Pain
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We have examined the effect of an intradermal injection of phenylephrine (1mg/0.1 ml), an alpha-1-adrenoceptor agonist in normal subjects, and patients with sympathetically-independent (SIP) and sympathetically-maintained pain (SMP). Normal subjects and SIP patients experienced only brief stinging pain, while subsets of both sympathectomized and non-sympathectomized SMP patients (6/9 and 4/8, respectively) experienced an additional abnormal pain response accompanied by mechano-allodynia around the injection site. ⋯ Abnormal pain response evoked by norepinephrine or phenylephrine injection in the ipsilateral symptomatic limb of SMP patients may be due to injury-evoked nociceptor responsiveness to catecholamines. However, such a response in contralateral asymptomatic limbs suggests an additional factor that more likely than not is of central origin and may or may not be related to sympathectomy and its success or failure to treat pain.
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Our objective was to determine the efficacy and safety of valdecoxib (a cyclo-oxygenase 2 inhibitor) in the treatment of arthritis. Randomised, controlled trials comparing 10 or 20mg valdecoxib with placebo or non-steroidal anti-inflammatory drugs (NSAIDs) in patients with active osteoarthritis or rheumatoid arthritis. The manufacturer provided clinical trial reports. ⋯ At an appropriate dose valdecoxib was as effective as NSAIDs in osteoarthritis and rheumatoid arthritis. There were fewer gastrointestinal adverse event withdrawals and endoscopically detected ulcers. Convincing evidence of reduced major gastrointestinal adverse events could not be addressed by the trials.
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Comparative Study
Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care.
This study examined the relations between disability, as measured by the Pain Disability Index (PDI) and self-efficacy, fear avoidance variables (kinesiophobia and catastrophizing), and pain intensity, using a prospective design. Two primary health care samples (n(1)=210; n(2)=161) of patients with subacute, chronic or recurring musculoskeletal pain completed sets of questionnaires at the beginning of a physiotherapy treatment period. Multiple hierarchial regression analyses showed that self-efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample. ⋯ Gender, age, and pain duration were not related to disability. These findings suggest that self-efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain. The findings also suggest that pain-related beliefs, such as self-efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration in these patients.
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Clonidine, an alpha-2 adrenergic agonist, is an extremely potent antinociceptive agent. However, the therapeutic utility of systemic clonidine for the treatment of pain is limited by centrally mediated side effects including sedation, hypotension and rebound hypertension. Given that alpha-2 adrenoceptors are expressed on the peripheral and central terminals of nociceptive fibers, we administered clonidine topically in order to avoid central effects. ⋯ Tolerance to the antinociceptive actions of clonidine was not blocked by topical administration of the NMDA antagonist, ketamine. In conclusion, topical administration of clonidine elicits antinociception by blocking the emerging pain signals at peripheral terminals via alpha-2 adrenoceptors without producing the undesirable central side effects observed following the systemic administration. The ineffectiveness of topical ketamine to block topical clonidine antinociceptive tolerance suggests that peripheral NMDA receptors do not mediate local clonidine antinociceptive tolerance.
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Randomized Controlled Trial Comparative Study Clinical Trial
Controlled trial of Internet-based treatment with telephone support for chronic back pain.
The purpose of this study was to investigate the effects of an Internet-based cognitive-behavioral intervention with telephone support for chronic back pain. Participants who met the criteria for chronic back pain (N=56) were randomly assigned to either an Internet-based cognitive behavioral self-help treatment or to a waiting-list control condition. The study period lasted 8 weeks and consisted of 1 week of self-monitoring prior to the intervention, 6 weeks of intervention, and 1 week of post-intervention assessment. ⋯ A follow-up of 3 months after treatment termination was completed in 92% (N=47) of the participants who completed the treatment intervention. Follow-up results showed that some improvement was maintained. Findings indicate that Internet-based self-help with telephone support, based on established psychological treatment methods, holds promise as an effective approach for treating disability in association with pain.