Pain
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In the cancer population, the term breakthrough pain typically refers to a transitory flare of pain in the setting of chronic pain managed with opioid drugs. The prevalence and characteristics of this phenomenon have not been defined, and its impact on patient care is unknown. We developed operational definitions for breakthrough pain and its major characteristics, and applied these in a prospective survey of patients with cancer pain. ⋯ Pain was related to the tumor in 42 (82%), the effects of therapy in 7 (14%), and neither in 2 (4%). Diverse interventions were employed to manage these pains, with variable efficacy. These data clarify the spectrum of breakthrough pains and indicate their importance in cancer pain management.
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An electrophysiological study was carried out in anesthetized rats to characterize the properties of single neurons in trigeminal (V) subnucleus caudalis. Each neuron was functionally classified in terms of its cutaneous mechanoreceptive field properties as low-threshold mechanoreceptive (LTM), wide dynamic range (WDR) or nociceptive-specific (NS), and its responsiveness was also tested to electrical stimulation of hypoglossal (XII) nerve muscle afferents. Some neurons were also tested with noxious stimulation of the tail or forepaw for the presence of diffuse noxious inhibitory controls (DNIC) of evoked responses. ⋯ In contrast to the LTM neurons, but consistent with our previous data in cats, many of the nociceptive neurons also received convergent excitatory inputs from XII muscle afferents, and the stimulus-response functions of the WDR neurons indicated that they were capable of coding the intensity of A and C fiber craniofacial muscle afferent inputs as well as those from cutaneous afferents. The study has also documented for the first time that muscle afferent-evoked responses as well as those evoked by cutaneous afferent inputs to nociceptive neurons are subject to DNIC. These findings indicate that subnucleus caudalis plays an important role in the transmission of superficial and deep nociceptive information from the craniofacial region of the rat, and also reveal that responses of the nociceptive neurons evoked by deep as well as superficial afferent inputs can be powerfully modulated by other nociceptive influences originating from widespread parts of the body.