Pain
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Comparative Study Clinical Trial
Lack of sex differences in modulation of experimental intraoral pain by diffuse noxious inhibitory controls (DNIC).
The aims of this study were to investigate possible sex differences in (a) intraoral pain evoked by topical application of capsaicin to the gingiva, and (b) the modulation of this pain by diffuse noxious inhibitory controls (DNIC). Three groups with a total of fifty-four healthy volunteers (20 men, 20 women using oral contraceptives (W+OC), 14 women not using (W-OC)) completed the study. In two sessions, intraoral pain was evoked by topical application of 30microL 5% capsaicin to the gingiva. ⋯ The degree of modulation by DNIC did not differ between groups (P=0.636). In conclusion, for a superficial type of intraoral pain, only minor sex differences were found in pain intensity and no differences in the degree of endogenous modulation by DNIC. Female sex and the use of OC may not consistently be associated with higher sensitivity to pain.
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Comparative Study
Comparative actions of the opioid analgesics morphine, methadone and codeine in rat models of peripheral and central neuropathic pain.
Controversy persists in relation to the analgesic efficacy of opioids in neuropathic pain. In the present study the effects of acute, subcutaneous administration of the mu-opioid receptor agonists morphine, methadone and codeine were examined in rat models of peripheral and central neuropathic pain. In the spared nerve injury (SNI) and chronic constriction injury (CCI) models of peripheral neuropathic pain, both morphine (6mg/kg) and methadone (3mg/kg) attenuated mechanical allodynia, mechanical hyperalgesia and cold allodynia for up to 1.5h post-injection (P<0.05); codeine (30mg/kg) minimally alleviated mechanical hypersensitivity in SNI, but not CCI rats. ⋯ The therapeutic window (based on antiallodynia versus ataxia) obtained for codeine, was vastly superior to that obtained with morphine or methadone in SNI and SCI rats. Furthermore, the therapeutic window for codeine in SCI rats was 4-fold greater than in SNI rats. Our results further support the efficacy of mu-opioid receptor agonists in alleviating signs of neuropathic pain in animal models of peripheral and especially central nerve injury.
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Meta Analysis Comparative Study
Acute pain: individual patient meta-analysis shows the impact of different ways of analysing and presenting results.
Individual patient meta-analysis using information from clinically homogeneous acute pain trials with observations over 24h was used to investigate different ways trials can be analysed and reported. There were 13 third-molar extraction trials, with 1,330 patients using rofecoxib 50mg, 303 using ibuprofen 400mg, and 570 using placebo. Pain relief scores were available at individual time points, plus time to remedication. ⋯ The distribution of pain relief was highly skewed, especially at later times, when almost no patient was average. Different cut points for pain relief (at least 25, 50 or 75% maxTOTPAR) and longer duration changed the NNT for ibuprofen compared with placebo, but less for rofecoxib, reflecting longer duration of action of rofecoxib. Reporting for each treatment group the percentage of patients with 25, 50 and 75% pain relief at various times after dose, and reporting the proportion of patients with good or complete pain relief, and inadequate pain relief, at each time point, would improve acute pain trial reporting.
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Comparative Study
The relationship between religion/spirituality and physical health, mental health, and pain in a chronic pain population.
This study sought to better understand the relationship between religion/spirituality and physical health and mental health in 122 patients with chronic musculoskeletal pain. The current study conceptualized religion/spirituality as a multidimensional factor, and measured it with a new measure of religion/spirituality for research on health outcomes (Brief Multidimensional Measure of Religion/Spirituality). Pain patients' religious and spiritual beliefs appear different than the general population (e.g. pain patients feel less desire to reduce pain in the world and feel more abandoned by God). ⋯ Forgiveness, negative religious coping, daily spiritual experiences, religious support, and self-rankings of religious/spiritual intensity significantly predicted mental health status. Religion/spirituality was unrelated to pain intensity and life interference due to pain. This study establishes relationships between religion/spirituality and health in a chronic pain population, and emphasizes that religion/spirituality may have both costs and benefits for the health of those with chronic pain.
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Multicenter Study Comparative Study
Towards a new taxonomy of idiopathic orofacial pain.
There is no current consensus on the taxonomy of the different forms of idiopathic orofacial pain (stomatodynia, atypical odontalgia, atypical facial pain, facial arthromyalgia), which are sometimes considered as separate entities and sometimes grouped together. In the present prospective multicentric study, we used a systematic approach to help to place these different painful syndromes in the general classification of chronic facial pain. This multicenter study was carried out on 245 consecutive patients presenting with chronic facial pain (>4 months duration). ⋯ Inside this large cluster, only stomatodynia (n=42) emerged as a distinct homogenous subgroup. In contrast, facial arthromyalgia (n=46) and an entity formed with atypical facial pain (n=25) and atypical odontalgia (n=13) could only be individualised by variables reflecting topographical characteristics. These data provide grounds for an evidence-based classification of idiopathic facial pain entities and indicate that the current sub-classification of these syndromes relies primarily on the topography of the symptoms.