Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.
The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. ⋯ However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition.
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Review Comparative Study
The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review.
The study design is a systematic review of randomised clinical trials (RCTs). The objectives of the present study are to assess the effectiveness of physiotherapy and (spinal) manipulation in patients with tension-type headache (TTH). No systematic review exists concerning the effectiveness of physiotherapy and (spinal) manipulation primarily focussing on TTH. ⋯ Only two studies were considered to be of high quality, but showed inconsistent results. Because of clinical heterogeneity and poor methodological quality in many studies, it appeared to be not possible to draw valid conclusions. Therefore, we conclude that there is insufficient evidence to either support or refute the effectiveness of physiotherapy and (spinal) manipulation in patients with TTH.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of diffuse noxious inhibitory controls on temporal summation of the RIII reflex in humans.
The aim of this study was to investigate the effects of diffuse noxious inhibitory controls (DNICs) on the temporal summation of the nociceptive flexion reflex (RIII reflex) in humans. Recordings were obtained from 36 healthy adults (16 M, 20 F), and the area and temporal summation threshold (TST) of the RIII reflex were measured. The subjective intensity of the painful sensation was rated on an 11-point visual analogue scale (VAS). ⋯ To summarize, activation of DNICs through the CPT significantly increased the TST of the RIII reflex in healthy subjects. This inhibitory effect was gender-specific. Whereas other findings are based on psychophysical evaluations, the results of this experimental study provide an objective neurophysiological demonstration that DNICs attenuate temporal summation in humans and confirm the presence of significant differences in pain modulation mechanisms between men and women.
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Comparative Study
Management of occupational back injuries: differences among African Americans and Caucasians.
This study examined differences in the case management of occupational low back injuries in a large, racially diverse population of Workers' Compensation claimants in Missouri. Participants were African Americans (N=580) and non-Hispanic whites (N=892) who had filed occupational injury claims that were settled over an 18-month period. Telephone interview data were gathered regarding diagnoses, legal representation, demographics, and socioeconomic status. ⋯ Simultaneous-entry, hierarchical multiple and logistic regression analyses showed significant and substantial effects for injury-related variables, socioeconomic status, and race across all Workers' Compensation variables. Differences remained for both injury and African Americans and lower socioeconomic status workers after controlling for injury, and for African Americans after controlling for both injury and socioeconomic status. Because Workers' Compensation mandates equal access to treatment and disability reimbursement for all injured workers, the differences observed in this study may reflect sociocultural biases in disability management among healthcare providers.
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Comparative Study
Laboratory pain perception and clinical pain in post-menopausal women and age-matched men with osteoarthritis: relationship to pain coping and hormonal status.
The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. ⋯ A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.