Pain
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Clinicians use patients' recall of pain and disability relief as indicators of therapeutic effectiveness. Recall can change over time, however, and is influenced by factors other than true relief, including current health status. We have determined the trend in the relative contribution of current pain/disability and actual relief (current-baseline score) to relief recall over the course of 1 year. ⋯ Complaint characteristics including LBP chronicity, sciatica, LBP history, and comorbidity; psychosocial variables including stress, depression, and well being; sociodemographics; and treating provider type are not important independent predictors of pain and disability relief recall in ambulatory LBP patients. Perceived relief is too weakly related to present pain and disability to be accurate enough for use as a clinical assessment tool for individual patients. Physicians may need to use objective relief data to give the patient a realistic idea of actual improvement.
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Pain-related somatosensory-evoked potential following CO(2) laser stimulation (laser-evoked potential (LEP)) is now used not only for research objectives, but also for clinical applications. Estimating the conduction velocity (CV) of the spinothalamic tract (STT) by analyzing LEP following activation of Adelta-fibers (Adelta-CVSTT) by CO(2) laser stimulation has been performed previously, but estimating the CV of STT following activation of C-fibers (C-CVSTT) has not. This is the first report to estimate the C-CVSTT in humans; by using the novel method of CO(2) laser stimulation applied to tiny skin areas. ⋯ The nociceptive signal of the C-fibers in STT is probably conveyed by unmyelinated axons of projection neurons to reach the thalamus. Our findings provide the first physiological evidence of the signals ascending through unmyelinated axons in the spinal cord in humans. In addition, estimating C-CVSTT and Adelta-CVSTT combined with conventional methods to measure the CV of the posterior column using electrical stimulation should be useful and have important clinical applications, particularly in patients with spinal cord lesions showing various kinds of sensory disturbances.
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This study examined the impact of pain on self-rated health status in the community-dwelling older adults using the 1993 public release data of the Asset and Health Dynamics Among the Oldest Old (AHEAD). AHEAD is a population-based household survey designed to examine the dynamic interactions between health, family, and economic variables among US older adults. Results showed that 33% of the older adults reported frequent pain and 20% reported significant pain resulting in activity limitation. ⋯ Other predictors (P<0.01) include functional impairment (OR=2.78), chronic diseases (OR=1.89), minority status (OR=1.88), education (OR=1.77), and physician visits (OR=1.64). This study documents the adverse impact of pain on self-rated health as well as the fact that the experience of pain and poor subjective health and well-being is greatest among the most socially disadvantaged older adults (minorities and those with the least education). The findings suggest that treating and controlling pain may significantly enhance the subjective health and well-being of community-dwelling older adults.
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Neuropathic pain is a debilitating chronic syndrome that often arises from injuries to peripheral nerves. Such pain has been hypothesized to be the result of an aberrant expression and function of sodium channels at the site of injury. ⋯ These data provide direct evidence linking NaV1.8 to neuropathic pain. As NaV1.8 expression is restricted to sensory neurons, this channel offers a highly specific and effective molecular target for the treatment of neuropathic pain.