Pain
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Randomized Controlled Trial Multicenter Study Comparative Study
Gabapentin in traumatic nerve injury pain: a randomized, double-blind, placebo-controlled, cross-over, multi-center study.
A double-blind, randomized, placebo-controlled cross-over multi-center study was conducted to evaluate the efficacy and safety of gabapentin in the treatment of neuropathic pain caused by traumatic or postsurgical peripheral nerve injury, using doses up to 2400 mg/day. The study comprised a run-in period of two weeks, two treatment periods of five weeks separated by a three weeks' washout period. The primary efficacy variable was the change in the mean pain intensity score from baseline to the last week of treatment. ⋯ Both the Patient (p=0.023) and Clinician (p=0.037) Global Impression of Change indicated a better response with gabapentin compared with placebo. Gabapentin was well tolerated. The most common adverse effects were dizziness and tiredness.
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Randomized Controlled Trial Comparative Study
Effects of progressive muscle relaxation training on nociceptive flexion reflex threshold in healthy young adults: a randomized trial.
Although prior studies have demonstrated effects of progressive muscle relaxation (PMR) in reducing self-reported pain, no laboratory studies have examined the effects of PMR on objective indicators of descending modulation of nociception. This randomized controlled study utilized the nociceptive flexion reflex (NFR) to evaluate nociceptive responding among 55 college-age men and women (mean age=19.4+/-1.2 years). Participants completed laboratory assessments of NFR threshold and questionnaires evaluating pain and stress. ⋯ Ratings of pain did not change during the study, but PMR participants reported decreased stress following the PMR intervention. This is the first study with a randomized no-treatment control group demonstrating the effect of a brief PMR protocol on descending inhibition of nociception. Results support the efficacy of PMR in reducing nociceptive response and provide further evidence of the utility of behavioral pain management strategies.
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Comparative Study
Quantitative testing of pain perception in subjects with PTSD--implications for the mechanism of the coexistence between PTSD and chronic pain.
Post-traumatic stress disorder (PTSD) often co-occurs with chronic pain. Neither the underlying mechanism of this comorbidity nor the nature of pain perception among subjects with PTSD is well defined. This study is the first systematic and quantitative evaluation of pain perception and chronic pain in subjects with PTSD. ⋯ These results suggest that subjects with PTSD exhibit an intense and widespread chronic pain and a unique sensory profile of hyposensitivity to pain accompanied by hyper-reactivity to suprathreshold noxious stimuli. These features may be attributed to the manner with which PTSD subjects emotionally interpret and respond to painful stimuli. Alternatively, but not mutually exclusive, the findings may reflect altered sensory processing among these subjects.
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Comparative Study
Principle components analysis of pain thresholds to thermal, electrical, and mechanical stimuli suggests a predominant common source of variance.
We addressed the question whether pain thresholds to different stimuli measure independent aspects of pain or one common phenomenon. In the first case, different stimuli are required to completely characterize a subject's pain sensitivity. In the second case, different stimuli are redundant and can be used to calculate composite scores across pain modalities. ⋯ Only minor variance components, each explaining <14% of the total variance, indicated a distinction of pain stimuli. There, a pattern of similarities and dissimilarities emerged agreeing with known distinct mechanisms of nociceptive responses to different stimuli. We conclude that characterizing a person as being generally stoical or complaining to any painful stimulus appears to be justified at least at pain threshold level.