[Correspondence] Methadone for prisoners – Authors' reply

Daniel D'Hotman and colleagues make important points that forced withdrawal from methadone causes predictable pain and suffering, is a disproportionate double punishment, and does not cure the addiction, and question why substance dependence is treated differently to other medical disorders. We suggest that addiction is treated differently owing to the stigma associated with the disease and its treatment. Addiction is fundamentally misunderstood to be a moral failing rather than a chronic relapsing brain disease.

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Lean mass predicts conditioned pain modulation in adolescents across weight status

Abstract

Background

There is a wide continuum of conditioned pain modulation (CPM) in adults with older adults experiencing an attenuated CPM response compared with younger adults. Less is known for adolescents and the role of anthropometrics.

Methods

Fifty-six adolescents (15.1 ± 1.8 years; 32 normal weight and 24 overweight/obese; 27 boys) completed in a CPM session that included anthropometric testing. Pressure pain thresholds were measured at the nailbed and deltoid muscle (test stimuli) with the foot submerged in a cool or ice water bath (conditioning stimulus). Weight status, body composition (Dual-energy X-ray absorptiometry scan), physical activity levels and clinical pain were also evaluated.

Results

The CPM response in adolescents was similar across sites (nailbed vs. deltoid), weight status (normal vs. overweight/obese) and sex. CPM measured at the deltoid muscle was positively associated with left arm lean mass but not fat mass; lean mass of the arm uniquely predicted 10% of the CPM magnitude. CPM measured at the nailbed was positively correlated with physical activity levels.

Conclusions

These results suggest that lean mass and physical activity levels may contribute to endogenous pain inhibition in adolescents across weight status.

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Social environment alters opioid-induced hyperalgesia and antinociceptive tolerance in adolescent mice

Abstract

Background

Chronic opioid treatment is complicated by the development of tolerance and hyperalgesia. Social environment alters both opioid-induced behaviours and nociceptive mechanisms. Our previous studies demonstrated that, in adolescent rodents, the susceptibility to acquire opioid dependence and reward is dependent on the nature of social housing conditions. Specifically, our previous studies demonstrate that housing morphine-treated mice with drug-naïve animals mitigates the abuse liability of opioids. Thus, this study tested the effect of social housing conditions on the development of adaptive processes to morphine antinociception.

Method

Adolescent males were group-housed in different conditions. In the mixed treatment condition, mice treated with 20 mg/kg morphine (i.e. ‘morphine cage-mates’) and saline (i.e. ‘saline cage-mates’) were housed together. In the separated treatment conditions, all mice in the cage received morphine (i.e. ‘morphine only’) or saline (i.e. ‘saline only’). All animals were tested for baseline pain sensitivity and for the response to morphine in the tail withdrawal, hot plate, acetone and von Frey filament tests, during and after discontinuation of opioid treatment.

Results

Both morphine cage-mate and morphine only animals developed antinociceptive tolerance. However, this effect was more robust and persistent in the morphine only group. Notably, morphine only animals, but not morphine cage-mates, developed opioid-induced hyperalgesia.

Conclusion

This study demonstrates that housing morphine-treated mice with drug-naïve animals mitigates the development of opioid-induced hyperalgesia and antinociceptive tolerance. Thus, this study indicates that social environment influences the effectiveness of opioid pain management.

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Robot-guided neuronavigated rTMS as an alternative therapy for central (neuropathic) pain: Clinical experience and long-term follow-up

Abstract

Background

Repetitive transcranial magnetic stimulation (rTMS) appears as a useful tool to alleviate neuropathic pain but only few data are available for the long-term benefit of this treatment.

Methods

Here we report the effects of rTMS sessions, considered as a possible therapy for pain relief after a failure of different medications in patients with central (neuropathic) pain. We review here the prospectively collected data of the first forty patients treated as follow: 20 Hz stimulation delivered over the contralateral primary motor cortex (M1), each 3–4 weeks.

Results

A total of 440 rTMS sessions was collected (mean sessions number: 11, range: 1–37, follow-up 312 days on average, maximum 2.8 years). After four sessions, nine patients (22.5%) discontinued rTMS because of a lack of efficiency (<10% pain-relief). The other 31 patients (77.5%) had a cumulative effect across sessions leading to a mean pain relief of 41% for a duration of 15.6 days. A correlation was observed between pain relief in the first session and long-term pain relief (R = 0.649. p = 5.6*10⁻⁶). Both intensity and duration of pain relief were significantly better for patients with persistent laser evoked potentials (LEPs, p = 0.049 and 0.0018). We did not observe any adverse-effects.

Conclusion

These results suggest that repeated sessions of 20 Hz rTMS over M1 are interesting in clinical practice for the treatment of selected patients with central pain. Both the cumulative effects across the first sessions and the long duration of pain-relief should impact further randomized trials that are warranted to conclude formally on rTMS efficiency in central pain.

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A Systematic Review of Pharmacological Treatments of Pain After Spinal Cord Injury: An Update

Differences in pain coping between Black and White Americans: A meta-analysis

Compared to White individuals, Black individuals experience greater pain across clinical and experimental modalities. These race differences may be due to differences in pain-related coping. Several studies examined the relationship between race and pain coping; however, no meta-analytic review has summarized this relationship or attempted to account for differences across studies. The goal of this meta-analytic review was to quantify race differences in the overall use of pain coping strategies as well as specific coping strategies.

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Bilateral absent uterine arteries

A 52 year old woman presented with right flank pain and dysuria. Pelvic ultrasound showed a large uterine leiomyoma. Fibroid embolisation versus myomectomy was discussed given her perimenopausal...

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