Pain
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Multicenter Study Comparative Study
Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain.
Both cross-sectional studies of chronic pain and sleep deprivation experiments suggest a bi-directional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate (1) whether in-hospital insomnia independently predicts long-term pain after burn injury and (2) whether in-hospital pain predicts future insomnia symptoms. ⋯ In-hospital insomnia and pre-burn mental health symptoms were also highly significant predictors of insomnia. This study provides support for a long-term, prospective and reciprocal interaction between insomnia and pain. Future work should ascertain whether treatment of insomnia and pain during acute injury can prevent or minimize chronic pain.
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Comparative Study
Brain dynamics for perception of tactile allodynia (touch-induced pain) in postherpetic neuralgia.
Postherpetic neuralgia (PHN) is a debilitating chronic pain condition often accompanied by a sensation of pain when the affected region is touched (tactile allodynia). Here we identify brain regions involved in stimulus-induced touch-evoked pain (dynamical mechanical allodynia, DMA), compare brain activity between DMA and spontaneous pain (described earlier for the same patients in [Geha PY, Baliki MN, Chialvo DR, Harden RN, Paice JA, Apkarian AV. Brain activity for spontaneous pain of postherpetic neuralgia and its modulation by lidocaine patch therapy. ⋯ However, mainly responses in the bilateral putamen and left medial temporal gyrus were related to the magnitude of allodynia. Both DMA and spontaneous pain perceptions were best represented within the same sub-cortical structures but with minimal overlap, implying that PHN pain modulates behavioral learning and hedonics. These results have important clinical implications regarding adequate therapy.
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Comparative Study
Onset, prognosis and risk factors for widespread pain in schoolchildren: a prospective 4-year follow-up study.
Little is known about the epidemiology of widespread pain (WSP) in children and adolescents. This study aims to estimate the new-onset and prognosis of WSP in schoolchildren and investigate factors predicting its development. A prospective study was conducted among 1756 schoolchildren (age 10-12 years) in Southern Finland. ⋯ Of the children who were free of WSP at baseline, 18% reported new-onset WSP at 1-year follow-up and 3% reported these symptoms at both follow-up times. The independent baseline risk factors of WSP were older age (OR 1.3 95% CI 1.0-1.8), female gender (OR 1.4, 1.1-1.9), depressiveness (OR 1.5, 1.1-2.2) and regional back pain symptoms (Neck pain: OR 1.7, 1.1-2.4; Upper back pain: OR 2.1, 1.1-4.1; Lower back pain: OR 3.0, 1.6-5.7). Both psychological factors and somatic pain symptoms predict future development of WSP in adolescents.
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Comparative Study
Estimation of pain intensity in emergency medicine: a validation study.
This study was designed to estimate the validity of an 11-point verbal numerical rating scale (VNRS) and a 100 Unit (U) plasticized visual analogue scale (VASp) using a 100mm paper visual analogue scale (VAS) as a gold standard, to recommend the best method of reporting the intensity of acute pain in an emergency department (ED). A convenience sample of 1176 patients with acute pain were recruited in the ED of a teaching hospital. Patients >18 years and able to use the different scales were included. ⋯ In conclusion, the VASp has a small bias, acceptable limits of agreement and an excellent intra-class correlation. It is probably a valid tool to estimate acute pain in the ED. However, the VNRS is less valid in that context because of its wide limits of agreement and variable bias (mainly in lower scores).