Dissociation proneness and pain hyposensitivity in current and remitted borderline personality disorder

Abstract

Background

Stress‐related dissociation has been shown to negatively co‐vary with pain perception in current borderline personality disorder (cBPD). While remission of the disorder (rBPD) is associated with normalized pain perception, it remains unclear whether dissociation proneness is still enhanced in this group and how this feature interacts with pain sensitivity.

Methods

Twenty‐five cBPD patients, 20 rBPD patients, and 24 healthy controls (HC) participated in an experiment using the script‐driven imagery approach. We presented a personalized stressful and neutral narrative. After listening to the scripts, dissociation and heat pain thresholds (HPT) were assessed.

Results

Compared to HC, cBPD patients showed enhanced dissociation and exhibited significantly enhanced HPT in the neutral condition, while rBPD participants were in between. After listening to the stress script, both clinical groups exhibited enhanced dissociation scores. Current BPD participants responded with significantly higher HPT, while rBPD only showed a trend in the same direction. However, both BPD groups showed significantly increased HPT compared to the HC in the stress condition, but did not differ from each other. Dissociation proneness correlated significantly positively with pain hyposensitivity only in cBPD.

Conclusion

Dissociation proneness is enhanced in both BPD groups. This feature is clearly positively related to pain hyposensitivity in cBPD, but not in rBPD. However, the data indicate that stress causes the pain perception in rBPD to drift away from that obtained in HC. These results highlight the volatile state of BPD remission and might have important implications for the care of BPD patients in the remitted stage.

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Breakthrough pain is not a fixed fraction of constant cancer pain

Abstract

This journal recently published a paper by Currow et al., entitled "A randomised, double‐blind, crossover, dose ranging study to determine the optimal dose of oral opioid to treat breakthrough pain for patients with advanced cancer already established on regular opioids” (Currow et al., 2010). Currow et al. demonstrated that for breakthrough pain (BTP) there were no differences between giving rescue opioids doses of 1/6, 1/8 or 1/12 of the scheduled daily opioid dose.

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Necessary Components of Psychological Treatment for Chronic Pain: More Packages for Groups or Process‐Based Therapy for Individuals?

Abstract

This journal recently published a paper by Sharpe et al., entitled “Necessary components of psychological treatments in chronic pain management programs: A Delphi study” (Sharpe, Jones, Ashton‐James, Nicholas, & Refshauge, 2020). These researcher sought the views of authors of relevant RCTs published up to September 2016 and supplemented these with input from psychologists working in pain management programs in Australia.

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Psychological and pain profiles in persons with patellofemoral pain as the primary symptom

Abstract

Background

Patellofemoral pain (PFP) is defined biomechanically, but is characterised by features that fit poorly within nociceptive pain. Mechanisms associated with central sensitisation may explain why, for some, symptoms appear nociplastic. This study compares psychological and somatosensory characteristics between those with persistent PFP and controls.

Methods

150 adults with PFP were compared to 61 controls. All participants completed a survey evaluating participant characteristics, PFP‐related constructs and psychological factors: anxiety, depression, pain catastrophizing, kinesiophobia, pain self‐efficacy. Participants also attended a session of somatosensory testing, which included knee and elbow thermal and mechanical detection and pain thresholds, conditioned pain modulation (CPM), and temporal summation of pain (TSP). Differences were evaluated using analysis of covariance (sex as covariate). Multivariate backward stepwise linear regression examined how psychological and somatosensory variables relate to PFP (Knee injury & Osteoarthritis Outcome Score‐patellofemoral).

Results

The PFP group had multimodal reduced pain thresholds at the knee and elbow (Standardised Mean Difference (SMD), p: 0.86 to 1.2, <0.001), reduced mechanical detection at the elbow (0.43, 0.01) and higher TSP (0.41, 0.01). CPM was not different. Psychological features demonstrated small effects (0.47‐0.59, 0.01‐0.04). The PFP group had a 55% (95% CI: 0.47 to 0.62) risk of kinesiophobia and an 11% (0.06 to 0.15) reduced pain self‐efficacy risk. Kinesiophobia, knee pressure pain threshold, pain self‐efficacy and pain catastrophizing explained 40% of KOOS‐PF variance (p = <0.001).

Conclusions

Widespread hyperalgesia and evidence of symptom amplification may reflect nociplastic pain. Clinicians should be aware that kinesiophobia and the nociplastic pain may characterise the condition.

Significance

(1) Individuals with patellofemoral pain have widespread reduced pain thresholds to pressure and thermal stimuli. (2) Mechanically‐induced pain is likely amplified in those with patellofemoral pain. (3) Pain‐related fear is highly prevalent and helps explain patellofemoral pain‐related disability.

What’s already known about this topic?

(1) Pressure pain threshold can be lower in individuals with patellofemoral pain.

What does this study add?

(1) This is the first study to explore a combined range of psychological and psychophysical tests in patellofemoral pain. (2) This study provides strong evidence of nociplastic pain in patellofemoral pain.

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Interpretation biases and visual attention in the processing of ambiguous information in chronic pain

Abstract

Background

Theories propose that interpretation biases and attentional biases might account for the maintenance of chronic pain symptoms, but the interactions between these two forms of biases in the context of chronic pain are understudied.

Methods

To fill this gap, sixty‐three participants (40 females) with and without chronic pain completed an interpretation bias task that measures participants’ interpretation styles in ambiguous scenarios and a novel eye‐tracking task where participants freely viewed neutral faces that were given ambiguous pain‐/health‐related labels (i.e., “doctor”, “patient” and “healthy people”). Eye movements were analysed with the Hidden Markov Models (EMHMM) approach, a machine‐learning data‐driven method that clusters people’s eye movements into different strategy subgroups.

Results

Adults with chronic pain endorsed more negative interpretations for scenarios related to immediate bodily injury and long‐term illness than healthy controls, but they did not differ significantly in terms of their eye movements on ambiguous faces. Across groups, people who interpreted illness‐related scenarios in a more negative way also focused more on the nose region and less on the eye region when looking at patients’ and healthy people’s faces and, to a lesser extent, doctors’ faces. This association between interpretive and attentional processing was particularly apparent in participants with chronic pain.

Conclusions

In sum, the present study provided evidence for the interplay between multiple forms of cognitive biases. Future studies should investigate whether this interaction might influence subsequent functioning in people with chronic pain.

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Lack of relationship between epidermal denervation by capsaicin and incisional pain behaviors: a laser scanning confocal microscopy study in rats

Abstract

Background

Spontaneous pain after surgical incision is a significant problem for most post‐operative patients. Pain management that relies on opioids is hindered by numerous side effects, fueling interest in non‐opioid alternatives and multimodal approaches. Subcutaneous capsaicin infiltration has shown potential for reducing post‐operative pain, but there are unanswered questions about safety and possible side effects. In adult rats, we characterized the analgesic effects of pre‐operative capsaicin infiltration into the skin prior to plantar incision and assessed wound healing and epidermal innervation.

Methods

The surgical site on the plantar surface of the rat hind paw was infiltrated with 1% capsaicin or vehicle 30 minutes or 1 week prior to surgical incision. Spontaneous and evoked pain behaviors were assessed. Digital images of incised hind paws were used to quantify the surface area of the wound after suture removal. Epidermal nerve fiber quantification was performed on peri‐incisional tissue biopsies.

Results

Intraplantar administration of capsaicin 30 minutes before surgical incision attenuated spontaneous pain behaviors, heat hyperalgesia, epidermal innervation, but it did not alter the rate of wound healing. Incisional pain hypersensitivity returned to baseline 2 weeks post‐incision, at a time when no recovery of epidermal innervation is observed.

Conclusions

Subcutaneous infiltration of capsaicin prior to surgical incision attenuated incision‐induced pain behaviors and reduced epidermal innervation around the incision site. The long‐lasting epidermal denervation by capsaicin had no impact in the rate of wound healing and recovery from pain behaviors.

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Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017

AbstractObjectiveTo use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for...

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The BMJ Awards 2020: Primary care team

Opioid reduction programme—Crimond Medical CentrePatients have gained a better understanding of chronic pain and cut drug useTo tackle a range of problems, the practice team took control of the list...

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A systematic review and meta-analysis of pregabalin preclinical studies

Despite large efforts to test analgesics in animal models, only a handful of new pain drugs have shown efficacy in patients. Here, we report a systematic review and meta-analysis of preclinical studies of the commercially successful drug pregabalin. Our primary objective was to describe design characteristics and outcomes of studies testing the efficacy of pregabalin in behavioral models of pain. Secondarily, we examined the relationship between design characteristics and effect sizes. We queried MEDLINE, Embase, and BIOSIS to identify all animal studies testing the efficacy of pregabalin published before January 2018 and recorded experimental design elements addressing threats to validity and all necessary data for calculating effect sizes, expressed as the percentage of maximum possible effect. We identified 204 studies (531 experiments) assessing the efficacy of pregabalin in behavioral models of pain. The analgesic effect of pregabalin was consistently robust across every etiology/measure tested, even for pain conditions that have not responded to pregabalin in patients. Experiments did not generally report using design elements aimed at reducing threats to validity, and analgesic activity was typically tested in a small number of model systems. However, we were unable to show any clear relationships between preclinical design characteristics and effect sizes. Our findings suggest opportunities for improving the design and reporting of preclinical studies in pain. They also suggest that factors other than those explored in this study may be more important for explaining the discordance between outcomes in animal models of pain and those in clinical trials.

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Primary care for low back pain: we don't know the half of it

No abstract available

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Ethnic disparities in pain processing among healthy adults: μ-opioid receptor binding potential as a putative mechanism

Although ethnic differences in pain perception are well documented, the underlying mechanism for these outcomes has not been established. µ-opioid receptor (MOR) function might contribute to this disparity, given that MORs play a key role in pain sensitivity and modulation. However, no study has characterized ethnic differences in MOR physiology. This study sought to address this knowledge gap by examining differences in µ-selective agonist binding potential (BPND; [11C]-Carfentanil) between 27 non-Hispanic black (NHB) and 27 demographically similar, non-Hispanic white participants. Participants completed questionnaires and two 90-minute high-resolution research tomograph positron emission tomography (PET) imaging sessions. During PET imaging, a capsaicin or control cream was applied to individuals' arms, and pain ratings were collected. Bonferroni-corrected PET volumes of interest analyses revealed significantly greater [11C]-Carfentanil BPND among NHB participants in bilateral ventral striatum ([left]: F1,52 = 16.38, P < 0.001; [right]: F1,52 = 21.76, P < 0.001), bilateral dorsolateral prefrontal cortex ([left] F1,52 = 17.3, P < 0.001; [right]: F1,52 = 14.17, P < 0.001), bilateral subgenual anterior cingulate cortex ([left]: F1,52 = 10.4, P = 0.002; [right]: F1,52 = 12.91, P = 0.001), and right insula (F1,52 = 11.0, P = 0.002). However, there were no significant main effects of condition or ethnicity × condition interaction effects across models, likely attributable to individual variability in the direction of change within groups. BPND values were significantly correlated with pain ratings collected during the capsaicin condition (r range = 0.34-0.46, P range = 0.01-0.001). Results suggest that NHB individuals might have generally greater unoccupied MOR density than non-Hispanic white peers. Findings have implications for physiological differences underlying ethnicity-related pain disparities. If replicated, these results further emphasize the need for tailored treatments in historically underserved populations.

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Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial

Publication date: April 2020

Source: Archives of Physical Medicine and Rehabilitation, Volume 101, Issue 4

Author(s): Liliam B. Priore, Simon Lack, Carmen Garcia, Fabio M. Azevedo, Danilo de Oliveira Silva

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Directional discrimination is better for noxious laser stimuli than for innocuous laser stimuli

Abstract

Background

The directional discrimination is lower for painful laser heat compared to non‐painful mechanical stimulation. The aim of the current study was to investigate how the directional discrimination of radiant heat stimulation depends on stimulation intensity and displacement velocity.

Methods

Fifteen healthy subjects were stimulated in the right volar forearm with a CO₂ laser at intensities that were expected to be either painful (46°C) or non‐painful (39°C). The laser beam was continuously displaced distal‐proximally along the arm during the stimulation. After the stimulation, subjects indicated the perceived direction and intensity (NRS: 0: perception 3: pain 10: maximum pain). Stimulations were delivered with five lengths (20, 40, 60, 80 and 100 mm) and three velocities (10, 30 and 100 mm/s). To estimate the directional discrimination threshold (DDT) the data were fitted to a sigmoidal curve.

Results

For the lower intensity (39°C) the DDT was 81.8 mm for the slowest velocity, and above 100 mm for the two faster velocities. For the higher intensity (46°C) the DDT was 58.8 and 69.6 mm for the slowest velocity and middle velocity, respectively, and above 100 mm for the fastest velocity. The perceived intensity increased with stimulation length, stimulation intensity and decreasing velocity (LMM, p < .001).

Conclusions

This study shows how the DDT for thermal stimuli is shorter for higher intensity and lower displacement velocities. Additionally, it was shown that for the velocity where directional discrimination is optimal for mechanical stimuli it is not possible to discriminate a thermal stimulus.

Significance

This study showed that the directional discrimination of painful laser stimuli is better than that for non‐painful laser stimuli. These findings supplements our current knowledge regarding the tempo‐spatial discrimination in the nociceptive system, where evidence from previous discrimination studies differs somewhat regarding difference between painful and non‐painful discrimination. This, therefore, indicates that there is lacking knowledge regarding the discrimination within the nociceptive system.

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Temporal aspects of endogenous pain modulation during a noxious stimulus prolonged for 1 day

Abstract

Background

This study investigated (a) if a prolonged noxious stimulus (24‐hr topical capsaicin) in healthy adults would impair central pain inhibitory and facilitatory systems measured as a reduction in conditioned pain modulation (CPM) and enhancement of temporal summation of pain (TSP) and (b) if acute pain relief or exacerbation (cooling and heating the capsaicin patch) during the prolonged noxious stimulus would affect central pain modulation.

Methods

Twenty‐eight participants (26.2 ± 1.0 years; 12 women) wore a transdermal 8% capsaicin patch on the forearm for 24 hr. Data were collected at baseline (Day 0), 1 hr, 3 hr, Day 1 (post‐capsaicin application) and Day 3/4 (post‐capsaicin removal) that included capsaicin‐evoked pain intensity, heat pain thresholds (HPTs), TSP (10 painful cuff pressure stimuli on leg) and CPM (cuff pressure pain threshold on the leg prior vs. during painful cuff pressure conditioning on contralateral leg). After 3 hr, cold (12°C) and heat (42°C) stimuli were applied to the capsaicin patch to transiently increase and decrease pain intensity.

Results

Participants reported moderate pain scores at 1 hr (2.5 ± 2.0), 3 hr (3.7 ± 2.4), and Day 1 (2.4 ± 1.8). CPM decreased 3‐hr post‐capsaicin (p = .001) compared to Day 0 and remained diminished while the capsaicin pain score was reduced (0.4 ± 0.7, p < .001) and increased (6.6 ± 2.2, p < .001) by patch cooling and heating. No significant differences occurred for CPM during patch cooling or heating compared to initial 3HR; however, CPM during patch heating was reduced compared with patch cooling (p = .01). TSP and HPT did not change.

Conclusions

This prolonged experimental pain model is useful to provide insight into subacute pain conditions and may provide insight into the transition from acute to chronic pain.

Significance

During the early hours of a prolonged noxious stimulus in healthy adults, CPM efficacy was reduced and did not recover by temporarily removing the ongoing pain indicating a less dynamic neuroplastic process.

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Prevalence and associated psychosocial and health factors of chronic pain in adolescents: Differences by sex and age

Abstract

Background

Chronic pain is a common issue in adolescents. Prevalence of pain and associated factors present differently in sex and age subgroups; however, the interaction of sex and age combined has not been thoroughly assessed. This study aimed to identify psychosocial and health factors associated with chronic pain in younger and older adolescent girls and boys.

Methods

Students from five schools in grades 5–10 self‐completed a pain survey. Participants were 2,280 adolescents (52% girls) aged 10–18 years (M = 12.95, SD = 1.84). Data were analysed using multivariate logistic regression models.

Results

Chronic pain was present in 33% of participants. The risk of chronic pain increased by 29% in girls, compared to 16% in boys, per year of age (p = .039). Overall, depression (OR = 2.05, p < .001), anxiety (OR = 1.51, p < .001), lower school satisfaction (OR = 1.41, p = .034) and sleep issues (OR = 2.34, p < .001) were associated with chronic pain. Stratified analyses identified unique significant associations between chronic pain and psychosocial factors. In boys aged 10–13 years, higher socioeconomic status (OR = 1.76, p = .024) and poorer school performance (OR = 1.60, p = .027) were uniquely important; in girls aged 10–13 years, lower school satisfaction (OR = 2.92, p = .003) was associated with pain, and in older girls aged 14–18 years, anxiety (OR = 1.74, p = .009) was significantly associated with pain. When these differences were assessed statistically, only lower school satisfaction had significant differences between subgroups (p = .049).

Conclusions

Many psychosocial and health factors are similarly important, with few differences, for chronic pain in girls and boys at different stages of adolescence.

Significance

We report evidence that negative psychosocial and health factors are related to a higher prevalence of chronic pain in adolescents. Furthermore, the relationships between anxiety, socioeconomic status, lower school satisfaction and lower school performance with pain may vary between adolescents of differing sexes and ages. Understanding how possible risk factors for chronic pain contribute differently to the pain experience of adolescent girls and boys is an important step towards lowering the prevalence of this common health condition.

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Learning to fear pain after observing another's pain: An experimental study in schoolchildren

Abstract

Background

Children of individuals with chronic pain have an increased vulnerability to experience pain problems, possibly through observation of pain in their parents. As pain‐related fear (PRF) is a critical factor in the development and maintenance of chronic pain, the current experimental study examined the acquisition of PRF through observational learning and subsequent extinction after first‐hand experience of the feared stimulus.

Methods

Healthy children (8–16 years) observed either their mother or a stranger performing two cold pressor tasks (CPT) filled with coloured water. In a differential conditioning procedure, one colour (CS+) was combined with genuine painful facial expressions and the other colour (CS−) with neutral facial expressions. Following this observation phase, children performed both CPTs (10°C) themselves.

Results

Children expected the CS+ to be more painful than the CS− and they reported being more afraid and hesitant to immerse in the CS+ compared to the CS−. Moreover, this fear was reflected in children's level of arousal in anticipation of CPT performance. This learned association extinguished after performing both CPTs. Effects were not moderated by whether the child observed their mother or a stranger, by the child's pain catastrophizing, trait PRF or trait anxiety. Remarkably, learning effects increased when the child perceived a larger difference between the model's painful and neutral facial expressions.

Conclusions

This study provides evidence for observational learning of PRF and subsequent extinction in schoolchildren. This acquisition of PRF by observing parental pain may contribute to vulnerabilities in children of parents with chronic pain.

Significance

Children may acquire pain‐related fear by observing pain in others and this learned fear can diminish after first‐hand experience. Remarkably, observational learning did not depend on the children's relationship with the model, but it did depend on the intensity of pain that is perceived. A better understanding of the impact of observing (parental) pain may help clarify the intergenerational transmission of risk for pain and inform the development of preventive programs.

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Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

Abstract

Background

The relevance of post‐traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre‐treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain.

Methods

Participants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group‐based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self‐report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12‐month follow‐up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia.

Results

Traumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12‐month follow‐up. There were no overall significant changes in PTSD symptom severity at post‐treatment or follow‐up, but 24.6% of the participants showed potential clinically significant change at follow‐up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment.

Conclusions

Neither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain‐focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment.

Significance

Pain‐focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain‐focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.

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Ultrasound‐guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic‐assisted thoracic surgery

Abstract

Background

The deep serratus anterior plane block (SAPB) is a promising novel regional anaesthesia technique for blockade of the anterolateral chest wall. Evidence for the efficacy of SAPB versus other analgesic techniques in thoracic surgery remains inadequate.

Aims

This study compared ultrasound‐guided continuous SAPB with a surgically placed continuous thoracic paravertebral block (SPVB) technique in patients undergoing videoscopic‐assisted thoracic surgery (VATS).

Methods

In a single‐centre, double‐blinded, randomized, non‐inferiority study, we allocated 40 patients undergoing VATS to either SAPB or SPVB, with both groups receiving otherwise standardized treatment, including multimodal analgesia. The primary outcome was 48‐hr opioid consumption. Secondary outcomes included numerical rating scale (NRS) for postoperative pain, patient‐reported worst pain score (WPS) as well as functional measures (including mobilization distance and cough strength).

Results

A 48‐hr opioid consumption for the SAPB group was non‐inferior compared with SPVB. SAPB was associated with improved NRS pain scores at rest, with cough and with movement at 24 hr postoperatively (p = .007, p = .001 and p = .012, respectively). SAPB was also associated with a lower WPS (p = .008). Day 1 walking distance was improved in the SAPB group (p = .012), whereas the difference in cough strength did not reach statistical significance (p = .071). There was no difference in haemodynamics, opioid side effects, length of hospital stay or patient satisfaction between the two groups.

Conclusions

The SAPB, as part of a multimodal analgesia regimen, is non‐inferior in terms of 48‐hr opioid consumption compared to SPVB and is associated with improved functional measures in thoracic surgical patients.

ClinicalTrials.gov Identifier: NCT03768193.

Significance

The SAPB interfascial plane block is an efficacious alternative method of opioid‐sparing analgesia in high‐risk thoracic surgical patients as part of an enhanced recovery programme.

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Von Frey testing revisited: Provision of an online algorithm for improved accuracy of 50% thresholds

Abstract

Background

In the pain field, it is essential to quantify nociceptive responses. The response to the application of von Frey filaments to the skin measures tactile sensitivity and is a surrogate marker of allodynia in states of peripheral and/or central sensitization. The method is widely used across species within the pain field. However, uncertainties appear to exist regarding the appropriate method for analysing obtained data. Therefore, there is a need for refinement of the calculations for transformation of raw data to quantifiable data.

Methods

Here, we briefly review the fundamentals behind von Frey testing using the standard up‐down method and the associated statistics and show how different parameters of the statistical equation influence the calculated 50% threshold results. We discuss how to obtain the most accurate estimations in a given experimental setting.

Results

To enhance accuracy and reproducibility across laboratories, we present an easy to use algorithm that calculates 50% thresholds based on the exact filaments and their interval using math beyond the traditional methods. This tool is available to the everyday user of von Frey filaments and allows the insertion of all imaginable ranges of filaments and is thus applicable to data derived in any species.

Conclusion

We advocate for the use of this algorithm to minimize inaccuracies and to improve internal and external reproducibility.

Significance

The von Frey testing procedure is standard for assessing peripheral and central sensitization but is associated with inaccuracies and lack of transparency in the associated math. Here, we describe these problems and present a novel statistical algorithm that calculates the exact thresholds using math beyond the traditional methods. The online platform is transparent, free of charge and easy to use also for the everyday user of von Frey filaments. Application of this resource will ultimately reduce errors due to methodological misinterpretations and increase reproducibility across laboratories.

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Issue Information

European Journal of Pain, Volume 24, Issue 4, Page 667-668, April 2020.

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The use of quantitative sensory testing in cancer pain assessment: A systematic review

Abstract

Objective

To summarize the literature on the use of quantitative sensory testing (QST) in the assessment of pain in people with cancer and to describe which QST parameters consistently demonstrate abnormal sensory processing in patients with cancer pain.

Databases and Data Treatment

Medline, EMBASE, AMED, CINAHL, SCOPUS and CENTRAL were searched for observational or experimental studies using QST in patients with a cancer diagnosis and reporting pain. Search strategies were based on the terms “quantitative sensory testing”, “cancer”, “pain”, “cancer pain” and “assessment”. Databases were searched from inception to January 2019. Data were extracted and synthesized narratively, structured around the different QST modalities and sub‐grouped by cancer pain aetiology (tumour‐ or treatment‐related pain).

Results

Searches identified 286 records of which 18 met the eligibility criteria for inclusion. Three studies included patients with tumour‐related pain, and 15 studies included patients with pain from chemotherapy‐induced peripheral neuropathy (CIPN). Across all studies, 50% (9/18) reported sensory abnormities using thermal detection thresholds (cool and warm), 44% (8/18) reported abnormal mechanical detection thresholds using von‐Frey filaments and 39% (7/18) found abnormal pinprick thresholds. Abnormal vibration and thermal pain (heat/cold) thresholds were each reported in a third of included studies.

Conclusion

This systematic review highlights the lack of published data characterizing the sensory phenotype of tumour‐related cancer pain. This has implications for our understanding of the underlying pathophysiological mechanisms of cancer pain. Understanding the multiple mechanisms driving cancer pain will help to move towards rational individualized analgesic treatment choices.

Significance

This systematic review found that pain in cancer patients is associated with abnormal sensory responses to thermal, mechanical and pinprick stimuli. However, these findings are based primarily on studies of chemotherapy‐induced peripheral neuropathy and data on tumour‐related pain are lacking, warranting further research.

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Opioids for chronic osteoarthritis pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration

Abstract

Background and Objective

This updated systematic review evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain.

Databases and Data Treatment

Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double‐blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences with 95% confidence intervals. We added two new studies with 397 participants for a total of 22 studies with 8,942 participants. Study duration ranged between 4 and 24 weeks. Studies with a parallel and cross‐over design: Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo. There was a clinically relevant harm related to the dropout rate due to adverse events. The frequency of serious adverse events did not differ from placebo. Enriched enrolment randomized withdrawal design: Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo. Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo.

Conclusions

Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from 4 to 24 weeks for osteoarthritis pain.

Significance

Within the context of randomized controlled trials (4–24 weeks), opioids provided no clinically relevant pain relief and no clinically relevant reduction in disability compared with placebo in chronic osteoarthritis pain (hip, knee). Number needed to treat for an additional dropout due to side effects was 5 (95% confidence interval 4–7). Two studies found no signals of abuse and addiction. The frequency of serious adverse events including deaths did not differ from placebo.

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Strong opioid consumption and its correlation with pain intensity and inpatient complexity. A six‐year analysis in a tertiary hospital

Abstract

Background

An increasing trend in opioid consumption has been observed worldwide in last decades. However, data related to opioid utilization in hospital settings is scarce. The aim of this study was to determine the evolution of use of strong opioids and pain intensity in a tertiary hospital during six years.

Methods

Consumption of strong opioid analgesics used at the hospital at any time between 2012 and 2017 was collected. Data were expressed on oral morphine equivalents (OMEs) per 100 bed‐days. Pain intensity was measured by the Numerical Rating Scale (NRS) and the percentage of patients who experienced a NRS value ≥ 3 and ≥ 7 were calculated. Case mix index (CMI) was also collected. Data were quantified in medical and surgical area separately.

Results

Consumption of opioids varied from 812.4 to 1038.8 OMEs/100 bed‐days and from 967.3 to 1023.7 in medical and surgical area. The percentage of patients that experienced a value of NRS≥3 and ≥7 in medical area increased from 24.2% and 5.5% to 31.7% and 7.5%, (p=0.038, p=0.040). It was observed a correlation between the percentage of patients that experienced a NRS≥7 in two consecutive determinations and opioid prescription in medical area (p=0.039).The CMI increased from 1.05 and 0.91 to 1.18 and 1.04 in medical and surgical area (p=0.020, p=0.004).

Conclusions

Consumption of strong opioids has remained stable, both in medical and surgical area, during last years. A correlation between prescription of opioids and pain intensity is observed in case of repeated and severe pain in medical departments.

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Appropriate referral and selection of patients with chronic pain for Spinal Cord Stimulation: European consensus recommendations and e‐health tool

ABSTRACT

Background

Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic, neuropathic‐like and ischaemic pain. However, the heterogeneity of patients in daily clinical practice makes it often challenging to determine which patients are eligible for this treatment, resulting in undesirable practice variations. This study aimed to establish patient‐specific recommendations for referral and selection of SCS in chronic pain.

Methods

A multidisciplinary European panel used the RAND/UCLA Appropriateness Method (RUAM) to assess the appropriateness of (referral for) SCS for 386 clinical scenarios in 4 pain areas: chronic low back pain and/or leg pain, complex regional pain syndrome, neuropathic pain syndromes, and ischaemic pain syndromes. In addition, the panel identified a set of psychosocial factors that are relevant to the decision for SCS treatment.

Results

Appropriateness of SCS was strongly determined by the neuropathic or neuropathic‐like pain component, location and spread of pain, anatomic abnormalities, and previous response to therapies targeting pain processing (e.g. nerve block). Psychosocial factors considered relevant for SCS selection were: lack of engagement, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress, and unwillingness to reduce high‐dose opioids. An educational e‐health tool was developed that combines clinical and psychosocial factors into an advice on referral/selection for SCS.

Conclusions

The RUAM was useful to establish a consensus on patient‐specific criteria for referral/selection for SCS in chronic pain. The e‐health tool may help physicians learn to apply an integrated approach of clinical and psychosocial factors.

Significance

Determining the eligibility of Spinal Cord Stimulation in patients with chronic pain requires careful consideration of a variety of clinical and psychosocial factors. Using a systematic approach to combine evidence from clinical studies and expert opinion, a multidisciplinary European expert panel developed detailed recommendations to support appropriate referral and selection for SCS in chronic pain. These recommendations are available as an educational e‐health tool (https://www.scstool.org/).

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Necessary components of psychological treatment in pain management programs: A Delphi study

Abstract

Background

There are various approaches to the psychological management of chronic pain and it is difficult to know which components of psychological therapies are necessary or desirable for the effective management of chronic pain.

Methods

We conducted a Delphi study to develop a consensus on the necessary and desirable psychological intervention strategies for chronic pain management. First, we identified 49 components of treatments that had been used in a treatment evaluated in a randomized controlled trial (RCT) through a systematic review. In the first round of the Delphi process, 23 (32% of 72) authors who had completed RCTs in chronic pain took part. In round 2, these experts plus clinicians working at pain management programs around Australia were invited to take part, and 44 experts completed the study.

Results

The panel agreed that it was necessary to include psycho‐education, particularly about pain mechanisms and the role of thoughts in maintaining pain. Cognitive approaches were deemed necessary, although the panel did not specify one particular strategy. Finally, approaches to increase activity were deemed necessary, including the strategies of pacing, goal setting, graded exposure. Relaxation training and relapse prevention were also deemed necessary.

Conclusions

There was a consensus that there were many desirable strategies to include in psychological chronic pain management approaches, but that treatments should include psychoeducation, approaches to increase activity and cognitive approaches as a first line of intervention. Where patients fail to benefit from these approaches, experts identified other desirable strategies that could be utilized.

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The Impact of Preoperative Chronic Opioid Therapy in Patients Undergoing Decompression Laminectomy of the Lumbar Spine

Study Design. Retrospective review of electronic medical records (EMR). Objective. This study aims to (1) characterize the pattern of opioid utilization in patients undergoing spine surgery and (2) compare the postoperative course between patients with and without chronic preoperative opioid prescriptions. Summary of Background Data. Postoperative pain management for patients with a history of opioid usage remains a challenge for spine surgeons. Opioids are controversial in this setting due to side effects and potential for abuse and addiction. Given the increasing rate of opioid prescriptions for spine-related pain, more studies are needed to evaluate patterns and risks of preoperative opioid usage in surgical patients. Methods. EMR were reviewed for patients (age > 18) with lumbar spinal stenosis undergoing lumbar laminectomy in 2011 at our institution. Data regarding patient demographics, levels operated, pre/postoperative medications, and in-hospital length of stay were collected. Primary outcomes were length of stay and duration of postoperative opioid usage. Results. One hundred patients were reviewed. Fifty-five patients had a chronic opioid prescription documented at least 3 months before surgery. Forty-five patients were not on chronic opioid therapy preoperatively. The preoperative opioid group compared with the non-opioid group had a greater proportion of females (53% vs. 40%), younger mean age (63 yrs vs. 65 yrs), higher frequency of preoperative benzodiazepine prescription (20% vs. 11%), longer average in-hospital length of stay (3.7 d vs. 3.2 d), and longer duration on postoperative opioids (211 d vs. 79 d). Conclusion. Patients on chronic opioids prior to spine surgery are more likely to have a longer hospital stay and continue on opioids for a longer time after surgery, compared with patients not on chronic opioid therapy. Spine surgeons and pain specialists should seek to identify patients on chronic opioids before surgery and evaluate strategies to optimize pain management in the pre- and postoperative course. Level of Evidence: 3

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Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up

Study Design. Retrospective review of a prospective database. Objective. The aim of this study was to evaluate postop clinical recovery among adult spinal deformity (ASD) patients between frailty states undergoing primary procedures Summary of Background Data. Frailty severity may be an important determinant for impaired recovery after corrective surgery. Methods. It included ASD patients with health-related quality of life (HRQLs) at baseline (BL), 1 year (1Y), and 3 years (3Y). Patients stratified by frailty by ASD-frailty index scale 0-1(no frailty: <0.3 [NF], mild: 0.3–0.5 [MF], severe: >0.5 [SF]). Demographics, alignment, and SRS-Schwab modifiers were assessed with χ2/paired t tests to compare HRQLs: Scoliosis Research Society 22-question Questionnaire (SRS-22), Numeric Rating Scale (NRS) Back/Leg Pain, Oswestry Disability Index (ODI). Area-under-the-curve (AUC) method generated normalized HRQL scores at baseline (BL) and f/u intervals (1Y, 3Y). AUC was calculated for each f/u, and total area was divided by cumulative f/u, generating one number describing recovery (Integrated Health State [IHS]). Results. A total of 191 patients were included (59 years, 80% females). Breakdown of patients by frailty status: 43.6% NF, 40.8% MF, 15.6% SF. SF patients were older (P = 0.003), >body mass index (P = 0.002). MF and SF were significantly (P <� 0.001) more malaligned at BL: pelvic tilt (NF: 21.6°; MF: 27.3°; SF: 22.1°), pelvic incidence and lumbar lordosis (7.4°, 21.2°, 19.7°), sagittal vertical axis (31 mm, 87 mm, 82 mm). By SRS-Schwab, NF were mostly minor (40%), and MF and SF markedly deformed (64%, 57%). Frailty groups exhibited BL to 3Y improvement in SRS-22, ODI, NRS Back/Leg (P <� 0.001). After HRQL normalization, SF had improvement in SRS-22 at year 1 and year 3 (P <� 0.001), and NRS Back at 1Y. 3Y IHS showed a significant difference in SRS-22 (NF: 1.2 vs. MF: 1.32 vs. SF: 1.69, P <� 0.001) and NRS Back Pain (NF: 0.52, MF: 0.66, SF: 0.6, P = 0.025) between frailty groups. SF had more complications (79%). SF/marked deformity had larger invasiveness score (112) compared to MF/moderate deformity (86.2). Controlling for baseline deformity and invasiveness, SF showed more improvement in SRS-22 IHS (NF: 1.21, MF: 1.32, SF: 1.66, P <� 0.001). Conclusion. Although all frailty groups exhibited improved postop disability/pain scores, SF patients recovered better in SRS-22 and NRS Back. Despite SF patients having more complications and larger invasiveness scores, they had overall better patient-reported outcomes, signifying that with frailty severity, patients have more room for improvement postop compared to BL quality of life. Level of Evidence: 3

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Patients With Persistent Low Back Pain and Nerve Root Involvement: To Operate, or Not to Operate, That Is the Question

Study Design. Prospective cohort study. Objective. The aims of this study were to evaluate the outcome of surgical and nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after 2 years and to identify predictors for nonsuccess. Summary of Background Data. Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted. Methods. This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Nonsuccess was defined as a Roland-Morris Disability score above 4 (0–23) or a Numeric Rating Scale back and leg pain score above 20 (0–60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and magnetic resonance imaging findings. Results. Rates of nonsuccess at 2 years were approximately 30% in surgically treated patients with LHD, approximately about 60% in patients with LSS for disability, and 30% and 40%, respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male sex (odds ratio [OR] 2.04, 95% confidence interval [CI]: 1.02–4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28–5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51–6.21, P <� 0.01), and widespread pain (OR 3.59, 95% CI: 1.36–9.46, P = 0.01). Conclusion. The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male sex, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made. Level of Evidence: 3

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Effectiveness of Percutaneous Electrical Nerve Stimulation for Musculoskeletal Pain: A Systematic Review and Meta‐analysis

Abstract

Background and Objective

To evaluate the effects of percutaneous electrical stimulation (PENS) alone or as an adjunct with other interventions on pain and related‐disability in musculoskeletal pain conditions.

Databases and Data Treatment

Search of MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PubMed, PEDro, Cochrane Library, SCOPUS and Web of Science databases. Randomised controlled trials where at least one group received any form of PENS for musculoskeletal condition. Studies had to include humans and collect outcomes on pain and related‐disability in musculoskeletal pain. Risk of bias was assessed by the Cochrane Guidelines, the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated.

Results

Sixteen studies were included and included heterogeneous musculoskeletal conditions with short or mid‐term follow‐ups. PENS alone had a large effect (SMD ‐1.22, 95%CI ‐1.66 to ‐0.79) on pain and a small effect (SMD ‐0.33, 95%CI ‐0.61 to ‐0.06) on related‐disability at short‐term as compared to sham. A moderate effect of PENS alone (SMD ‐0.71, 95%CI ‐1.23 to ‐0.19) on pain when compared to other interventions was observed. The inclusion of PENS with other interventions had a moderate effect for decreasing pain at short‐ (SMD ‐0.70, 95%CI ‐1.02 to ‐0.37) and mid‐term (SMD ‐0.68, 95%CI ‐1.10 to ‐0.27). No effect at mid‐term (SMD ‐0.21, 95%CI ‐0.52 to 0.10) on related‐disability was seen. The risk of bias was generally low; but the heterogenicity of the results downgraded the level of evidence.

Conclusion

There is low level of evidence suggesting the effects of PENS alone or in combination for pain, but not related‐disability, in musculoskeletal pain.

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GABAergic modulation of Secondary hyperalgesia: A randomized controlled 4‐way crossover trial with the α2‐subunit preferring GABA positive allosteric modulator, N‐Desmethyl‐Clobazam in healthy volunteers

Abstract

The antihyperalgesic and sedative effects of the α2‐subunit preferring GABA_A positive allosteric modulator (GAM), N‐Desmethyl‐Clobazam (NDMC), 20 and 60 mg, were assessed in a randomized, placebo and active‐controlled (clonazepam 1,5 mg), 4‐way crossover study, in healthy volunteers, using the UVB‐induced experimental pain model. Single (20, 40, 60 mg) and repeated doses (20mg over 15 days) NDMC pharmacokinetic were evaluated.

Thirty‐two subjects participated to the study. Primary outcome parameter was maximal change in the area of cutaneous UVB irradiation‐induced secondary hyperalgesia (ASH).

ASH decreased under all treatments. Mean (SD) relative change was 79 (22) %, 83 (24) %, 77 (30) % and 92 (16) % for placebo, NDMC20, NDMC60 and clonazepam, respectively. Neither absolute change nor relative change in ASH was significantly different between NDMC60 and placebo (mean difference= 2.3 cm² [95%CI 4.0 to 8.5], p=0.462 and 0.4% [‐11.9 to 12.6], p=0.952, respectively). An overall treatment effect was found on level of sedation. Compared to placebo, sedation was higher under clonazepam (mean difference= 39 mm [30 to 49] on a visual analog scale, p<0.001) while NDMC was free of sedative effect. NDMC pharmacokinetic after single doses showed poor absorption, but was linear. Steady‐state plasma concentrations of NDMC20 were attained within 14 days, with low between‐subjects variability. Mean steady‐state concentration (C_S‐S, SD) reached 209 (22) ng/mL.

NDMC absence of sedative effect and its overall well characterized safety coming from years of utilization as a metabolite from clobazam, raise the prospect of dose escalating trials in patients to quantify its clinical utility.

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Minocycline reduces experimental muscle hyperalgesia induced by repeated nerve growth factor injections in humans: A placebo‐controlled double‐blind drug‐crossover study

Abstract

Background

Hyperalgesia is a heightened pain response to a noxious stimulus and is a hallmark of many common neuropathic and chronic pain conditions. In a double‐blind placebo‐controlled drug‐crossover trial the effects of concomitant and delayed minocycline treatment on the initiation and resolution of muscle hyperalgesia were tested.

Methods

An initial cohort (n=10) received repeated injections (5 µg: days 0, 2 and 4) of nerve growth factor (NGF) in the flexor carpi ulnaris muscle of the forearm and pressure pain thresholds were collected at day 0 (control), day 7 (peak) and day 14 (recovery). A second cohort (n=18) underwent an identical procedure, however, half received a placebo between days 0‐7 before switching to minocycline from days 7‐14 (P1/M2), while the remaining subjects received minocycline (day 0: 200mg then 100mg b.i.d. for 7 days) before switching to placebo (M1/P2).

Results

The initial cohort exhibited a diffuse muscular pain hypersensitivity with a decrease in pressure pain thresholds at day 7 before a partial return to normalcy at day 14. The P1/M2 treatment group exhibited an identical peak in hypersensitivity at day 7, however, after switching to minocycline in week 2 showed a significant reduction in muscle hyperalgesia compared to the initial cohort at day 14. The M1/P2 treatment group had significantly less (~50%) hyperalgesia at day 7 compared to the other groups.

Conclusions

This study indicates that the administration of minocycline can reduce experimentally induced muscle pain regardless of the time of administration.

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Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors

Abstract

Background

Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates’ pain responses and may lead to inaccurate pain assessment when not appropriately considered.

Objectives

We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN.

Methods

We videotaped 154 full‐term and preterm neonates of different GAs during 1‐5 capillary heel sticks in their first 14 days of life. For each heel stick we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models.

Results

Premature birth (b = ‐0.721), caffeine (b = ‐0.302), and the behavioural states quiet and awake (b = ‐0.283), active and asleep (b = ‐0.158), and quiet and asleep (b = ‐0.498) were associated with changes in behavioural pain scores. Premature birth (b = ‐0.232), mechanical ventilation (b = ‐0.196), and duration of the heel stick procedure (b = 0.0004) were associated with changes in physiological pain scores. Premature birth (b = ‐0.907), Caffeine (b = ‐0.402), the behavioural states quiet and awake (b = ‐0.274), and quiet and asleep (b = ‐0.459), and duration of the heel stick procedure (b = 0.001) were associated with changes in the modified BPSN total scores.

Conclusions

Postmenstrual age, behavioural state, caffeine and ventilation status have an influence on neonates’ pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs.

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Anodal transcranial direct current stimulation over the primary motor cortex attenuates capsaicin‐induced dynamic mechanical allodynia and mechanical pain sensitivity in humans

Abstract

Background

Anodal transcranial direct current stimulation over the primary cortex has been shown to activate regions of the brain involved in the descending modulation of pain sensitivity. However, more research is required in order to dissect the spinal cord analgesic mechanisms associated with the development of central sensitisation.

Methods

In this randomised, double blind, cross over study 12 healthy participants had baseline mechanical stimulus response (S/R) functions measured before and after the development of capsaicin‐induced ongoing pain sensitivity. The effects of 20 min of either real or sham transcranial direct current stimulation (tDCS, 2 mA) over the primary motor cortex on dynamic mechanical allodynia (DMA) and mechanical pain sensitivity (MPS) was then investigated.

Results

Topical application of capsaicin resulted in an increase in area under the pain ratings curve for both DMA (p < .01) and MPS (p < .01). The effects of tDCS on the area under the curve ratio (i.e. post/pre‐treatment) revealed significant analgesic effects over DMA (p < .05) and MPS (p < .05) when compared to sham.

Conclusions

This study demonstrates that anodal tDCS over the primary motor cortex can reduce both dynamic and static forms of mechanical pain sensitivity associated with the development of DMA and MPS, respectively. The use of tDCS may provide a novel mechanism‐driven therapy in chronic pain patients with altered mechanical S/R functions.

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Pain modulation by illusory body rotation: a new way to disclose the interaction between the vestibular system and pain processing

Abstract

Background

Clinical and experimental evidence advocates a structural and functional link between the vestibular and other sensory systems. For instance, visuo‐vestibular and vestibular‐somatosensory interactions have been widely reported. However, whether visual inputs carrying vestibular information can modulate pain is not yet clear. Recent evidence using natural vestibular stimulation and moving visual stimuli points at an unspecific effect of distraction.

Methods

By using immersive virtual reality (VR), we created a new way to prompt the vestibular system through the vision of static visual cues, studying the possible interaction with pain. Twenty‐four healthy participants were visually immersed in a virtual room which could appear with five different degrees of rotation in the sagittal axis, either toward the right, left or with no rotation. Participants’ heat pain thresholds and subjective reports of perceived body rotation, sense of presence and attention were measured.

Results

‘Being’ in a tilted room induced the sensation of body rotation in our participants, even though they were always in an upright position. Importantly, we also found that rotating the visual scenario can modulate the participants’ pain thresholds, determining a significant increase when a left tilt is displayed. Additionally, positive correlations between the perceived body midline rotation and pain threshold were found, and all VR conditions were equally distractive.

Conclusions

Vestibular information present in static visual cues can modulate experimental pain according to a side‐dependent manner and bypassing supramodal attentional mechanisms. These findings may help refining pain management approaches based on multimodal stimulation.

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Intranasal pain in a patient with Behcet’s disease

A 52 year old woman with Behçet’s disease presented with two to three days of severe pain in her left nostril. She had Behçet’s associated bowel, oral, and cerebral vasculitis and had been taking...

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Covid-19: Trump proposes tax cuts and improved health insurance, but millions are not covered

The US president, Donald Trump, has proposed eliminating the payroll tax to ease the financial pain faced by US people and businesses owing to the covid-19 outbreak. He also suggested help for the...

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Aquatic cycling improves knee pain and physical functioning in patients with knee osteoarthritis: a randomised controlled trial

Publication date: Available online 10 March 2020

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Stefanie Rewald, AF Ton Lenssen, Pieter J. Emans, Rob A. de Bie, Gerard van Breukelen, Ilse Mesters

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Identifying pain perceptual biases related to fear of pain and threat in a pain‐free sample

Abstract

Background

The association between fear of pain (FOP) and pain intensity has remained unclear. The current study aimed to examine whether highly pain‐fearful participants showed pain perceptual biases to general painful stimulus or to specific threatening painful stimulus.

Methods

Fifty‐nine undergraduates were recruited into low (n=30) and high (n=29) FOP groups and completed a threatening pain perception task with two tasks. Task 1 assessed pain perceptual biases by calculating the percentage of near‐threshold pain stimulus judged as painful and assessing the average pain intensity ratings to those painful stimuli. Task 2 assessed pain perceptual biases by measuring pain ratings to each single threshold (low intensity) and twice‐threshold (high intensity) pain stimulus.

Results

Results from task 1 indicated that higher FOP levels were associated with higher pain sensitivity when pain was appraised as a threat, reflected as high FOP group reporting higher pain intensity to those stimuli judged as painful in high threat condition than in low threat condition. Consistently, results from task 2 observed that when noxious stimulus intensity increased to threshold pain and twice threshold pain levels, high FOP group also generally reported higher pain intensity in high threat condition than in low threat condition. However, for both tasks, no such threat level differences were observed in low FOP group.

Conclusions

The current research emphasized that participants with higher FOP level showed pain perceptual biases to specific threatening painful stimulus. Threat appraisal of pain played a key role in the positive association between pain‐related fear and pain perceptual biases.

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The roles of race, sex, and cognitions in response to experimental pain

Abstract

Background

This study reports a multivariate test of sex and race differences in experimental pain, and the degree to which these differences could be uniquely attributable to three levels of cognition: primary appraisals (threat, challenge), secondary appraisals (pain catastrophizing) and/or cognitive processes (mindful observing, non‐reactivity). Both the predictive and mediator role of the cognitive variables was of interest.

Methods

The study employed a cross‐sectional experimental design, with the cold pressor task employed as the pain stimulus. The total sample included N = 355 healthy adults (67% female, 33% male; 70% Caucasian, 30% Asian).

Results

Significant sex and race differences on pain tolerance were found, with females and racial minorities reporting less pain tolerance (ps < .001). Males reported significantly higher challenge appraisals and non‐reactivity, and lower pain catastrophizing than females; Asians reported significantly higher threat appraisals and pain catastrophizing than Caucasians. In multivariate analyses, challenge appraisals and non‐reactivity emerged as the strongest predictors of pain tolerance. Further, challenge appraisals mediated the sex‐pain tolerance association (p = .017).

Conclusions

This study showed that race and sex differences, at least in part, may be accounted for by differences in pain‐related cognitions.

Significance

The three levels of cognition investigated in this research represent changeable, important processes for potentially mitigating the impact of pain in vulnerable groups.

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