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Abdominal surgery decreases food-reinforced operant responding in rats: relevance of incisional pain.
Martin TJ, Kahn WR, Eisenach JC.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1083, USA. tjmartin@wfubmc.edu
BACKGROUND: Establishment of early oral nutrition after surgery is associated with a decrease in morbidity and mortality. The following studies were undertaken to determine how surgery influences food-reinforced behavior in rats and to determine the relevance of afferent input from the incision site on this behavior. METHODS: Rats were trained to press a lever for food pellets to assess the effects of various abdominal surgical manipulations. Operant requirements and food availability were also manipulated. The effects of wound infiltration with bupivacaine and denervation of the abdominal musculature in the area of the incision were similarly examined. RESULTS: Incision of the skin and abdominal musculature produced significant behavioral effects. Food pellets earned were significantly decreased, with gut manipulation producing effects of greater magnitude and duration than incision alone. Operant requirements or different schedules of food availability did not influence the effect of surgery on behavior. Infiltration of the wound with bupivacaine produced a reversal of the effects of surgery on behavior after skin and muscle incision but had minimal effects when the viscera were manipulated. Similarly, denervation of the abdominal musculature reversed the effects of abdominal incision on behavior. CONCLUSIONS: Food maintained behavior is disrupted after laparotomy in rats. The time course and magnitude of this disruption, as well as its reversal by bupivacaine or denervation, are consistent with postoperative incisional pain. Manipulation of the viscera produces a greater effect than laparotomy alone, and additional mechanisms unrelated to incisional pain affect food reinforcement and feeding after surgery.
PMID: 16129990 [PubMed - indexed for MEDLINE]
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Postamputation pain and sensory changes in treatment-naive patients: characteristics and responses to treatment with tramadol, amitriptyline, and placebo.
Wilder-Smith CH, Hill LT, Laurent S.
Brain-Gut Research Group, Bern, Switzerland. cws@braingut.com
BACKGROUND: Pain after amputation is common but difficult to treat, and few controlled treatment studies exist. METHODS: In the current study, 94 treatment-naive posttraumatic limb amputees with phantom pain (intensity: mean visual analog scale score [0-100], 40 [95% confidence interval, 38-41]) were randomly assigned to receive individually titrated doses of tramadol, placebo (double-blind comparison), or amitriptyline (open comparison) for 1 month. Nonresponders were crossed over to the alternative active treatment. RESULTS: After 1 month, phantom pain intensity was 1 (0-2) in the 48 tramadol responders (mean dose, 448 mg [95% confidence interval, 391-505 mg]), 0 (0-0) in the 40 amitriptyline responders (55 [50-59] mg), and 0 (0-0) in the 2 placebo responders, with similar effects on stump pain. Cytochrome P-450 2D6 slow metabolizers derived greater analgesia from tramadol and less from amitriptyline compared with fast metabolizers in the first treatment week (P < 0.01). Electrical pain thresholds increased and pain during suprathreshold stimulation decreased markedly on the stump and, to a lesser extent, on the contralateral limb after 1 month of treatment with amitriptyline or tramadol. Adverse effects were minor in all groups, but more common with tramadol. CONCLUSIONS: In treatment-naive patients, both amitriptyline and tramadol provided excellent and stable phantom limb and stump pain control with no major adverse events. Both drugs demonstrated consistent and large antinociceptive effects on both the stump and the intact limbs.
Publication Types:
PMID: 16129989 [PubMed - indexed for MEDLINE]
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Predicting postoperative pain by preoperative pressure pain assessment.
Hsu YW, Somma J, Hung YC, Tsai PS, Yang CH, Chen CC.
Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan. yungwei.hsu@msa.hinet.net
BACKGROUND: The goal of this study was to evaluate whether preoperative pressure pain sensitivity testing is predictive of postoperative surgical pain. METHODS: Female subjects undergoing lower abdominal gynecologic surgery were studied. A pressure algometer was used preoperatively to determine the pressure pain threshold and tolerance. A visual analog scale (VAS) was used to assess postoperative pain. A State-Trait Anxiety Inventory was used to assess patients' anxiety. Subjects received intravenous patient-controlled analgesia for postoperative pain control. The preoperative pain threshold and tolerance were compared with the postoperative VAS pain score and morphine consumption. RESULTS: Forty women were enrolled. Their preoperative pressure pain threshold and tolerance were 141 +/- 65 kPa and 223 +/- 62 kPa, respectively. The VAS pain score in the postanesthesia care unit and at 24 h postoperatively were 81 +/- 24 and 31 +/- 10, respectively. Highly anxious patients had higher VAS pain scores in the postanesthesia care unit (P < 0.05). Pressure pain tolerance was significantly correlated with the VAS at 24 h postoperatively (P < 0.001, r = -0.52). Pressure pain tolerance after fentanyl administration (mean, 272 +/- 68 kPa) correlated significantly with morphine consumption in the first 24 h postoperatively (P < 0.002, r = -0.48). CONCLUSIONS: Assessment of preoperative pressure pain tolerance is significantly correlated with the level of postoperative pain. Pain tolerance assessment after fentanyl was administered and fentanyl sensitivity predicted the dose of analgesics used in the first 24 h after surgery. The algometer is thus a simple, useful tool for predicting postoperative pain and analgesic consumption.
PMID: 16129988 [PubMed - indexed for MEDLINE]
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Nerve stimulator-guided paravertebral blockade combined with sevoflurane sedation versus general anesthesia with systemic analgesia for postherniorrhaphy pain relief in children: a prospective randomized trial.
Naja ZM, Raf M, El Rajab M, Ziade FM, Al Tannir MA, Lonnqvist PA.
Department of Anesthesia and Pain Medicine, Makassed General Hospital, Beirut, Lebanon. zouhnaja@yahoo.com
BACKGROUND: Improvement of the duration of postoperative analgesia is desirable in children undergoing inguinal hernia repair. METHODS: Fifty children aged 5-12 yr were prospectively randomized to receive either paravertebral nerve blockade or general anesthesia (sevoflurane-fentanyl-nitrous oxide-oxygen) combined with standardized postoperative systemic analgesia, both combined with light sevoflurane anesthesia, for inguinal hernia repair. RESULTS: Mean pain scores were significantly lower in paravertebral nerve blockade patients compared with patients treated with systemic analgesia during the entire 48-h observational period (P < 0.05). Analgesic consumption was significantly higher in the systemic analgesia group (88%) compared with the paravertebral nerve blockade group (32%) (P < 0.001). Parental satisfaction was significantly higher (80 vs. 48%; P < 0.05) and same-day discharge was possible in a higher proportion of patients in the paravertebral blockade group (80% vs. 52%; P < 0.05). CONCLUSIONS: Paravertebral nerve blockade was associated with improved postoperative pain relief; reduced analgesic consumption, and faster hospital discharge compared with a systemic analgesia protocol in children undergoing herniorrhaphy.
Publication Types:
PMID: 16129986 [PubMed - indexed for MEDLINE]
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Ankle Pain in a 13-year-old Boy.
Guehring T, Daniels M, Delling G, Carstens C, Ludwig K.
From the *Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany; and the daggerInstitute for Osteopathology, University Hamburg-Eppendorf, Hamburg, Germany.
PMID: 16131904 [PubMed - as supplied by publisher]
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Failure to Resurface the Patella during Total Knee Arthroplasty May Result in More Knee Pain and Secondary Surgery.
Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF, Mont MA.
From the *Department of Orthopedic Surgery, Rothman Institute of Orthopedics at Thomas Jefferson University, Philadelphia, PA; the daggerDepartment of Orthopaedic Surgery, University of Virginia, Charlottesville, VA; the double daggerGeriatric Research Education and Clinical Center, Minneapolis VA Medical Center, Minneapolis, MN; and the section signDepartment of Orthopedic Surgery, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD.
Resurfacing the patella during primary total knee arthroplasty is controversial. The objective of this meta-analysis was to evaluate the outcome of total knee arthroplasty with or without resurfacing of the patella with particular attention to patient satisfaction, incidence of anterior knee pain, patellar complications, and the need for secondary operations. Computerized databases were searched for citations and published randomized clinical trials relevant to patellar resurfacing from 1966-2003. Of 158 citations identified as related to patellar resurfacing during total knee arthroplasty, 14 articles met all inclusion criteria for this study. The incidence of anterior knee pain was greater in knees with nonresurfaced patellas. Secondary resurfacings for anterior knee pain was needed in 8.7% of nonresurfaced knees. No difference in reported complications existed. Total knee arthroplasty resulted in improvement of functional outcome regardless of whether the patella was resurfaced. Based on the results of this meta-analysis, nonresurfacing of the patella during primary total knee arthroplasty is likely to result in a greater incidence of anterior knee pain, the need for secondary resurfacing in almost one in 10 patients, and possibly less patient satisfaction.Level of Evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
PMID: 16131890 [PubMed - as supplied by publisher]
Antinociceptive activity of the selective iNOS inhibitor AR-C102222 in rodent models of inflammatory, neuropathic and post-operative pain.
Labuda CJ, Koblish M, Tuthill P, Dolle RE, Little PJ.
Department of Pharmacology, Adolor Corporation, 700 Pennsylvania Drive, Exton, PA 19341, United States.
Nitric oxide generated by the nitric oxide synthase (NOS) isoforms contributes to pain processing. The selective inhibition of iNOS might represent a novel, therapeutic target for the development of antinociceptive compounds. However, few isoform-selective inhibitors of NOS have been developed. The present experiments examined the anti-inflammatory and antinociceptive activity of a selective inducible nitric oxide (iNOS) inhibitor, AR-C102222, on arachidonic acid-induced ear inflammation, Freund's complete adjuvant (FCA)-induced hyperalgesia, acetic acid-induced writhing, and tactile allodynia produced by L5 spinal nerve ligation (L5 SNL) or hindpaw incision (INC). AR-C102222 at a dose of 100mg/kg p.o., significantly reduced inflammation produced by the application of arachidonic acid to the ear, attenuated FCA-induced mechanical hyperalgesia, and attenuated acetic acid-induced writhing. In the L5 SNL and INC surgical procedures, tactile allodynia produced by both procedures was significantly reduced by 30mg/kg i.p. of AR-C102222. These data demonstrate that the selective inhibition of iNOS produces antinociception in different models of pain and suggest that the iNOS-NO system plays a role in pain processing.
PMID: 16125426 [PubMed - as supplied by publisher]
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Vagus nerve stimulation suppresses pain but has limited effects on neurogenic inflammation in humans.
Kirchner A, Stefan H, Bastian K, Birklein F.
Neurologische Klinik, University of Erlangen-Nuremberg, Germany; Neurologische Universitatsklinik Mainz, Schwabachanlage 6, D-91054 Erlangen, Germany.
Left vagus nerve stimulation reduces pain perception in humans. In animal studies it has been shown that beyond the inhibitory effect, which the vagus nerve exerts via its widespread central connections, there might be also a peripheral effect on nociceptors. In humans, the exact mechanisms of VNS-mediated analgesia are still unclear. To test whether VNS also affects activation of primary nociceptive afferents in humans, we investigated 11 patients before and after implantation of a vagus nerve stimulator by using tonic pressure as pain stimulus. Vasodilator axon reflexes ("neurogenic" inflammation) were quantified by laser-Doppler-imaging and served as surrogates for primary afferent activation. Pain was measured on a visual analogue scale (VAS). The squeezing experiment was performed three times at 15min intervals in each session. As controls 9 healthy age- and gender-matched subjects were studied. As shown in our previous study, VNS significantly reduces pain to tonic pressure. Likewise, there was a moderate reduction of the blood flow within the area of the axon reflex, which indicates a possible but limited inhibitory effect of VNS on peripheral nociceptors. Our data suggests that VNS might affect peripheral nociceptor function in humans. Since VNS has been shown to be more effective in experimental procedures in which pain magnitude is amplified by central processing, further studies are warranted to elucidate whether the central or peripheral effect is most important for VNS-mediated analgesia.
PMID: 16125425 [PubMed - as supplied by publisher]
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CHF3381, a novel antinociceptive agent, attenuates capsaicin-induced pain in rats.
Bassani F, Bergamaschi M, Tonino Bolzoni P, Villetti G.
Chiesi Farmaceutici S.p.A., R&D Department, via Palermo 26/A, 43100 Parma, Italy.
Here, we have examined the effect of the novel antinociceptive agent CHF3381 on the development of nocifensive behaviour as well as secondary mechanical allodynia and hyperalgesia induced by intraplantar injection of capsaicin in rats. Vehicle, CHF3381 or gabapentin were orally administered 1 h before capsaicin injection. The duration of nocifensive behaviour was measured during the first 5 min after capsaicin injection. Secondary mechanical allodynia and hyperalgesia were measured at 5 and 15 min after capsaicin injection, respectively. CHF3381 produced a significant suppression of nocifensive behaviour and completely blocked the development of mechanical allodynia and hyperalgesia at 100 and 200 mg/kg. Gabapentin weakly inhibited the development of nocifensive behaviour and mechanical allodynia. On the contrary, gabapentin (100 mg/kg) completely prevented the development of mechanical hyperalgesia. In conclusion, CHF3381 had full efficacy for all the capsaicin-induced pain parameters tested, suggesting that CHF3381 may have a therapeutic utility in the management of pain states involving central sensitisation.
PMID: 16125167 [PubMed - indexed for MEDLINE]
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Effect of celecoxib, a cyclooxygenase-2 inhibitor, on the pathophysiology of adjuvant arthritis in rat.
Noguchi M, Kimoto A, Kobayashi S, Yoshino T, Miyata K, Sasamata M.
Pharmacology Laboratories Institute for Drug Discovery Research, Yamanouchi Pharmaceutical Co., Ltd., 21, Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan.
We investigated the efficacy of celecoxib, a specific cyclooxygenase (COX)-2 inhibitor, on arthritic pathophysiology and confirmed its gastric safety in adjuvant-induced arthritis rats. Results were compared with those for loxoprofen, a non-selective COX inhibitor. Arthritis was induced by injection of 1 mg of Mycobacterium butyricum in 50 microl of liquid paraffin into the left footpad of Lewis rats. The drugs were given by twice daily oral administration for 10 days beginning 15 days after adjuvant injection, with celecoxib at 0.01-3 mg/kg/day and loxoprofen at 0.01-3 mg/kg/day. Celecoxib significantly inhibited paw swelling, hyperalgesic response, and joint destruction (radiographic and histopathological findings) in these arthritic rats. These effects of celecoxib were superior to those of loxoprofen. Further, the administration of loxoprofen (3 mg/kg/day) caused significant gastric lesions, whereas celecoxib at the same dose did not. These results suggest that COX-2-mediated prostaglandins may play an important role in the progression of pathophysiology in this model and that celecoxib may be a useful therapeutic agent for the treatment of rheumatoid arthritis, with greater safety than non-selective COX inhibitors.
PMID: 15862805 [PubMed - indexed for MEDLINE]
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Chemoradiotherapy-induced esophagitis pain relieved by topical morphine: three cases.
Gairard-Dory AC, Schaller C, Mennecier B, Molard A, Gourieux B, Beretz L, Quoix E.
Publication Types:
PMID: 16125024 [PubMed - in process]
Comment on:
Persistent low back pain.
Meyer MA.
Publication Types:
PMID: 16136714 [PubMed - indexed for MEDLINE]
Comment on:
Persistent low back pain.
Singla AK, Stojanovic M, Barna S.
Publication Types:
PMID: 16135847 [PubMed - indexed for MEDLINE]
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Effect of the cannabinoid CB1 receptor antagonist, SR141716, on nociceptive response and nerve demyelination in rodents with chronic constriction injury of the sciatic nerve.
Costa B, Trovato AE, Colleoni M, Giagnoni G, Zarini E, Croci T.
Department of Biotechnology and Bioscience, University of Milano-Bicocca, piazza della Scienza 2, 20126 Milano, Italy. barbara.costa@unimib.it
Many reports have shown the efficacy of cannabinoid agonists in chronic pain, whereas no report exists concerning the potential effect of cannabinoid antagonists following prolonged treatment. We tested the effects of repeated administration of the selective cannabinoid receptor type 1 (CB1) antagonist, SR141716 (rimonabant), in rats with chronic constriction injury of the sciatic nerve (CCI), an animal model of neuropathic pain. The repeated oral administration of SR141716 (1, 3 and 10 mg/kg, once a day for 1 week, from day 7 after the injury) dose dependently attenuated both thermal and mechanical hyperalgesia. A similar effect was observed in CCI wild-type mice, whereas SR141716 was unable to elicit pain relief in CB1 knockout mice, suggesting CB1 receptors involvement in the SR141716-induced antihyperalgesia. The antihyperalgesic activity of SR141716 was associated with a significant reduction of several pro-inflammatory and pro-nociceptive mediators such as tumor necrosis factor alpha (TNFalpha), prostaglandin-E2 (PGE2), lipoperoxide and nitric oxide (NO) levels. The histological analysis of sciatic nerve sections showed a marked degeneration of myelinated fibers in CCI rats, which was substantially reduced after repeated administration of SR141716. This suggests that the compound may favour myelin repair and consequently promote long-lasting functional recovery. This was confirmed by the maintenance of recovery for at least four weeks after treatment discontinuation. In conclusion, the present findings suggest that SR141716 is effective not only in alleviating neuropathic pain but also in favouring the nerve myelin repair.
PMID: 15936882 [PubMed - indexed for MEDLINE]
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Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial.
Sjogren T, Nissinen KJ, Jarvenpaa SK, Ojanen MT, Vanharanta H, Malkia EA.
Department of Health Sciences, University of Jyvaskyla, P.O. Box 35, FIN-40014 Jyvaskyla, Finland. tuulikki.sjogren@sport.jyu.fi
The purpose of the study was to examine the effects of a workplace physical exercise intervention on the perceived intensity of headache and the intensity of symptoms in the neck and shoulders, as well as on the extension and flexion strength of the upper extremities. The study was a cluster randomized controlled trial. The cross-over design consisted of physical exercise intervention (15 weeks) and no-intervention (15 weeks). The subjects (n=53) were office workers (mean age 46.6 (SD 8.4)) who reported headache (n=41) symptoms in the neck (n=37) or shoulders (n=41), which had restricted their daily activities during the last 12 months. Pain symptoms were measured using the Borg CR10 scale and muscular strength with a 5RM test. Statistical analyses were based on linear mixed models. Physical exercise intervention resulted in a slight, but statistically significant, decrease in the intensity of headache and neck symptoms, as well as an increase in the extension strength of the upper extremities. The mean decrease in headache during the 5-week period was 0.64 CR10 (95% CI 0.28-1.00) (P=0.001) or 49% (95% CI 22-77), and 0.42 CR10 (95% CI 0.11-0.72) (P=0.002) or 49% (95% CI 13-85) in the intensity of neck symptoms. The mean increase in the extension strength of the upper extremities was 1.3 kg (95% CI 0.5-2.1) (P=0.001) or 4% (95% CI 1-6). The intervention had no effect on the intensity of shoulder symptoms or the flexion strength of the upper extremities. Specific exercise may be clinically important to alleviate headache and neck symptoms.
Publication Types:
PMID: 15927388 [PubMed - indexed for MEDLINE]
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Liposomal drug delivery for postoperative pain management.
Viscusi ER.
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USA. eugene.viscusi@jefferson.edu
PMID: 16135355 [PubMed - in process]
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Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale.
Kaki AM, El-Yaski AZ, Youseif E.
Department of Anesthesia and Critical Care Medicine, King Abdulaziz University Hospital, Jeddah 21461, Saudi Arabia. amkaki@yahoo.com
BACKGROUND AND OBJECTIVES: Although the literature contains information about prevalence and incidence of low-back pain (LBP), little information is available about the contribution of the neuropathic element to LBP. Our study was designed to investigate the prevalence of neuropathic pain among a sample of chronic LBP patients in Saudi Arabia by use of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. METHODS: A total of 1,169 patients from 117 centers agreed to participate in the study over a period of 6.5 months. The LANSS pain scale was applied to each patient in an interview format. The characteristics of pain and sensory dysfunction were tested and recorded. RESULTS: According to the LANSS pain scale, 639 patients (54.7%) had scores of 12 points or more, which suggested a neuropathic type of pain, and 530 patients (45.3%) had scores of less than 12, which suggested a nociceptive type of pain. Factors that are associated with neuropathic pain are advanced age, female gender, increased height, white race, hypertension and diabetes, a history of smoking, previous back surgery, and previous medications. CONCLUSION: Neuropathic pain is a major contributor to chronic LBP, and the LANSS pain scale is a useful tool to distinguish patients with neuropathic pain from those with nociceptive pain.
PMID: 16135345 [PubMed - in process]
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The neuropathic pain scales.
Benzon HT.
Publication Types:
PMID: 16135344 [PubMed - in process]
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Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit.
Shum GL, Crosbie J, Lee RY.
Physiotherapy Department, United Christian Hospital, Hong Kong.
STUDY DESIGN: Experimental study to describe lumbar spine and hip joint movements during sit-to-stand and stand-to-sit. OBJECTIVES: To examine differences in the kinematics and joint coordination of the lumbar spine and hips during sit-to-stand and stand-to-sit between healthy subjects and patients with subacute low back pain (LBP). SUMMARY OF BACKGROUND DATA: There is a paucity of information on the coordination of movements of lumbar spine and hips during sit-to-stand and stand-to-sit. The effect of LBP, with or without nerve root signs, is largely unknown. METHODS: A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips during sit-to-stand and stand-to-sit. Sixty subacute LBP participants with or without straight leg raise signs and 20 healthy asymptomatic participants were recruited. The kinematic patterns of lumbar spine and hips were analyzed. Coordination between the two joints was studied by relative phase angle analysis. RESULTS: The mobility of the spine and hips was significantly limited in back pain subjects. It was observed that LBP subjects employed various strategies to compensate for the limited motions at the hips and lumbar spine. The contribution of the lumbar spine relative to that of the hip was found to be reduced for subjects with LBP. The lumbar spine-hip joint coordination was significantly altered in back pain subjects, in particular, those with positive straight leg raise sign. CONCLUSION: Back pain was related to changes in the kinematics and coordination of the lumbar spine and hips during sit-to-stand and stand-to-sit. Assessment of back pain patients should include kinematic analysis of the hips as well as the spine.
PMID: 16135992 [PubMed - in process]
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The symptom of night pain in a back pain triage clinic.
Harding IJ, Davies E, Buchanan E, Fairbank JT.
Nuffield Orthopaedic Centre, Oxford, United Kingdom. ianharding@doctors.net.uk
STUDY DESIGN: Prospective longitudinal study of patients attending a back pain triage clinic with night pain. OBJECTIVE: To assess the importance of the symptom of night pain in patients attending a back pain triage clinic. SUMMARY OF BACKGROUND DATA: The 1994 US Agency for Health Care Policy and Research guidelines suggest nighttime pain should be used as a "red flag." Night pain is known to occur in many conditions, and although common in patients with known serious pathology, the prevalence of night pain in a back pain triage clinic is not known. METHODS: A total of 482 consecutive patients attending a back pain triage clinic were assessed, including history of frequency and duration of night pain. Clinical examination was performed, and demographic data obtained. Magnetic resonance imaging was performed if indicated according to local guidelines. Oswestry, visual analog scales (for pain), and hospital anxiety depression scale, patient-based outcome scores were obtained. RESULTS: There were 213 patients who had night pain, with 90 having pain every night. No serious pathology was identified. Patients with night pain had 4.95 hours continuous sleep (range 2-7) and were woken 2.5 times/night (range 0-6). Patients with pain every night had higher Oswestry, visual analog scale, and hospital anxiety depression scale scores than those who did not. CONCLUSIONS: Although it is a significant and disruptive symptom for patients, these results challenge the specificity of the presence of night pain per se as a useful diagnostic indicator for serious spinal pathology in a back pain triage clinic.
PMID: 16135990 [PubMed - in process]
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Osteogenic protein-1 (osteogenic protein-1/bone morphogenetic protein-7) inhibits degeneration and pain-related behavior induced by chronically compressed nucleus pulposus in the rat.
Kawakami M, Matsumoto T, Hashizume H, Kuribayashi K, Chubinskaya S, Yoshida M.
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan. kawakami@wakayama-med.ac.jp
STUDY DESIGN: To study the therapeutic efficacy of intradiscal injection of osteogenic protein-1 (OP-1) to reduce degeneration and associated discogenic pain. OBJECTIVE: To evaluate if intradiscal injection of OP-1 can reverse disc degeneration and reduce hyperalgesia, a pain-related behavior. SUMMARY OF BACKGROUND DATA: We showed that induction of hyperalgesia was higher in rats exposed to compressed nucleus pulposus (NP). It has been reported that intradiscal injection of OP-1 stimulates synthesis of proteoglycans and collagen in normal intervertebral discs. METHODS: Rats were divided into several groups. In the sham group, the rings of an Ilizarov-type apparatus were only applied to the tail without compression. In the compressed NP group, the apparatus was used to apply chronically compression to the tail. Four weeks after surgery, the NP group was subdivided into 3 groups: saline-treated and OP-1-treated, which was divided into 2 groups (i.e., the continuous compression OP-1 [COP-1] group, in which compression was continuously applied to the tail for 4 weeks after OP-1 treatment and the release compression OP-1 [ROP-1] group, in which compression was released at treatment. Either physiologic saline or OP-1 was injected into the instrumented NP. The treated NP was harvested and applied to the left lumbar nerve roots 4 weeks after injection. Hyperalgesia was measured up to 3 weeks after surgery. The degree of disc degeneration and the appearance of the extracellular matrix in the intervertebral discs were evaluated by histology. RESULTS: Mechanical hyperalgesia was observed in the sham and saline groups, but not in the OP-1 treated group. In the saline group, NP cells became spindle-shaped. In the OP-1 group, the NP cells became swollen with vacuolated cytoplasm, and the content of the extracellular matrix was markedly increased. CONCLUSION: OP-1 injection into degenerative intervertebral disc resulted in the enhancement of the extracellular matrix and the inhibition of pain-related behavior.
PMID: 16135982 [PubMed - in process]
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Transient cervical nerve root compression in the rat induces bilateral forepaw allodynia and spinal glial activation: mechanical factors in painful neck injuries.
Hubbard RD, Winkelstein BA.
Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104-6392, USA.
STUDY DESIGN: An in vivo rat model of transient cervical nerve root compression. OBJECTIVES: To investigate the potential for cervical nerve root compression to produce behavioral hypersensitivity and examine its dependence on compression. SUMMARY OF BACKGROUND DATA: Clinically, nerve root injury has been hypothesized as a potential source of neck pain, particularly because cervical nerve roots are at mechanical risk for injury during neck loading. Lumbar radiculopathy models of nerve root ligation show that mechanical allodynia and spinal glial changes depend on nerve root deformation magnitude. However, no investigation has been performed to examine cervical nerve root compression as a cause of pain. METHODS: Two compressive forces (10 and 60 grams force [gf]) were transiently applied to the C7 nerve roots unilaterally using microvascular clips in separate groups (n = 12 each). Sham procedures were also performed in a separate group of rats (n = 12). Bilateral forepaw mechanical allodynia was monitored after surgery for 7 days. On day 7, spinal glial activation was assessed using immunohistochemistry to investigate its dependence on nerve root compressive force, in the context of behavioral hypersensitivity. RESULTS: Bilateral allodynia was observed following injury, which was significantly (P < 0.042) increased over sham and baseline responses. No difference in allodynia was found between the 10 and 60 gf injuries. Astrocytic and microglial activation were observed in the ipsilateral dorsal horn following compression, with only astrocytic activation paralleling allodynia patterns. CONCLUSIONS: Results imply a force threshold exists less than 10 gf for persistent pain symptoms following transient cervical nerve root compression. Findings also suggest that spinal glial activation may be related to behavioral sensitivity and may modulate cervical nerve root mediated pain.
PMID: 16135981 [PubMed - in process]
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Sensory motor learning in patients with chronic low back pain: a prospective pilot study using optoelectronic movement analysis.
Schon-Ohlsson CU, Willen JA, Johnels BE.
Sahlgrenska Academy, Goteborg University, Institute of Occupational Therapy and Physiotherapy, Goteborg, Sweden. christina.schon-ohlsson@fhs.gu.se
STUDY DESIGN: The effect of sensory motor learning (SML) on chronic low back pain (CLBP) patients' movement capacity was evaluated with the optoelectronic Posturo-Locomotion-Manual (PLM) test. OBJECTIVE: To study SML changes of an intentional dynamic behavior of daily life in a group of CLBP patients and compare the performance with an age- and sex-matched group of back-healthy individuals. SUMMARY OF BACKGROUND DATA: In a previous study, the PLM test was found reliable when used in CLBP patients. SML addresses dynamic movement capacity. There is little scientific evidence of the effectiveness of educational interventions in improving motor behavior. METHODS: Twelve patients with treatment-resistant CLBP were selected by two orthopedic spine surgeons. Twelve back-healthy age- and sex-matched individuals were included as controls. The patients participated in weekly SML lessons during a maximum of 12 months. All study participants were investigated with the PLM test, before intervention, directly after intervention, and 10 to 12 months after completion of the intervention, and patients were compared with controls. RESULTS: Before intervention significant differences in performance were found between the group of patients and the healthy control group. After the intervention, the CLBP patients had improved their performance so there were no longer any significant differences between the groups. The results were retained 12 months after intervention. CONCLUSIONS: The study shows that the CLBP patients had learned and retained a more efficient behavior. The results suggest that SML is an effective intervention for nonspecific CLBP patients.
PMID: 16135974 [PubMed - in process]
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