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Pain Conditions (pain + condition)

Distribution by Scientific Domains

Medical Sciences	92%

Distribution within Medical Sciences

Pain Medicine	39%
Neurology	18%
11 Other Subdomains	43%

Kinds of Pain Conditions

chronic pain condition

neuropathic pain condition

Selected Abstracts

Allodynia in Migraine: Association With Comorbid Pain Conditions

HEADACHE, Issue 9 2009
Gretchen E. Tietjen MD
Background., Cutaneous allodynia (CA) in migraine is a clinical manifestation of central nervous system sensitization. Several chronic pain syndromes and mood disorders are comorbid with migraine. In this study we examine the relationship of migraine-associated CA with these comorbid conditions. We also evaluate the association of CA with factors such as demographic profiles, migraine characteristics, and smoking status that may have an influence on the relationships of CA to pain and mood. Methods., Data are from a cross-sectional multicenter study of comorbid conditions in persons seeking treatment in headache clinics. Diagnosis of migraine was determined by a physician based on the International Classification of Headache Disorders-II criteria. Participants completed a self-administered questionnaire ascertaining sociodemographics, migraine-associated allodynia, physician-diagnosed comorbid medical and psychiatric disorders, headache-related disability, current depression, and anxiety. Results., A total of 1413 migraineurs (mean age = 42 years, 89% women) from 11 different headache treatment centers completed a survey on the prevalence of comorbid conditions. Aura was reported by 38% and chronic headache by 35% of the participants. Sixty percent of the study population reported at least one migraine-related allodynic symptom, 10% reported ,4 symptoms. Symptoms of CA were associated with female gender, body mass index, current smoking, presence of aura, chronic headaches, transformed headaches, severe headache-related disability, and duration of migraine illness from onset. The prevalence of self-reported physician diagnosis of comorbid pain conditions (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and psychiatric conditions (current depression and anxiety) was also associated with symptoms of CA. Adjusted ordinal regression indicated a significant association between number of pain conditions and severity of CA (based on symptom count). Adjusting for sociodemographics, migraine characteristics, and current depression and anxiety, the likelihood of reporting symptoms of severe allodynia was much higher in those with 3 or more pain conditions (odds ratio = 3.03, 95% confidence interval: 1.78-5.17), and 2 pain conditions (odds ratio = 2.67, 95% confidence interval: 1.78-4.01) when compared with those with no comorbid pain condition. Conclusion., Symptoms of CA in migraine were associated with current anxiety, depression, and several chronic pain conditions. A graded relationship was observed between number of allodynic symptoms and the number of pain conditions, even after adjusting for confounding factors. This study also presents the novel association of CA symptoms with younger age of migraine onset, and with cigarette smoking, in addition to confirming several previously reported findings. [source]

Are Spirituality and Religiosity Resources for Patients with Chronic Pain Conditions?

PAIN MEDICINE, Issue 2 2009
Arndt Büssing Prof Dr
ABSTRACT Objective., We studied whether or not spirituality/religiosity is a relevant resource for patients with chronic pain conditions, and to analyze interrelations between spirituality/religiosity (SpREUK Questionnaire; SpREUK is an acronym of the German translation of "Spiritual and Religious Attitudes in Dealing with Illness"), adaptive coping styles that refer to the concept of locus of disease control (AKU Questionnaire; AKU is an acronym of the German translation of "Adaptive Coping with Disease"), life satisfaction, and appraisal dimensions. Patients., In a multicenter cross-sectional study, 580 patients with chronic pain conditions were enrolled. Results., We found that the patients relied on both external powerful sources of disease control and on internal powers and virtues, while Trust in Higher Source (intrinsic religiosity) or Illness as Chance (reappraisal) were valued moderately; Search for Meaningful Support/Access (spiritual quest orientation) was of minor relevance. Stepwise regression analyses revealed that the internal sources of disease control, such as Conscious and Healthy Way of Living and Positive Attitudes, were (apart from the religious denomination) the strongest predictors of patients' reliance on spirituality/religiosity. Both behavioral styles were rated significantly lower in patients who regarded themselves as neither religious nor spiritual. Positive disease interpretations such as Challenge and Value were clearly associated with a spiritual quest orientation and intrinsic religiosity. Conclusion., The associations between spirituality/religiosity, positive appraisals. and internal adaptive coping strategies indicate that the utilization of spirituality/religiosity goes far beyond fatalistic acceptance, but can be regarded as an active coping process. The findings support the need for further research concerning the contributions of spiritual coping in adjustment to chronic pain. [source]

Allodynia in Migraine: Association With Comorbid Pain Conditions

Sensory function and pain in a population of patients treated for breast cancer

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009
O. J. VILHOLM
Background: Chronic pain is often reported after surgery for breast cancer. This study examined pain and sensory abnormalities in women following breast cancer surgery. Methods: Sensory tests were carried out on the operated and contra-lateral side in 55 women with chronic pain after breast cancer treatment and in a reference group of 27 pain-free women, who had also undergone treatment for breast cancer. Testing included a numeric rating score of spontaneous pain, detection and pain threshold to thermal and dynamic mechanical stimuli and temporal summation to repetitive pinprick stimulation. The neuropathic pain symptom inventory was applied for participants with chronic pain. Results: The mean age was 58.6 years for the pain patients and 60.6 years for the pain-free patients. Thermal thresholds were significantly higher on the operated side than on the contra-lateral side in both groups and side difference in warmth detection threshold was significantly higher in the pain group than in the pain-free group (mean 3.8 °C vs. 1.1 °C, P=0.01). The frequency of cold allodynia was higher in participants with pain than in pain-free participants (15/53 vs. 1/25, P=0.01), and the frequency of temporal summation evoked by repetitive pinprick was higher in participants with pain than in pain-free participants (23/53 vs. 2/25, P=0.0009). The frequency of dynamic mechanical allodynia did not differ significantly between the two groups. Conclusion: These findings suggest that chronic pain after surgery for breast cancer is associated with sensory hyperexcitability and is a neuropathic pain condition. [source]

God Image and Happiness in Chronic Pain Patients: The Mediating Role of Disease Interpretation

PAIN MEDICINE, Issue 5 2010
Jessie Dezutter dra
Abstract Objective., The present study explored the role of the emotional experience of God (i.e., positive and negative God images) in the happiness of chronic pain (CP) patients. Framed in the transactional model of stress, we tested a model in which God images would influence happiness partially through its influence on disease interpretation as a mediating mechanism. We expected God images to have both a direct and an indirect (through the interpretation of disease) effect on happiness. Design., A cross-sectional questionnaire design was adopted in order to measure demographics, pain condition, God images, disease interpretation, and happiness. One hundred thirty-six CP patients, all members of a national patients' association, completed the questionnaires. Results., Correlational analyses showed meaningful associations among God images, disease interpretation, and happiness. Path analyses from a structural equation modeling approach indicated that positive God images seemed to influence happiness, both directly and indirectly through the pathway of positive interpretation of the disease. Ancillary analyses showed that the negative influence of angry God images on happiness disappeared after controlling for pain severity. Conclusion., The results indicated that one's emotional experience of God has an influence on happiness in CP patients, both directly and indirectly through the pathway of positive disease interpretation. These findings can be framed within the transactional theory of stress and can stimulate further pain research investigating the possible effects of religion in the adaptation to CP. [source]

The Role of Glia and the Immune System in the Development and Maintenance of Neuropathic Pain

PAIN PRACTICE, Issue 3 2010
Ricardo Vallejo MD
Abstract Neuropathic pain refers to a variety of chronic pain conditions with differing underlying pathophysiologic mechanisms and origins. Recent studies indicate a communication between the immune system and the nervous system. A common underlying mechanism of neuropathic pain is the presence of inflammation at the site of the damaged or affected nerve(s). This inflammatory response initiates a cascade of events resulting in the concentration and activation of innate immune cells at the site of tissue injury. The release of immunoactive substances such as cytokines, neurotrophic factors, and chemokines initiate local actions and can result in a more generalized immune response. The resultant neuroinflammatory environment can cause activation of glial cells located in the spinal cord and the brain, which appear to play a prominent role in nociception. Glial cells, also known as neuroglia, are nonconducting cells that modulate neurotransmission at the synaptic level. Glial cells can be subdivided into two primary categories: microglia and macroglia, which include astrocytes and oligodendrocytes. Astrocytes and microglia are known to play a role in the development, spread, and potentiation of neuropathic pain. Following peripheral nociceptive activation via nerve injury, microglia become activated and release pro-inflammatory cytokines such as tumor necrosis factor-,, interleukin-1,, and interleukin-6, thereby initiating the pain process. Microglia propagate the neuroinflammation by recruiting other microglia and eventually activating nearby astrocytes, which prolongs the inflammatory state and leads to a chronic neuropathic pain condition. Our review focuses on the role of glia and the immune system in the development and maintenance of neuropathic pain. [source]

Mazes, Conflict, and Paradox: Tools for Understanding Chronic Pain

PAIN PRACTICE, Issue 3 2009
Cary A. Brown PhD
Abstract This article presents an argument for framing chronic pain within a complex adaptive systems (CAS) paradigm. The first aim of this article is to demonstrate how chronic pain can be framed as a CAS and how paradox, one of the core characteristics of a CAS, exists within the chronic pain experience. The second aim is to illustrate how paradox exists at multiple levels within the health care encounter and ongoing experience of chronic pain. Finally, the article will use the example of interactions at the patient/clinician level to illustrate how health care workers' efforts to deal with issues emergent from the range of paradoxes have for the most part been ineffective, and at times harmful, to persons experiencing chronic pain. This article uses the example of chronic pain to explore how the manner in which health care providers and patients recognize and deal with paradoxes can either worsen the pain experience or help generate creative new ways to manage the chronic pain condition. The CAS principles discussed in this article hold application across a range of chronic conditions for which a traditional biomedical paradigm proves insufficient. [source]

Persistent Genital and Pelvic Pain after Childbirth

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009
Laurel Q.P. Paterson BA
ABSTRACT Introduction., Although genital pain and pelvic pain are common and well-documented problems in the early postpartum period, little is known about their course. The few published studies of such pain beyond 1 year postpartum have focused primarily on the perineum and have not assessed pain onset. Aim., To investigate the prevalence and characteristics of all types of genital and pelvic pain in the second year postpartum, and to explore risk factors for their persistence. Methods., Over a 6-month period, a questionnaire on genital/pelvic pain, sociodemographic and childbirth variables, breastfeeding, and chronic pain history was mailed to patients of the collaborating obstetrician at 12 months postpartum. Main Outcome Measures., The prevalence, characteristics, and correlates of persistent genital/pelvic pain with postpartum onset. Results., Almost half of the 114 participants (82% response rate; M = 14 months postpartum) reported a current (18%) or resolved (26%) episode of genital or pelvic pain lasting 3 or more months. Just under one in 10 (9%) mothers continued to experience pain that had begun after they last gave birth. This pain was described at various locations (e.g., vaginal opening and pelvic area), as moderate in intensity and unpleasantness, and most often as burning, cutting, or radiating. Although it was triggered by both sexual and nonsexual activities, none of the mothers affected were receiving treatment. Univariate analyses revealed that only past diagnosis with a nongenital chronic pain condition (e.g., migraine headache) was significantly correlated with (i) any history of chronic genital/pelvic pain or (ii) the persistence of pregnancy- or postpartum-onset genital or pelvic pain. Conclusions., Postpartum genital and pelvic pain persists for longer than a year for a significant percentage of mothers. Women with a history of other chronic pain appear to be particularly vulnerable to developing persistent genital or pelvic pain. Paterson LQP, Davis SNP, Khalifé S, Amsel R, and Binik YM. Persistent genital and pelvic pain after childbirth. J Sex Med 2009;6:215,221. [source]

ORIGINAL RESEARCH,SEXUAL PAIN DISORDERS: The Association between Sexual Function, Pain, and Psychological Adaptation of Men Diagnosed with Chronic Pelvic Pain Syndrome Type III

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2008
Sylvie Aubin PhD
ABSTRACT Introduction., Prostatitis/chronic pelvic pain syndrome (CPPS) is known to have a negative impact on quality of life, especially on intimate relationships and sexual function. Information is, however, missing on the contribution of demographic and psychological variables to sexual variables. Aim., We compared the sexual function of men with CPPS to men without pain, and examined the relationship between the sexual, demographic, and psychological measures in men with CPPS. Main Outcome Measures., Self-report questionnaires assessing demographic, pain, sexual function, and psychological adaptation. Methods., The sample consisted of 72 men diagnosed with CPPS and 98 men without any pain condition. Self-report questionnaires measuring demographic, pain, and sexual function were completed once at the eligibility visit by all subjects. CPPS subjects completed additional questionnaires related to pain and psychological adaptation. Results., CPPS subjects differed from controls by reporting significantly less frequent sexual desire or thoughts, less frequent sexual activities, less arousal/erectile function, less orgasm function, and higher frequencies of genital pain during/after intercourse. When we adjusted for age and marital status, the difference between groups remained for thoughts/desire, frequency of sexual activity, and arousal/erectile function. Analysis of factors related to sexual function in CPPS subjects included pain status and psychological adaptation. Results showed that frequency of sexual activity decreased with increasing depression, whereas arousal/erectile function decreased with increasing pain symptoms and stress appraisal. Orgasm function decreased with increasing depression and pleasure/satisfaction decreased with increasing pain symptoms, stress appraisal, and decreasing belief of a relationship between emotions and pain. Conclusions., We found a differential sexual profile for men with CPPS when compared to men without pain. The results suggest that interventions addressing psychological factors affecting sexual responses should be further studied in prospective clinical trials as one possible way to improve sexual function and satisfaction in men with CPPS. Aubin S, Berger RE, Herman JR, and Ciol MA. The association between sexual function, pain, and psychological adaptation of men diagnosed with chronic pelvic pain syndrome type III. J Sex Med 2008;5:657,667. [source]

Sympathetic block with botulinum toxin to treat complex regional pain syndrome,

ANNALS OF NEUROLOGY, Issue 3 2009
Ian Carroll MD
Complex regional pain syndrome is a refractory pain condition with few tested therapies. We hypothesized that botulinum toxin A (BTA) would prolong analgesia after sympathetic blocks in patients with complex regional pain syndrome. We compared the duration of standard lumbar sympathetic block (LSB) with bupivacaine to LSB with bupivacaine and BTA in nine patients with refractory complex regional pain syndrome. Median time to analgesic failure was 71 (95% confidence interval, 12,253) days after LSB with BTA compared with fewer than 10 days (95% confidence interval, 0,12) after standard LSB (log-rank, p < 0.02). BTA profoundly prolonged the analgesia from sympathetic block in this preliminary study. Ann Neurol 2009;65:348,351 [source]

EFNS guidelines on neurostimulation therapy for neuropathic pain

EUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2007
G. Cruccu
Pharmacological relief of neuropathic pain is often insufficient. Electrical neurostimulation is efficacious in chronic neuropathic pain and other neurological diseases. European Federation of Neurological Societies (EFNS) launched a Task Force to evaluate the evidence for these techniques and to produce relevant recommendations. We searched the literature from 1968 to 2006, looking for neurostimulation in neuropathic pain conditions, and classified the trials according to the EFNS scheme of evidence for therapeutic interventions. Spinal cord stimulation (SCS) is efficacious in failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS) type I (level B recommendation). High-frequency transcutaneous electrical nerve stimulation (TENS) may be better than placebo (level C) although worse than electro-acupuncture (level B). One kind of repetitive transcranial magnetic stimulation (rTMS) has transient efficacy in central and peripheral neuropathic pains (level B). Motor cortex stimulation (MCS) is efficacious in central post-stroke and facial pain (level C). Deep brain stimulation (DBS) should only be performed in experienced centres. Evidence for implanted peripheral stimulations is inadequate. TENS and r-TMS are non-invasive and suitable as preliminary or add-on therapies. Further controlled trials are warranted for SCS in conditions other than failed back surgery syndrome and CRPS and for MCS and DBS in general. These chronically implanted techniques provide satisfactory pain relief in many patients, including those resistant to medication or other means. [source]

Dissociable neural activity to self- vs. externally administered thermal hyperalgesia: a parametric fMRI study

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2008
C. Mohr
Abstract Little is known regarding how cognitive strategies help to modulate neural responses of the human brain in ongoing pain syndromes to alleviate pain. Under pathological pain conditions, any self-elicited contact with usually non-painful stimuli may become painful. We examined whether the human brain is capable of dissociating self-controlled from externally administered thermal hyperalgesia in the experimental capsaicin model. Using functional magnetic resonance imaging, 17 male subjects were investigated in a parametric design with heat stimuli at topically capsaicin-sensitized skin. In contrast to external stimulation, self-administered pain was controllable. For both conditions application trials without noticeable thermal stimulation were introduced and used as high-level baseline (HLB) to account for the capsaicin-induced ongoing pain and other covariables. Following subtraction of the HLB, the anterior insula and the anterior cingulate cortex (ACC) but not the somatosensory cortices maintained parametric neural responses to thermal hyperalgesia. A stronger pain-related activity increase during self-administered stimuli was observed in the posterior insula. In contrast, prefrontal cortex showed stronger increases to uncontrollable external heat stimuli. In the state of ongoing pain (capsaicin), pain-intensity-encoding regions (anterior insula, ACC) but not those with sensory discriminative functions (SI, SII) showed graded, pain-intensity-related neural responses in thermal hyperalgesia. Some areas were able to dissociate between self- and externally administered stimuli in thermal hyperalgesia, which might be related to differences in perceived controllability. Thus, neural mechanisms maintain the ability to dissociate external from self-generated states of injury in thermal hyperalgesia. This may help to understand how cognitive strategies potentially alleviate chronic pain syndromes. [source]

Disparate cholinergic currents in rat principal trigeminal sensory nucleus neurons mediated by M1 and M2 receptors: a possible mechanism for selective gating of afferent sensory neurotransmission

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 12 2006
Kristi A. Kohlmeier
Abstract Neurons situated in the principal sensory trigeminal nucleus (PSTN) convey orofacial sensory inputs to thalamic relay regions and higher brain centres, and the excitability of these ascending tract cells is modulated across sleep/wakefulness states and during pain conditions. Moreover, acetylcholine release changes profoundly across sleep/wakefulness states and ascending sensory neurotransmission is altered by cholinergic agonists. An intriguing possibility is, therefore, that cholinergic mechanisms mediate such state-dependent modulation of PSTN tract neurons. We tested the hypotheses that cholinergic agonists can modulate PSTN cell excitability and that such effects are mediated by muscarinic receptor subtypes, using patch-clamp methods in rat and mouse. In all examined cells, carbachol elicited an electrophysiological response that was independent of action potential generation as it persisted in the presence of tetrodotoxin. Responses were of three types: depolarization, hyperpolarization or a biphasic response consisting of hyperpolarization followed by depolarization. In voltage-clamp mode, carbachol evoked corresponding inward, outward or biphasic currents. Moreover, immunostaining for the vesicle-associated choline transporter showed cholinergic innervation of the PSTN. Using muscarinic receptor antagonists, we found that carbachol-elicited PSTN neuron hyperpolarization was mediated by M2 receptors and depolarization, in large part, by M1 receptors. These data suggest that acetylcholine acting on M1 and M2 receptors may contribute to selective excitability enhancement or depression in individual, rostrally projecting sensory neurons. Such selective gating effects via cholinergic input may play a functional role in modulation of ascending sensory transmission, including across behavioral states typified by distinct cholinergic tone, e.g. sleep/wakefulness arousal levels or neuropathic pain conditions. [source]

Changes after acupuncture in patients with chronic pain conditions , what is clinically important?

FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2007
W Weidenhammer
[source]

Allodynia in Migraine: Association With Comorbid Pain Conditions

The Influence of Gender and Sex Steroids on Craniofacial Nociception

HEADACHE, Issue 2 2007
Brian E. Cairns PhD
Several pain conditions localized to the craniofacial region show a remarkable sex-related difference in their prevalence. These conditions include temporomandibular disorders and burning mouth syndrome as well as tension-type, migraine, and cluster headaches. The mechanisms that underlie sex-related differences in the prevalence of these craniofacial pain conditions remain obscure and likely involve both physiological and psychosocial factors. In terms of physiological factors relevant to the development of headache, direct evidence of sex-related differences in the properties of dural afferent fibers or durally activated second-order trigeminal sensory neurons has yet to be provided. There is, however, evidence for sex-related differences in the response properties of afferent fibers and second-order trigeminal sensory neurons that convey nociceptive input from other craniofacial tissues associated with sex-related differences in chronic pain conditions, such as those that innervate the masseter muscle and temporomandibular joint. Further, modulation of craniofacial nociceptive input by opioidergic receptor mechanisms appears to be dependent on biological sex. Research into mechanisms that may contribute to sex-related differences in trigeminal nociceptive processing has primarily focused on effect of the female sex hormone estrogen, which appears to alter the excitability of trigeminal afferent fibers and sensory neurons to noxious stimulation of craniofacial tissues. This article discusses current knowledge of potential physiological mechanisms that could contribute to sex-related differences in certain craniofacial pain conditions. [source]

The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2008
D. L. Hoffman
Summary Objective:, The current review describes how the health status profile of people with fibromyalgia (FM) compares to that of people in the general population and patients with other health conditions. Methods:, A review of 37 studies of FM that measured health status with the 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) or the 12-item Short-Form Health Survey (SF-12). Results:, Studies performed worldwide showed that FM groups were significantly more impaired than people in the general population on all eight health status domains assessed. These domains include physical functioning, role functioning difficulties caused by physical problems, bodily pain, general health, vitality (energy vs. fatigue), social functioning, role functioning difficulties caused by emotional problems and mental health. FM groups had mental health summary scores that fell 1 standard deviation (SD) below the general population mean, and physical health summary scores that fell 2 SD below the general population mean. FM groups also had a poorer overall health status compared to those with other specific pain conditions. FM groups had similar or significantly lower (poorer) physical and mental health status scores compared to those with rheumatoid arthritis, osteoarthritis, osteoporosis, systemic lupus erythematosus, myofacial pain syndrome, primary Sjögren's syndrome and others. FM groups scored significantly lower than the pain condition groups mentioned above on domains of bodily pain and vitality. Health status impairments in pain and vitality are consistent with core features of FM. Conclusions:, People with FM had an overall health status burden that was greater in magnitude compared to people with other specific pain conditions that are widely accepted as impairing. [source]

Impact of the CYP2D6 genotype on post-operative intravenous oxycodone analgesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010
S. T. ZWISLER
Background: Oxycodone is a semi-synthetic opioid with a ,-receptor agonist-mediated effect in several pain conditions, including post-operative pain. Oxycodone is metabolized to its active metabolite oxymorphone by O -demethylation via the polymorphic CYP2D6. The aim of this study was to investigate whether CYP2D6 poor metabolizers (PMs) yield the same analgesia post-operatively from intravenous oxycodone as extensive metabolizers (EMs). Methods: Two hundred and seventy patients undergoing primarily thyroid surgery or hysterectomy were included and followed for 24 h post-operatively. The CYP2D6 genotype was blinded until study procedures had been completed for all patients. All patients received intravenous oxycodone as pain treatment for 24 h post-operatively and morphine 5 mg was used as escape medication. A responder was characterized as a patient without the need for escape medication and a positive evaluation in a questionnaire 24 h post-operatively. Results: Twenty-four patients were PM (8.9%) and 246 were EM (91.1%). One PM (4.17%, CI=0.1,21.1) was a non-responder and 42 EM (17.07%, CI=12.6,22.4) were non-responders. The non-responder rate did not differ between the two genotypes (P=0.14). There was no difference in the total consumption of oxycodone between the two genotypes (EM=14.7 mg, CI=13.0,16.4 and PM=13.0 mg, CI=8.9,17.0, P=0.42). The mean oxymorphone/oxycodone ratios were 0.0031 and 0.00081 in the EMs and PMs, respectively (P<0.0001). Conclusion: This study showed for the first time in patients that the oxymorphone formation depends on CYP2D6, but we found no difference in the post-operative analgesic effect of intravenous oxycodone between the two CYP2D6 genotypes. [source]

Health-related quality of life in persons with long-term pain after a stroke

JOURNAL OF CLINICAL NURSING, Issue 4 2004
Marita Widar MSc
Background., No study has, to our knowledge, previously been published on health-related quality of life (HRQoL) in a group suffering from long-term pain after a stroke. Aim., The aim of the present study was to describe HRQoL in persons with long-term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status. Design., This study has a design combining qualitative and quantitative methods. Methods., Forty three participants suffering from long-term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self-report questionnaires, SF-36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used. Results., The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF-36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF-36. The men had more decreased vitality than the women. Conclusion., The results show, that the participants in this study have a lower HRQoL due to their long-term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care. Relevance to clinical practice., Awareness and understanding of the patients' perceptions and transitions with regard to their life situation and suffering from long-term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons. [source]

High intrathecal bupivacaine for severe pain in the head and neck

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009
C. LUNDBORG
Background: Severe pain in the head and neck is associated with a lowered quality of life and conventional pain therapy often does not provide adequate relief. The aims of this study were to investigate the efficacy, pain relief, benefits and adverse effects of intracisternal or high cervical (IHC) administration of bupivacaine in patients with severe pain in the head, neck and face regions. Methods: Between 1990 and 2005, 40 patients (age 27,84 years) were treated with continuous IHC infusions of bupivacaine for various non-cancer (n=15) or cancer-related (n=25) refractory pain conditions (duration 1 month,18 years) in the head, neck, mouth and shoulder regions. Results: Visual analogue scale scores and opioid requirements decreased markedly after the start of the treatment and remained lowered throughout the study. No tachyphylaxis for bupivacaine was observed. Major side effects were few and most often transient. Most patients showed unchanged or improved mobility. There was no mortality, neurological damage or other severe events attributable to procedures in the study protocol. Conclusion: For patients with severe and refractory pain in areas innervated by cranial and upper cervical nerves, cervical high spinal analgesia can provide safe and effective analgesia. [source]

Influence of topical capsaicin on facial sensitivity in response to experimental pain

JOURNAL OF ORAL REHABILITATION, Issue 1 2007
Y.-S. LEE
summary, Capsaicin, the pungent component of the red pepper, has been used as an analgesic in a variety of pain conditions, but sensory impairment after long-term treatment has been concerned. This study investigated the influence of topical capsaicin on various types of sensations including pain in the facial areas innervated by the mental nerve, and also evaluated whether the measurement of cutaneous current perception threshold (CPT) is reliable for the quantification of sensory change following capsaicin application. Twenty healthy subjects were given topical capsaicin cream (0·075%), which was applied to the mental area unilaterally, four times daily for 2 weeks. Burning sensation after capsaicin application gradually decreased with repeated applications. Repeated topical capsaicin resulted in reduced sensation to mechanical, heat and cold pain without changing non-painful tactile sensation. It also resulted in increased CPTs at 5 Hz and 250 Hz stimuli but no change in the CPTs at 2000 Hz from the first evaluation after capsaicin treatment and throughout the treatment period. This study demonstrated that topical capsaicin treatment for the management of chronic localized pain can be safely applied to the face without affecting non-painful normal sensations, and that CPT testing is a clinically useful tool for the quantification of sensory changes following capsaicin application. [source]

Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006
J. Højsted
Background:, Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. Methods:, Patients were assessed at referral (T0) and after a treatment period of 3 months (T3) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T0 to T3 was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. Results:, Thirty-three patients were assessed at T0 and 27 at T3. The prevalence of BTP declined significantly from T0 (90%) to T3 (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T0 to T3. The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). Conclusion:, BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression. [source]

Evaluation of a multidisciplinary outpatient pain management programme based at a community hospital

MUSCULOSKELETAL CARE, Issue 2 2009
Mei Wong DClinPsy
Objective:,To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. Methods:,Patients attending the PMP were assessed at three intervals (pre-training, and 18 and 44 weeks post-training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre-training and final follow-up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. Results:,Between 1997 and 2006, 163 patients completed at least six sessions out of the eight-week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre-training and final follow-up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self-efficacy questionnaire) at 18 weeks post-training and their improvement was sustained at the final follow-up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow-up. They also reported a significant reduction in pain-related GP and consultant visits at their final follow-up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS-Anx) and sickness impact profile scores, these were not statistically significant. Conclusion:,The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Role of spinal cord glia in the central processing of peripheral pain perception

NEUROGASTROENTEROLOGY & MOTILITY, Issue 5 2010
S. Bradesi
Abstract Background, The discovery that glial activation plays a critical role in the modulation of neuronal functions and affects the spinal processing of nociceptive signalling has brought new understanding on the mechanisms underlying central sensitization involved in chronic pain facilitation. Spinal glial activation is now considered an important component in the development and maintenance of allodynia and hyperalgesia in various models of chronic pain, including neuropathic pain and pain associated with peripheral inflammation. In addition, spinal glial activation is also involved in some forms of visceral hyperalgesia. Purpose, We discuss the signalling pathways engaged in central glial activation, including stress pathways, and the neuron,glia bidirectional relationships involved in the modulation of synaptic activity and pain facilitation. In this expanding field of research, the characterization of the mechanisms by which glia affect spinal neuro-transmission will increase our understanding of central pain facilitation, and has the potential for the development of new therapeutic agents for common chronic pain conditions. [source]

Nonimmersive Virtual Reality Mirror Visual Feedback Therapy and Its Application for the Treatment of Complex Regional Pain Syndrome: An Open-Label Pilot Study

PAIN MEDICINE, Issue 4 2010
Kenji Sato MD
Abstract Objective., Chronic pain conditions such as phantom limb pain and complex regional pain syndrome are difficult to treat, and traditional pharmacological treatment and invasive neural block are not always effective. Plasticity in the central nervous system occurs in these conditions and may be associated with pain. Mirror visual feedback therapy aims to restore normal cortical organization and is applied in the treatment of chronic pain conditions. However, not all patients benefit from this treatment. Virtual reality technology is increasingly attracting attention for medical application, including as an analgesic modality. An advanced mirror visual feedback system with virtual reality technology may have increased analgesic efficacy and benefit a wider patient population. In this preliminary work, we developed a virtual reality mirror visual feedback system and applied it to the treatment of complex regional pain syndrome. Design., A small open-label case series. Five patients with complex regional pain syndrome received virtual reality mirror visual feedback therapy once a week for five to eight sessions on an outpatient basis. Patients were monitored for continued medication use and pain intensity. Results., Four of the five patients showed >50% reduction in pain intensity. Two of these patients ended their visits to our pain clinic after five sessions. Conclusion., Our results indicate that virtual reality mirror visual feedback therapy is a promising alternative treatment for complex regional pain syndrome. Further studies are necessary before concluding that analgesia provided from virtual reality mirror visual feedback therapy is the result of reversing maladaptive changes in pain perception. [source]

Voltage-Gated Sodium Channels: Therapeutic Targets for Pain

PAIN MEDICINE, Issue 7 2009
Sulayman D. Dib-Hajj PhD
ABSTRACT Objective., To provide an overview of the role of voltage-gated sodium channels in pathophysiology of acquired and inherited pain states, and of recent developments that validate these channels as therapeutic targets for treating chronic pain. Background., Neuropathic and inflammatory pain conditions are major medical needs worldwide with only partial or low efficacy treatment options currently available. An important role of voltage-gated sodium channels in many different pain states has been established in animal models and, empirically, in humans, where sodium channel blockers partially ameliorate pain. Animal studies have causally linked changes in sodium channel expression and modulation that alter channel gating properties or current density in nociceptor neurons to different pain states. Biophysical and pharmacological studies have identified the sodium channel isoforms Nav1.3, Nav1.7, Nav1.8, and Nav1.9 as particularly important in the pathophysiology of different pain syndromes. Recently, gain-of-function mutations in SCN9A, the gene which encodes Nav1.7, have been linked to two human-inherited pain syndromes, inherited erythromelalgia and paroxysmal extreme pain disorder, while loss-of-function mutations in SCN9A have been linked to complete insensitivity to pain. Studies on firing properties of sensory neurons of dorsal root ganglia demonstrate that the effects of gain-of-function mutations in Nav1.7 on the excitability of these neurons depend on the presence of Nav1.8, which suggests a similar physiological interaction of these two channels in humans carrying the Nav1.7 pain mutation. Conclusions., These studies suggest that isoform-specific blockers of these channels or targeting of their modulators may provide novel approaches to treatment of pain. [source]

A Pilot Study Investigating the Effects of Fast Left Prefrontal rTMS on Chronic Neuropathic Pain

PAIN MEDICINE, Issue 5 2009
Jeffrey J. Borckardt PhD
ABSTRACT Objective., Stimulating the human cortex using transcranial magnetic stimulation (TMS) temporarily reduces clinical and experimental pain; however, it is unclear which cortical targets are the most effective. The motor cortex has been a popular target for managing neuropathic pain, while the prefrontal cortex has been investigated for an array of nociceptive pain conditions. It is unclear whether the motor cortex is the only effective cortical target for managing neuropathic pain, and no published studies to date have investigated the effects of prefrontal stimulation on neuropathic pain. Design., This preliminary pilot trial employed a sham-controlled, within-subject, crossover design to evaluate clinical pain as well as laboratory pain thresholds among four patients with chronic neuropathic pain. Each participant underwent three real and three sham 20-minute sessions of 10 Hz left prefrontal repetitive TMS. Daily pain diaries were collected for 3 weeks before and after each treatment phase along with a battery of self-report pain and mood questionnaires. Results., Time-series analysis at the individual patient level indicated that real TMS was associated with significant improvements in average daily pain in 3 of the 4 participants. These effects were independent of changes in mood in two of the participants. At the group level, a decrease of 19% in daily pain on average, pain at its worst, and pain at its least was observed while controlling for changes in mood, activity level and sleep. The effects of real TMS were significantly greater than sham. Real TMS was associated with increases in thermal and mechanical pain thresholds, whereas sham was not. No statistically significant effects were observed across the questionnaire data. Conclusions., The prefrontal cortex may be an important TMS cortical target for managing certain types of pain, including certain neuropathic pain syndromes. [source]

Impact of Chronic Musculoskeletal Pathology on Older Adults: A Study of Differences between Knee OA and Low Back Pain

PAIN MEDICINE, Issue 4 2009
Natalia E. Morone MD
ABSTRACT Objectives., The study aimed to compare the psychological and physical characteristics of older adults with knee osteoarthritis (OA) vs those of adults with chronic low back pain (CLBP) and to identify psychological and physical predictors of function as measured by gait speed. Design., Secondary data analysis. Method and Patients., Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate randomized controlled trials were selected for this study. Measures., Inclusion criteria for both trials included age ,65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months. Psychological constructs (catastrophizing, fear avoidance, self-efficacy, depression, affective distress) and physical measures (comorbid medical conditions, pain duration, pain severity, pain related interference, self-rated health) were obtained. Results., Subjects with CLBP had slower gait (0.88 m/s vs 0.96 m/s, P = 0.002) and more comorbid conditions than subjects with knee pain (mean 3.36 vs 1.97, P < 0.001). All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory,Affective Distress score. Self-efficacy, pain severity, and medical comorbidity burden were associated with slower gait regardless of the location of the pain. Conclusions., Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed. These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans. [source]