Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Loss of expectation-related mechanisms in Alzheimer's disease makes analgesic therapies less effective.
Expectation/placebo-related mechanisms and specific effects of therapies show additive effects, such that a therapy is less effective if the placebo component is absent. So far, the placebo component has been disrupted experimentally by using covert administrations of treatments. Here, we show for the first time that disruption of expectation/placebo-related analgesic mechanisms may occur in a clinical condition, Alzheimer's disease (AD). ⋯ We also found that the disruption of the placebo component occurred when reduced connectivity of the prefrontal lobes with the rest of the brain was present. Remarkably, the loss of these placebo-related mechanisms reduced treatment efficacy, such that a dose increase was necessary to produce adequate analgesia. These findings highlight the active role of cognition and prefrontal lobes in the therapeutic outcome and underscore the need of considering a possible revision of the therapeutic approach in Alzheimer patients in order to compensate for the loss of the endogenous expectation and placebo mechanisms.
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It is frequently necessary for patients to undergo multiple painful medical interventions as part of their diagnosis and care. Predictors of future pain report have yet to be established although initial pain level, affect, and memory of the procedure are often implicated. The purpose of this research was to establish a predictive model of future pain reporting using a standardized experimental pain stimulus. ⋯ An additional 13% of the variance was shared between Session 1 maximum pain intensity and remembered maximum pain intensity. The level of remembered Session 1 pain was significantly exaggerated from the initial pain report (p < or = .05) but not significantly different from the level of pain reported at Session 2. These findings provide strong evidence for a post-pain modulation phenomenon in which cognitive processes influence both pain recall and future pain reporting.
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Comparative Study
Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory.
The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39-58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. ⋯ Internal consistency reliability was excellent, ranging from .86 to .91. Validity was supported by significant correlations of child- and parent-report FDI scores with measures of school-related disability, pain, and somatic symptoms. Study results add to a growing body of empirical literature supporting the reliability and validity of the FDI for functional assessment of pediatric patients with chronic pain.
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Comparative Study
Local interactions between anandamide, an endocannabinoid, and ibuprofen, a nonsteroidal anti-inflammatory drug, in acute and inflammatory pain.
Anandamide, an endocannabinoid, is degraded by the enzyme fatty acid amide hydrolase which can be inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs). The present work was designed to study the peripheral interactions between anandamide and ibuprofen (a non-specific cyclooxygenase inhibitor) in the rat formalin test. We first determined the ED50 for anandamide (0.018 microg +/- 0.009), ibuprofen (0.18 microg +/- 0.09), and their combination (0.006 microg +/- 0.002). ⋯ In conclusion, locally (hind paw) injected anandamide, ibuprofen or combination thereof decreased pain behavior in the formalin test. The combination of anandamide with ibuprofen produced synergistic antinociceptive effects involving both cannabinoid CB1 and CB2 receptors. Comprehension of the mechanisms involved needs further investigation.
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Randomized Controlled Trial Comparative Study
Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience.
Chronic subthreshold stimulation of the contralateral precentral gyrus is used in patients with intractable neuropathic pain for more than 15 years. The aim of this study was to analyse retrospectively our own patient group with long term follow-up of 10 years. Seventeen patients with chronic neuropathic pain were treated with contralateral epidural stimulation electrodes. ⋯ Double-blind testing can identify non-responders. Patients with TNP profit more than patients with PSP. The positive effect can last for ten years in long-term follow-up.