-analysis (n = 706 patients total). Lidocaine (most commonly 5 mg/kg IV over 30-60 min) and mexiletine (median dose, 600 mg daily) were superior to placebo (weighted mean difference on a 0-100 mm pain intensity visual analog scale = -10.60; 95% confidence interval: -14.52 to -6.68; P < 0.00001) and equal to morphine, gabapentin, amitriptyline, and amantadine (weighted mean difference = -0.60; 95% confidence interval: -6.96 to 5.75) for neuropathic pain. The therapeutic benefit was more consistent for peripheral pain (trauma, diabetes) and central pain. The most common adverse effects of lidocaine and mexiletine were drowsiness, fatigue, nausea, and dizziness. The adverse event rate for systemically administered local anesthetics was more than for placebo but equivalent to morphine, amitriptyline, or gabapentin (odds ratio: 1.23; 95% confidence interval: 0.22 to 6.90). Lidocaine and mexiletine produced no major adverse events in controlled clinical trials, were superior to placebo to relieve neuropathic pain, and were as effective as other analgesics used for this condition.
PMID: 16301253 [PubMed - in process]
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Local anesthetics for the treatment of neuropathic pain: on the limits of meta-analysis.
Rathmell JP, Ballantyne JC.
Publication Types:
PMID: 16301252 [PubMed - in process]
A comment on the history of the pulsed radiofrequency technique for pain therapy.
Cosman ER.
Professor of Physics, Emeritus, Massachusetts Institute of Technology, Cambridge, Massachusetts. ecosman@cosmancompany.com.
PMID: 16306746 [PubMed - in process]
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Spinal Muscarinic and Nicotinic Subtypes Activated by Clonidine in Postincisional Pain.
Duflo F, Boselli E, Ryvlin P, Chassard D.
* Staff Anesthesiologist, double dagger Professor and Head of Department, Department of Anesthesiology and Intensive Care, Hopital de l'Hotel-Dieu, Lyon, France. dagger Professor and Head of Department, Department of Functional Neurology and Epileptology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Bron, France.
BACKGROUND:: A recent model of acute incisional pain has been characterized that strongly parallels the postoperative period in patients experiencing evoked pain. In that setting, abundant literature has revealed antihypersensitive effects produced by intrathecally administered alpha2-adrenergic receptor agonists, such as clonidine, in both animals and humans. Recent reports have suggested an obligatory role of spinal acetylcholine receptors in the analgesic action of intrathecal clonidine. The authors sought to determine the involvement of spinal muscarinic and nicotinic receptor subpopulations in the antihypersensitivity effect of intrathecal clonidine in a rodent model for human postoperative pain. METHODS:: After intrathecal catheterization, rats underwent superficial plantar incision. Clonidine or a combination of clonidine and muscarinic receptor subtype antagonists (M1, M2, M3, and M4) or nicotinic receptor subtype antagonists (alpha4beta2 and alpha7) were intrathecally administered, and withdrawal thresholds to mechanical stimuli were examined. RESULTS:: Spinal clonidine maximally reduced hypersensitivity adjacent to the wound 30 min after its injection. When animals were intrathecally pretreated with the M1 muscarinic antagonist toxin MT-7, the M3 muscarinic antagonist 4-diphenylacetoxy-N-methylpiperidine, and the M4 muscarinic antagonist toxin MT-3, clonidine lost its antihypersensitive action. When animals were intrathecally pretreated with the alpha4beta2 nicotinic receptor antagonist dihydro-beta-erythroidine, but not with the alpha7 nicotinic receptor antagonist methyllycaconitine, the antihypersensitivity action of clonidine was abolished. CONCLUSIONS:: These data indicate for the first time that the clonidine-induced increase in punctuate mechanical threshold is mediated via the activation of all but M2 muscarinic receptor subtypes, and via the activation of alpha4beta2 but not alpha7 nicotinic receptor subtypes in a rodent model for human postoperative pain.
PMID: 16306740 [PubMed - as supplied by publisher]
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Comparison of Morphine, Ketorolac, and Their Combination for Postoperative Pain: Results from a Large, Randomized, Double-blind Trial.
Cepeda MS, Carr DB, Miranda N, Diaz A, Silva C, Morales O.
* Professor, double dagger Pain Research Coordinator, section sign Anesthesia Resident, parallel Pain Fellow, Department of Anesthesia and Clinical Epidemiology Unit, Javeriana University School of Medicine. dagger Saltonstall Professor of Pain Research, Departments of Anesthesia and Medicine, Tufts-New England Medical Center, and Innovative Drug Delivery Systems, Inc., Boston, Massachusetts.
BACKGROUND:: Meta-analyses report similar numbers needed to treat for nonsteroidal antiinflammatory drugs (NSAIDs) and opioids. Differences in baseline pain intensity among the studies from which these numbers needed to treat were derived may have confounded the results. NSAIDs have an opioid-sparing effect, but the importance of this effect is unclear. Therefore, the authors sought to compare the proportions of subjects who obtain pain relief with ketorolac versus morphine after surgery and to determine whether the opioid-sparing effect of an NSAID reduces the magnitude of opioid side effects. METHODS:: The study was a double-blind, randomized controlled trial. The authors randomly assigned 1,003 adult patients to receive 30 mg ketorolac or 0.1 mg/kg morphine intravenously. They calculated the proportion of subjects who achieved at least 50% reduction in pain intensity 30 min after analgesic administration. Further, so long as pain intensity 30 min after analgesic administration was 5 or more out of 10, patients received 2.5 mg morphine every 10 min until pain intensity was 4 or less out of 10. The authors assessed the presence of opioid-related side effects. RESULTS:: Five hundred patients received morphine and 503 received ketorolac. Fifty percent of patients in the morphine group achieved pain relief, compared with 31% in the ketorolac group (difference, 19%; 95% confidence interval, 13-25%). The ketorolac-morphine group required less morphine (difference, 6.5 mg; 95% confidence interval, -5.8 to -7.2) and had a lower incidence of side effects (difference, 11%; 95% confidence interval, 5-16%) than the morphine group. CONCLUSIONS:: Opioids are more efficacious analgesics than NSAIDs, although historic data for these two drugs yield similar numbers needed to treat. Adding NSAIDs to the opioid treatment reduces morphine requirements and opioid-related side effects in the early postoperative period.
PMID: 16306736 [PubMed - as supplied by publisher]
Psychometric evaluation of multidimensional pain inventory (Swedish version) in a sample of elderly people.
Jakobsson U, Horstmann V.
Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden.
OBJECTIVES: The aim was to psychometrically evaluate the Swedish version of the Multidimensional Pain Inventory (MPI-S) and the "brief screening version of MPI-S" for use in an elderly sample. METHODS: This study comprised 175 people aged 76-99 years reporting pain and in need of help to manage daily living. The instrument's factor structures were investigated through factor analyses, convergent and discriminant validity were assessed through inter-scale correlations and correlations with items from SF-12. Reliability was assessed by Cronbach's alpha. RESULTS: The full-length version of MPI-S did not, in general, show any satisfactory validity and reliability when used among elderly. It had acceptable convergent and discriminant validity, but the factor analysis did not show a good model fit. Low alpha values were found for most of the sub-scales. However, the brief screening version of MPI showed acceptable validity and reliability, except for rather low alpha values in sections 3 and 4. CONCLUSION: The MPI-S instrument may not be very useful for measuring pain among frail elderly. The brief screening version may instead be a better alternative to the full version of the MPI-S. However, the small number of observations may be the reason to the lack of fit, and further studies are warranted.
PMID: 16300976 [PubMed - as supplied by publisher]
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Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography.
Nilsen KB, Westgaard RH, Stovner LJ, Helde G, Ro M, Sand TH.
Norwegian University of Science and Technology, Department of Neurosciences, N-7489 Trondheim, Norway.
The mechanisms of pain causation in fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) are still debated. We wanted to compare muscle activity and pain development during and after low-grade mental stress in FMS and SNP patients. Twenty-three women with FMS, 29 women with chronic SNP and 35 healthy women performed a stressful task lasting 60min followed by a 30min recovery period. We recorded surface electromyography over the trapezius, neck, temporalis and frontalis muscles. Subjects reported their pain at the corresponding locations together with the development of fatigue and perceived tension. Significant differences between FMS and SNP groups were not observed either for muscular or subjective responses. SNP patients and controls responded with more pain in the trapezius and neck regions than in the forehead, in contrast to FMS patients who had a more generalized pain response. Development of pain, tension and fatigue was not related to muscle activity for any group. We conclude that FMS and SNP patients have similar pain and electromyographic responses. The results suggest that similar pathophysiological mechanisms are involved although the responses are more generalised in FMS than in SNP patients. Muscular activity did not explain the pain which developed during the stressful task for either group. Pain lasted longer during recovery in both FMS and SNP patients compared to healthy controls, possibly a result of disease-related sensitisation in pain pathways.
PMID: 16300974 [PubMed - as supplied by publisher]
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Sex differences in cardiac and autonomic response to clinical and experimental pain in LBP patients.
Tousignant-Laflamme Y, Marchand S.
Universite de Sherbrooke, Faculty of Medicine and Health Sciences, Neurosurgery, 3001, 12e avenue Nord, Sherbrooke, Que., Canada J1H 5N4.
Rehabilitation professionals are currently using heart rate (HR) in order to assess the sincerity of effort in certain evaluations. It has been shown that a relation exists between HR and pain but no study has measured cardiac response during both clinical and experimental pain among a patient population using an intra-subject design. Thirty patients with low back pain (LBP) participated in this study including 16 men. Clinical pain was induced by applying a postero-anterior pressure (PA) on a painful lumbar segment for 15 and 30s in order to reproduce the patient's typical LBP at an intensity ranging between 50 and 70/100. Experimental pain was induced with a 15s thermal stimulus at a temperature which reproduced the same pain intensity as the 15s PA. For both reproduced clinical pain durations, we observed a rise in HR ranging between 8.5% and 12.67%. However, unlike men, women's cardiac response failed to show a constant rise in HR during the 30s PA. For all subjects, the rise in HR was much lower during the experimental pain condition (p<0.001), reaching only 5%. On the other hand, galvanic skin responses were significantly higher during the experimental pain condition (p<0.001). During this same condition, women also had a greater rise in galvanic skin responses than men (p=0.04). Finally, a significant correlation was found between both types of pain. These results suggest that pain induced during a clinical evaluation will produce a significant HR augmentation. However, heart rate variability analysis showed greater sympathetic cardiac regulation for men. The sex differences observed in this study call for caution when interpreting HR during pain assessment.
PMID: 16298532 [PubMed - as supplied by publisher]
Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes.
Swap CJ, Nagurney JT.
Massachusetts General Hospital, Boston, MA 02114, USA.
CONTEXT: The chest pain history, physical examination, determination of coronary artery disease (CAD) risk factors, and the initial electrocardiogram compose the information immediately available to clinicians to help determine the probability of acute myocardial infarction (AMI) or acute coronary syndrome (ACS) in patients with chest pain. However, conflicting data exist about the usefulness of the chest pain history and which components are most useful. OBJECTIVE: To identify the elements of the chest pain history that may be most helpful to the clinician in identifying ACS in patients presenting with chest pain. EVIDENCE ACQUISITION: MEDLINE and Ovid were searched from 1970 to September 2005 by using specific key words and Medical Subject Heading terms. Reference lists of these articles and current cardiology textbooks were also consulted. EVIDENCE SYNTHESIS: Certain chest pain characteristics decrease the likelihood of ACS or AMI, namely, pain that is stabbing, pleuritic, positional, or reproducible by palpation (likelihood ratios [LRs] 0.2-0.3). Conversely, chest pain that radiates to one shoulder or both shoulders or arms or is precipitated by exertion is associated with LRs (2.3-4.7) that increase the likelihood of ACS. The chest pain history itself has not proven to be a powerful enough predictive tool to obviate the need for at least some diagnostic testing. Combinations of elements of the chest pain history with other initially available information, such as a history of CAD, have identified certain groups that may be safe for discharge without further evaluation, but further study is needed before such a recommendation can be considered reasonable. CONCLUSION: Although certain elements of the chest pain history are associated with increased or decreased likelihoods of a diagnosis of ACS or AMI, none of them alone or in combination identify a group of patients that can be safely discharged without further diagnostic testing.
Publication Types:
PMID: 16304077 [PubMed - in process]
Tearing without pain after trigeminal root section for cluster headache.
Lin H, Dodick DW.
The Mayo Clinic, Scottsdale, AZ 85259, USA.
The cranial autonomic symptoms (CAS) in patients with cluster headache (CH) are considered to occur as a result of intense ophthalmic division pain. Five CH patients underwent transection of the trigeminal nerve root but continued to experience periodic CAS without pain, whereas another five patients continued to experience typical cluster headaches. These findings confirm that CH is generated by a central pacemaker and the pain may be expressed without activation of the peripheral trigeminovascular network.
PMID: 16301498 [PubMed - in process]
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Parent and family factors in pediatric chronic pain and disability: An integrative approach.
Palermo TM, Chambers CT.
Departments of Anesthesiology and Peri-Operative Medicine and Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA.
PMID: 16298492 [PubMed - as supplied by publisher]
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Pancreatic cancer pain and its correlation with changes in tumor vasculature, macrophage infiltration, neuronal innervation, body weight and disease progression.
Lindsay TH, Jonas BM, Sevcik MA, Kubota K, Halvorson KG, Ghilardi JR, Kuskowski MA, Stelow EB, Mukherjee P, Gendler SJ, Wong GY, Mantyh PW.
Neurosystems Center, 18-208 Moos Tower, School of Dentistry, University of Minnesota, 515 Delaware Street SE, Minneapolis, MN 55455, USA.
To begin to understand the relationship between disease progression and pain in pancreatic cancer, transgenic mice that develop pancreatic cancer due to the expression of the simian virus 40 large T antigen under control of the rat elastase-1 promoter were examined. In these mice precancerous cellular changes were evident at 6 weeks and these included an increase in: microvascular density, macrophages that express nerve growth factor and the density of sensory and sympathetic fibers that innervate the pancreas, with all of these changes increasing with tumor growth. In somatic tissue such as skin, the above changes would be accompanied by significant pain; however, in mice with pancreatic cancer, changes in pain-related behaviors, such as morphine-reversible severe hunching and vocalization only became evident at 16 weeks of age, by which time the pancreatic cancer was highly advanced. These data suggest that in mice as well as humans, there is a stereotypic set of pathological changes that occur as pancreatic cancer develops, and while weight loss generally tracks disease progression, there is a significant lag between disease progression and behaviors indicative of pancreatic cancer pain. Defining the mechanisms that mask this pain in early and mid-stage disease and drive the pain in late-stage disease may aid in earlier diagnosis, survival, and increased quality of life of patients with pancreatic cancer.
PMID: 16298491 [PubMed - as supplied by publisher]
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The role of threat-expectancy in acute pain: effects on attentional bias, coping strategy effectiveness and response to pain.
Boston A, Sharpe L.
School of Psychology, Clinical Psychology Unit F12, The University of Sydney, Sydney, NSW 2006, Australia.
The aims of this study were threefold. Firstly, to investigate the effect of increasing threat-expectancy on attentional biases towards pain-related words. Secondly, to determine the interaction between threat-expectancy and the effectiveness of two coping strategies on pain threshold and tolerance. Thirdly, to investigate the relationship between fear of pain and the experimental manipulations. One hundred undergraduate psychology students were randomly assigned to receive either threat-increasing or reassuring information about the cold pressor task. After reading the information, all participants completed the dot-probe task for four categories of pain-related words. Following the dot-probe task, participants were randomly allocated to one of two coping strategy conditions (focusing on affective vs sensory aspects of pain). Participants then completed the cold pressor task while engaging in the relevant coping strategy. There was a significant effect of threat on bias towards affective vs sensory pain words. Participants in the threat condition showed a stronger bias towards affective pain words. In contrast, the no-threat condition displayed a stronger bias towards sensory pain words. Significant interaction effects were observed between threat and coping strategy for threshold and tolerance. These results indicated that focusing on sensory pain sensations was helpful in the absence of threat, however, in the presence of threat was relatively unhelpful in comparison to focusing on the affective components of pain. The present results provide support for the fear-avoidance model of pain [Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85:317-332] and confirm the importance of threat-expectancy in hypervigilance towards pain and fear avoidance.
PMID: 16298490 [PubMed - as supplied by publisher]
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Mechanisms underlying enhanced P2X receptor-mediated responses in the neuropathic pain state.
Chen Y, Li GW, Wang C, Gu Y, Huang LY.
Department of Neuroscience and Cell Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1069, USA.
P2X3 and P2X2/3 receptors in dorsal root ganglia (DRG) appear to participate in producing nociceptive responses after nerve injury. However, the mechanisms underlying the receptor-mediated nociception in the neuropathic state remain unclear. Using spared nerve injury (SNI) rats, we found that allodynic and nocifensive (flinch) behavioral responses developed after injury can be reversed by P2X receptor antagonists, indicating an involvement of P2X receptors. Immunocytochemical studies revealed that P2X3 receptors are expressed in small and medium but rarely in large DRG neurons of both normal and SNI rats. Thus, contrary to the conventional view that only large Abeta cells mediate allodynia, small and medium cells are intimately involved in P2X3 receptor-mediated allodynia. Measuring ATP levels in the subcutaneous space of the rat paw, we showed that ATP release does not change after SNI. On the other hand, the P2X receptor agonist, alphabeta-methylene ATP produces 3.5-fold larger flinch responses at a 8.0-fold lower dose. Thus, sensitization of P2X3 receptors rather than a change in ATP release is responsible for the neuropathic pain behaviors. We further demonstrated that sensitization of P2X3 receptors arises from an increase in receptor function. ATP-induced P2X3 receptor-mediated currents in DRG neurons is 2.5-fold larger after SNI. The expression of P2X3 receptors on the cell membrane is significantly enhanced while the total expression of P2X3 receptors remained unchanged. Thus, the enhancement of trafficking of P2X3 receptors is likely an important mechanism contributing to the increase in receptor function after nerve injury.
PMID: 16298067 [PubMed - as supplied by publisher]
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Characterizing individual differences in heat-pain sensitivity.
Nielsen CS, Price DD, Vassend O, Stubhaug A, Harris JR.
Department of Psychology, University of Oslo, PO Box 1094 Blindern, NO-0317 Oslo, Norway; Department of Mental Health, Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, NO-0403, Oslo, Norway.
Heat induced pain has been shown to follow a positively accelerating power function for groups of subjects, yet the extent to which this applies to individual subjects is unknown. Statistical methods were developed for assessing the goodness of fit and reliability of the power function for data from individual subjects with the aim of using such functions for characterizing individual differences in heat-pain sensitivity. 175 subjects rated ascending and random series of contact heat stimuli with visual analogue scales for pain intensity (VAS-I) and unpleasantness (VAS-A). Curve fitting showed excellent model fit. Substitution of model estimates in place of observed VAS scores produced minimal bias in group means, about 0.3 VAS units in the ascending series and 1.0 in the random series, on a 0-100 scale. Individual power function exponents were considerably higher for the ascending than for the random series and somewhat higher for VAS-A than for VAS-I (means: ascending VAS-I=9.04, VAS-A=9.80; random VAS-I=4.95, VAS-A=5.67). The reliability of VAS estimates was high (>==.93), and for the ascending series it remained so when extrapolating 4 degrees C beyond the empirical range. Exponent reliability was high for the ascending series (VAS-I=.92; VAS-A=.91), but considerably lower for the random series (VAS-I=.69; VAS-A=.71). Individual differences constituted 60% of the total variance in pain ratings, whereas stimulus temperature accounted for only 40%. This finding underscores the importance of taking individual differences into account when performing pain studies.
PMID: 16298065 [PubMed - as supplied by publisher]
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Headache in schoolchildren: Association with other pain, family history and psychosocial factors.
Laurell K, Larsson B, Eeg-Olofsson O.
Department of Neuroscience, Uppsala University, Uppsala, Sweden.
Limited information exist about associations between different headache types and other pains, family history of pain, and psychosocial factors among children from the general population suffering from less severe headache. We interviewed 130 schoolchildren together with a parent to find out whether such factors differ between children with mainly infrequent and moderate migraine or tension-type headache as compared to those without primary headache. Children with headache, especially those with migraine reported other pains and physical symptoms more frequently than children without primary headache. Coherently, parents of children suffering from migraine reported their children to have significantly more somatic symptoms than parents of children without primary headache. In addition, first-degree relatives of children with headache suffered from more migraine, other pains, and physical symptoms compared with first-degree relatives of children without primary headache. Children with migraine visited the school nurse, used medication and were absent from school because of headache more often than those with tension-type headache. Few other differences in psychosocial factors were found between the three groups. Migraine among first-degree relatives and the total sum of physical symptoms in children were the strongest predictors of headache in logistic regression analysis. It is concluded that in schoolchildren with mainly infrequent and moderate headache, pain and physical symptoms cluster within individuals as well as their families, however, psychological and social problems are uncommon.
PMID: 16298064 [PubMed - as supplied by publisher]
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Risk factors for acute pain and its persistence following breast cancer surgery.
Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH.
Department of Psychology, State University of New York College at Geneseo, Geneseo, NY, USA; Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
Although more severe acute postoperative pain increases the risk of chronic pain following breast cancer surgery, few studies have examined the characteristics of patients who develop greater acute pain. To identify risk factors for acute pain and its persistence one month following breast cancer surgery, a sample of 114 women scheduled for breast cancer surgery was assessed preoperatively for demographic, clinical, and emotional functioning variables that were hypothesized to be associated with acute pain severity. Clinically meaningful postoperative pain was assessed at follow-up interviews 2, 10, and 30 days after surgery. In univariate analyses, the risk of clinically meaningful acute pain was increased among women who were younger, unmarried, had more invasive surgeries, and had greater preoperative emotional distress. In multiple logistic regression analyses, greater preoperative anxiety was the only variable that made an independent contribution to predicting clinically meaningful acute pain at 2 days after surgery whereas younger age, being unmarried, and preoperative anxiety each made an independent contribution to predicting clinically meaningful acute pain that persisted from 2 to 30 days after surgery. These results increase understanding of neurobiologic mechanisms and psychosocial processes that contribute to the development of acute pain following breast cancer surgery and have implications for the development of interventions to prevent it.
PMID: 16298063 [PubMed - as supplied by publisher]
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The significant other version of the Pain Catastrophizing Scale (PCS-S): Preliminary validation.
Cano A, Leonard MT, Franz A.
Department of Psychology, Wayne State University, 5057 Woodward Avenue, Detroit, MI 48202, USA.
Researchers have hypothesized that pain catastrophizing has a social function. Although work has focused on the catastrophizing of individuals with chronic pain (ICPs), little is known about the pain catastrophizing of their significant others. The purpose of this study was to test the validity of a revised version of the original PCS [Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524.] in which individuals were instructed to report on their own catastrophizing about their significant other's pain. In Study 1, a confirmatory factor analysis was conducted to determine the factor structure of the PCS-Significant Other (PCS-S) in a diverse sample of university undergraduates (n=264). An oblique second-order 3-factor model with two cross-loadings provided the best fit and this model was invariant across gender and racial groups. This factor structure was cross-validated in Study 2 with a second sample of university undergraduates (n=213). Results indicated that the 3-factor structure with two cross-loadings was a viable model of significant others' pain catastrophizing across gender and racial groups. In Study 3, this factor structure was replicated and the content validity of the PCS-S was examined in a sample of adult ICPs and their spouses (n=111). Spouse catastrophizing was related to ICP pain severity and interference as well as both spouses' depressive symptoms. In addition, ICPs were at a greater risk for psychological distress when both spouses had higher levels of catastrophizing. The PCS-S has the potential to be a useful and valid measure of pain catastrophizing in the significant others of ICPs.
PMID: 16298062 [PubMed - as supplied by publisher]
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Categorising the severity of neck pain: Establishment of cut-points for use in clinical and epidemiological research.
Fejer R, Jordan A, Hartvigsen J.
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Institute of Public Health, Epidemiology, University of Southern Denmark, Odense, Denmark.
Grading pain intensity scales into simple categories provides useful information for both clinicians and epidemiologists and methods to classify pain severity for numerical rating scales have been recommended. However, the establishment of cut-points is still in its infancy and little is known as to whether cut-points are affected by age or gender. The objectives of this paper were to establish optimal cut-points in pain severity in individuals with neck pain (NP) and to investigate if the cut-points were influenced by gender, age, and NP duration. Data from the population-based ;Funen Neck and Chest Pain Study' was used. Univariate and multivariate analyses of variance were performed to calculate optimal single and double cut-points for three different pain intensity scores within the past 2 weeks relative to two neck disability scales (;global assessment of NP' and the ;Copenhagen Neck Functional Disability Scale'). The two disability scales showed small differences in optimal cut-points. Furthermore, cut-points changed for each of the three pain intensity scales. Only small gender differences in cut-points were seen and no specific trend was noted in either single or double cut-points in different age groups. The cut-points were almost identical for acute, subacute, and chronic NP. This paper has implications for understanding the impact of using different pain intensity scales and provides reference cut-points in NP for use in future clinical and epidemiological research.
PMID: 16298059 [PubMed - as supplied by publisher]
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Illness burden mediates the relationship between pain and illicit drug use in persons living with HIV.
Tsao JC, Dobalian A, Stein JA.
Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd., Suite 1450, Los Angeles, CA 90024, USA.
We investigated predictive and concurrent relationships among reported pain, HIV/AIDS illness burden, and substance use history in 2267 participants in the longitudinal HIV Cost and Services Utilization Study (HCSUS). Substance use history was classified as screening positive for current illicit drug use (N=253), past drug use (N=617), and non-user (N=1397) at baseline. To control for demographic correlates, age, sex and socioeconomic status (SES) were included as predictors. Covariance structure models indicated greater pain at baseline among participants acknowledging current substance use. Pain at baseline was also directly predicted by greater HIV/AIDS illness burden, lower SES, and older age. At 6 months, pain was directly predicted by prior pain, worse concurrent HIV/AIDS illness burden and female sex. At 12 months, pain was predicted by older age, prior pain, and concurrent HIV/AIDS illness. It was also modestly but significantly predicted by current substance use at baseline. In addition to the direct effects on pain, there were significant indirect effects of demographic and drug use variables on pain mediated through HIV/AIDS illness burden and prior pain. There were significant and positive indirect effects of current and past drug use, greater age, and lower SES on pain at all three time periods. Pain at 6 months and pain at 12 months were also indirectly impacted by previous illness burden. Our results indicate that HIV+persons who screened positive for current use of a range of illicit substances experienced greater HIV/AIDS illness burden which in turn predicted increased pain.
PMID: 16297562 [PubMed - as supplied by publisher]
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Comment on Hendriks et al.: Prognostic factors for poor recovery in acute whiplash patients. Pain 2005;114:408-416.
Wynne-Jones G, Jones GT, Atherton K, Wiles NJ, Silman AJ, Macfarlane GJ.
Arthritis Research Campaign (arc) Epidemiology Unit, Division of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK.
Publication Types:
PMID: 16297561 [PubMed - as supplied by publisher]
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Effect of genetic knockout or pharmacologic inhibition of neuronal nitric oxide synthase on complete Freund's adjuvant-induced persistent pain.
Chu YC, Guan Y, Skinner J, Raja SN, Johns RA, Tao YX.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 355 Ross, 720 Rutland Avenue, Baltimore, MD 21205, USA; Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 112, Taiwan, ROC.
Nitric oxide (NO) acts as a neurotransmitter or neuromodulator involving in the modulation of thermal and/or inflammatory hyperalgesia. The neuronal nitric oxide synthase (nNOS) is a key enzyme for NO production in normal neuronal tissues, but its functional role in chronic pain remains unclear. The present study combined a genetic strategy with a pharmacologic approach to address the role of nNOS in the central mechanism of complete Freund's adjuvant (CFA)-induced chronic inflammatory pain. Targeted disruption of the nNOS gene significantly reduced CFA-induced mechanical pain hypersensitivity during the maintenance (but not the development) of inflammatory pain, while it failed to attenuate either development or maintenance of CFA-induced thermal pain hypersensitivity. Intraperitoneal administration of L-N(G)-nitro-arginine methyl ester (L-NAME), a non-specific NOS inhibitor, blocked CFA-evoked thermal and mechanical pain hypersensitivity at both development (2h) and maintenance (24h) phase in wild type mice, but had no effect in the knockout mice. Furthermore, intrathecal injection of either L-NAME or 7-nitroindazole, a selective nNOS inhibitor, markedly attenuated mechanical pain hypersensitivity at both 2 and 24h after CFA injection. Finally, spinal cord nNOS (but not endothelial NOS or inducible NOS) expression was up-regulated at 24h after CFA injection, occurring mainly in the ipsilateral superficial dorsal horn. Together, these data indicate that spinal cord nNOS may be essential for the maintenance of mechanical pain hypersensitivity and that it may also be sufficient for the development of mechanical pain hypersensitivity and for the development and maintenance of thermal pain hypersensitivity after chronic inflammation. Our findings suggest that spinal cord nNOS might play a critical role in central mechanisms of the development and/or maintenance of chronic inflammatory pain.
PMID: 16297560 [PubMed - as supplied by publisher]
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Behavioral changes and trigeminal ganglion sodium channel regulation in an orofacial neuropathic pain model.
Eriksson J, Jablonski A, Persson AK, Hao JX, Kouya PF, Wiesenfeld-Hallin Z, Xu XJ, Fried K.
Center for Oral Biology, Novum, Karolinska Institutet, P.O. Box 4064, S-141 04 Huddinge, Sweden.
We used a photochemical method to generate a partial ischemic injury to the infraorbital branch of the trigeminal nerve in rats. Following injury, rats developed a bilateral persistent hypersensitivity to mechanical stimulation in the territory innervated by the infraorbital nerve. In addition, spread of mechanical hypersensitivity beyond the facial region was noted. Heat hypersensitivity was also present, although to a lesser extent and of a shorter duration. In some rats, excessive facial grooming/scratching were observed. Morphological examination revealed a graded damage to the irradiated portion of the infraorbital nerve that was related to the duration of laser irradiation. Investigations of gene expression changes in injured trigeminal ganglion neurons of animals with behavioral signs of neuropathic pain demonstrated that the sodium channel alpha-subunit Na(v)1.3-absent in sham-operated animals-was expressed to a limited extent. mRNAs for Na(v)1.8 and Na(v)1.9 were reduced both with respect to proportions of expressing neurons and to intensities, whereas the beta3 subunit was markedly upregulated. mRNA levels of p11, a regulatory factor that facilitates the surface expression of Na(v)1.8, were unchanged. Previous findings have shown that injury to the trigeminal nerve branches may elicit responses that differ from those of segmental spinal nerves. Despite this we conclude that the key sodium channel regulations that are reported as consequences of nerve damage in the dorsal root ganglia seem to appear also in the trigeminal ganglion. Thus, novel analgesic drugs designed to target the sodium channel subtypes involved could be of use for the treatment of orofacial pain.
PMID: 16297558 [PubMed - as supplied by publisher]
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Development and validation of a dental pain-screening questionnaire.
Pau A, Croucher R, Marcenes W, Leung T.
Centre for Adult Oral Health, Institute of Dentistry, Barts and The London, Queen Mary's School of Medicine and Dentistry, University of London, Turner Street, London E1 2AD, UK.
Dental pain, estimated to affect 12-40% of community-dwelling adults, is a symptom of a wide range of clinical conditions. A population screening instrument is needed to study their prevalence. This project aimed to develop a questionnaire for classifying a sample of dental pain patients into three groups of common dental pain conditions, i.e. Group 1 (Acute periapical periodontitis and Irreversible pulpitis), Group 2 (Reversible pulpitis and Dentine hypersensitivity) and Group 3 (Pericoronitis). Initial items were generated through a literature review, individual unstructured patient interviews and consultation with experts. Items generated were administered to a sample of dental pain patients for self-completion. Responses were subjected to a series of factor and discriminant analyses to identify questions capable of differentiating the sample into three groups, originally categorized by clinical diagnosis, with high classification rates. The selected items were administered to a further sample of dental pain patients to test for its sensitivity and specificity in classifying the sample into three groups against the gold standard of clinical diagnosis. The final 16-item Dental Pain Questionnaire (DePaQ) was capable of correctly classifying 89.7% of dental pain cases initially categorized by clinical diagnoses. The sensitivity of the questionnaire was 0.80-Group1, 0.85-Group2 and 0.59-Group3. Specificity was 0.83-Group1, 0.89-Group2 and 0.90-Group3. The DePaQ, which can easily be administered by non-clinical personnel, may be used to collect epidemiological data on common dental pain conditions, assess dental needs for a specified population, and triage of patients seeking treatment for dental pain.
PMID: 16297557 [PubMed - as supplied by publisher]
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The economic impact of chronic pain in adolescence: Methodological considerations and a preliminary costs-of-illness study.
Sleed M, Eccleston C, Beecham J, Knapp M, Jordan A.
Pain Management Unit, University of Bath and Royal National Hospital for Rheumatic Diseases, Bath, UK.
Chronic pain in adulthood is one of the most costly conditions in modern western society. However, very little is known about the costs of chronic pain in adolescence. This preliminary study explored methods for collecting economic-related data for this population and estimated the cost-of-illness of adolescent chronic pain in the United Kingdom. The client service receipt inventory was specifically adapted for use with parents of adolescent chronic pain patients to collect economic-related data (CSRI-Pain). This method was compared and discussed in relation to other widely used methods. The CSRI-Pain was sent to 52 families of adolescents with chronic pain to complete as a self-report retrospective questionnaire. These data were linked with unit costs to estimate the total care cost package for each family. The economic impact of adolescent chronic pain was found to be high. The mean cost per adolescent experiencing chronic pain was approximately pound8000 per year, including direct and indirect costs. The adolescents attending a specialised pain management unit, who had predominantly non-inflammatory pain, accrued significantly higher costs, than those attending rheumatology outpatient clinics, who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated UK prevalence data of adolescent chronic pain demonstrates a cost-of-illness to UK society of approximately pound3840 million in one year. The implications of the study are discussed.
PMID: 16297552 [PubMed - as supplied by publisher]
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