The context of values in pain control: understanding the price effect in placebo analgesia

Placebo effects, a sum of different factors including non-specific effects, regression to the mean, natural history, and placebo responses, substantially contribute to clinical outcomes in diseases such as Parkinson's disease, depression, and immune function, as well as in acute and chronic pain conditions.10,33 Recent studies on placebo effects implicate the importance of informational context relative to medical treatments, most of which have no direct therapeutic effects on the body.42 One distinct feature of every therapeutic intervention is price, or treatment cost.

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Sex differences in interleukin-6 responses over time following laboratory pain testing among patients with knee osteoarthritis

Knee osteoarthritis (KOA) is a chronic pain condition that is one of the leading causes of physical impairment and disability across the world.40 The prevalence of KOA is expected to continuously escalate due to population aging and increases in obesity rates.63 Women are particularly at-risk for developing chronic pain and KOA.20,43 Further, women generally report higher pain-related symptoms (including KOA symptoms57), evoked-pain sensitivity, and lower pain tolerance compared to men.20,43

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Sensitivities to Thermal and Mechanical Stimuli: Adults with Sickle Cell Disease Compared to Healthy, Pain-free African American Controls

Until recent findings that sickle cell disease (SCD) pain has characteristics consistent with central or peripheral sensitization,12,27,28,43 it was typically viewed as acute or persistent pain and treated mostly with opioids. Often the etiology of SCD pain is thought to be only episodic, driven by vaso-occlusion and somatic or visceral tissue damage,1,2,4 however, it has become increasingly clear that adults with SCD also experience chronic pain. A growing body of evidence now supports,12,27,28,40,43, but is not conclusive, that sensitization contributes to chronic pain in some adults with SCD.

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Nociception Coma Scale Revised allows to identify patients with preserved neural basis for pain experience.

The Nociception Coma Scale-Revised (NCS-R) was developed to help assess pain in patients with disorders of consciousness (DOC). Several studies have shown its sensitivity in assessing response to acute noxious stimuli. However, they failed to determine a reliable cut-off score that could be used to infer pain processing in these patients.This retrospective cross-sectional study aimed to determine a NCS-R cut-off score supporting preserved neural basis for pain experience, based on brain metabolism preservation as measured by fluorodeoxyglucose positron emission tomography (FDG-PET).

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Ectopic pregnancy and miscarriage: diagnosis and initial management: summary of updated NICE guidance

What you need to knowThe guideline now includes new recommendations on the ultrasound features for diagnosis of a tubal ectopic pregnancyWomen without pain who have small ectopic pregnancies, low...

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Efficacy and harms of orally, intramuscularly or intravenously administered glucocorticoids for sciatica: A systematic review and meta‐analysis

Abstract

Background

Sciatica can be a debilitating condition and there is limited guidance on the use of glucocorticoids administered via the oral, intramuscular or intravenous route for this condition. These represent viable treatment options in the primary care setting.

Objective

To evaluate the evidence on efficacy and harms of oral, IM and IV glucocorticoid administration for sciatica.

Databases and Data Treatment

MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO (inception to October 2018) were searched for randomised placebo‐controlled trials evaluating oral, IV or IM glucocorticoid administration for sciatica. Two authors extracted outcomes data. Continuous pain and disability outcomes were converted to a 0 (no pain/disability) to 100 (worst pain/disability) scale. Data were pooled using a random effects model. Overall quality of evidence was assessed using GRADE. Primary outcomes were leg pain and disability. Primary follow‐up period was the immediate‐term (<2 weeks from administration). We also considered adverse events.

Results

Nine trials were eligible. One study [n=27] provided low quality evidence of a small reduction in disability with early administration of oral prednisone (within 1 week); MD ‐13.4 [‐23.3, ‐3.5] but not for pain MD ‐2.5 [‐16.9, 11.9]. There was low quality evidence from one study [n=78] of moderate reduction in disability and small reduction in pain with early (within 72‐hours of symptom onset) single intramuscular administration of methylprednisolone acetate; MD ‐24.5 [‐38.8, ‐10.2] and ‐14.0 [‐27.4, ‐0.6] respectively. There were no immediate‐term benefits with IV administration. There is moderate quality evidence from one study [n=267] that oral prednisone doubles the risk of adverse events compared with the placebo group; RR 95% CI 2.1 [1.4, 3.1].

Conclusion

The effects of glucocorticoids on immediate‐term leg pain or disability are uncertain. Future large high quality trials are needed to resolve this uncertainty.

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Most of the world’s population lacks access to opioid drugs for pain control

Smith and colleagues say that opioid prescribing is rising in many countries,1 with the result that use is “widespread.” While this may be true in high income countries, we must remember that lack of...

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