Pain
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Randomized Controlled Trial Clinical Trial
Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial.
To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling (DN) of local myofascial trigger points and sham laser acupuncture (Sham). ⋯ For patient assessment of change, non-local acupuncture was significantly superior both to Sham (1.7 points; 95% CI 1.0, 2.5; P = 0.0001) and DN (1.5 points; 95% CI 0.4, 2.6; P = 0.008) but there was no difference between DN and Sham (0.1 point; 95% CI -1.0, 1.2; P = 0.8). Acupuncture is superior to Sham in improving motion-related pain and ROM following a single session of treatment in chronic neck pain patients. Acupuncture at distant points improves ROM more than DN; DN was ineffective for motion-related pain.
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Randomized Controlled Trial Clinical Trial
Magnesium Bier's block for treatment of chronic limb pain: a randomised, double-blind, cross-over study.
Magnesium is a physiological antagonist of both calcium and the NMDA receptor. Patients with chronic pain of a limb (>1 month's duration) were treated with two Bier's blocks (250 mmHg, 10 m) in a randomised, double-blind, cross-over design. They received once 20% magnesium sulphate (500 mg) + lignocaine 1% (75 mg), and once physiological saline + lignocaine 1% (75 mg). ⋯ For patients with chronic limb pain, the addition of magnesium to a Bier's block with lignocaine improves and prolongs pain relief and reduces the number of treatment failures. The optimal dose of lignocaine to prevent magnesium-induced aching of the treated limb needs to be established. Bier's block with magnesium-lignocaine may provide a possible treatment alternative in these patients.
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To obtain parents' identification and description of the behaviors, health care procedures and daily living situations associated with pain in children with cerebral palsy (CP), surveys were sent to parents of children with CP recruited via a clinic case list and a parents' newsletter. Forty-three parents completed the survey. Results indicated that children's ability to communicate pain verbally did not influence whether or not their parent reported observing pain. ⋯ Range of motion manipulation was the therapy most frequently identified as painful by parents (58%), and the one with the highest mean intensity. Parents are able to observe pain in their children with CP regardless of the child's verbal fluency. Knowledge of behaviors and painful situations identified by parents can facilitate management of pain in children with CP.
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A variety of molecules released by inflammatory reactions in the dorsal root and dorsal root ganglion (DRG) may play important roles in the pathology of neuronal abnormalities in lumbar disc herniation. In order to elucidate the pathophysiological mechanisms of painful radiculopathy, secondary to lumbar disc herniation, we evaluated pain-related behavior and the change of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) expression in the DRG and dorsal root using a rat model of lumbar disc herniation. In the nucleus pulposus (NP) group, the left L4/5 nerve roots were exposed after hemilaminectomies and autologous intervertebral discs, which were obtained from coccygeal intervertebral discs, were implanted on each of the exposed nerve roots without mechanical compression. ⋯ We also injected NGF into the endoneurial space of the normal rat spinal nerve root and found that the NGF injection produced dose-dependent mechanical allodynia on the ipsilateral hind paw at 1 day after surgery and an increase in the percentage of BDNF-IR neurons in the DRG at 3 days after surgery compared to the group receiving saline injection. These findings suggest that in the lumbar disc herniation model, i.e. neuritis of the nerve root, increased NGF produced by the inflammatory responses in the dorsal root and DRG tissues may affect the production of BDNF in the DRG and may play important roles in the modulation of the dorsal horn neurons. These changes in neurotrophic factors in the primary afferents may be involved in the pathophysiological mechanisms of neuropathic pain produced by lumbar disc herniation.
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Randomized Controlled Trial Clinical Trial
Anger and pain sensitivity in chronic low back pain patients and pain-free controls: the role of endogenous opioids.
The experience of anger (i.e. trait anger) and anger management style (i.e. anger-in, anger-out) are related to sensitivity to acute and chronic pain stimuli, although underlying mechanisms are unknown. This study tested whether anger variables are associated with impaired endogenous opioid antinociceptive activity, and whether these relationships differed between chronic pain patients and healthy normals. Forty-three chronic low back pain (LBP) sufferers and 45 pain-free normals received opioid blockade (8 mg naloxone i.v.) or placebo blockade (saline) in randomized, counterbalanced order in separate sessions. ⋯ Anger-out x LBP/normal interactions were non-significant, suggesting that links between anger-out and drug effects were similar for patients and normals. Controlling for depression did not eliminate the significant relationship between anger-out and drug effects. Findings suggest that anger-in and anger-out affect pain sensitivity through different mechanisms: only the effects of anger-out may be mediated by endogenous opioid dysfunction.