Pain
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Randomized Controlled Trial Comparative Study
Comparing the responsiveness of a brief, multidimensional risk screening tool for back pain to its unidimensional reference standards: the whole is greater than the sum of its parts.
Back pain is a leading cause of disability. Previous research suggests that modifiable risk factors influence recovery from back pain, and practice guidelines recommend integrating such factors within primary care management. Toward this goal, a brief, multidimensional questionnaire, the STarT Back Tool, was designed to facilitate risk assessment by reducing the need to administer multiple, unidimensional questionnaires. ⋯ Reductions in STarT Back scores predicted meaningful improvement on all dependent variables. These findings suggest that the STarT Back Tool, instead of multiple risk questionnaires, can be used to measure recovery from back pain. Implications for future research and clinical practice are discussed.
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Comparative Study
Differential effects of left/right neuropathy on rats' anxiety and cognitive behavior.
Chronic pain is frequently accompanied by a deterioration of emotional behavior and cognitive function. A small number of studies in humans concluded that pain-associated negative affect is more pronounced when pain is localized in the left side of the body. It has been suggested that such side bias results from cortical function lateralization. ⋯ On the contrary, SNI-R animals presented cognitive deficits in all tasks except in the reference memory, but displayed a normal anxiety-like profile. Our results show that left- and right-sided neuropathic pain differentially affects emotional behavior, which is in accordance with previous observations in human subjects, both in experimentally induced pain and in chronic pain conditions. Additionally, our results demonstrate that the cognitive function deterioration associated with unilateral neuropathic chronic pain conditions is also differentially affected.
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Randomized Controlled Trial
Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia.
The extra-articular sacroiliac joint (SIJ) structure is a potential source for low back and pelvic pain. This study hypothesised that experimental pain induced in a superficial pelvic ligament causes (1) hyperalgesia to pressure, (2) distinct pain referral, and (3) an increased frequency of positive pain provocation tests of the SIJ complex. Thirty healthy subjects (15 females) participated in this study designed as a randomised crossover trial. ⋯ PPTs at the injection site and lateral to S2 were significantly reduced after hypertonic saline compared with baseline and isotonic saline (P<0.002). Significantly more subjects had positive pain provocation tests after hypertonic (67% of subjects) compared with isotonic saline (20%; P<0.001). These data demonstrate that the extra-articular SIJ structure accommodates nociceptors that are capable of inducing pain referral and regional hyperalgesia sensitive to manual pain provocation tests similar to what previously have been found in pelvic girdle pain patients.
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Emotion can modulate pain and spinal nociception, and correlational data suggest that cognitive-emotional processes can facilitate wind-up-like phenomena (ie, temporal summation of pain). However, there have been no experimental studies that manipulated emotion to determine whether within-subject changes in emotion influence temporal summation of pain (TS-pain) and the nociceptive flexion reflex (TS-NFR, a physiological measure of spinal nociception). The present study presented a series of emotionally charged pictures (mutilation, neutral, erotic) during which electric stimuli at 2 Hz were delivered to the sural nerve to evoke TS-pain and TS-NFR. ⋯ Although pain and NFR both summated in response to the 2-Hz stimulation series, the magnitude of pain summation (TS-pain) and NFR summation (TS-NFR) was not modulated by picture-viewing. These results imply that, at least in healthy humans, within-subject changes in emotions do not promote central sensitization via amplification of temporal summation. However, future studies are needed to determine whether these findings generalize to clinical populations (eg, chronic pain).
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The role of psychosocial and physical factors in the development of shoulder pain has now been clearly demonstrated. However, only a few studies have analyzed these associations over time. The main goal of this study was to evaluate the predictive value of work-related psychological and mechanical factors on chronic shoulder pain. ⋯ Awkward posture (OR=1.43 [1.25 to 1.63]), psychological demand (OR=1.24 [1.09 to 1.40]), and decision latitude (OR=1.21 [1.04 to 1.41] work-related factors in 1990 were associated with the development of chronic shoulder pain between 1990 and 1995. These results suggest that awkward posture, forceful effort, job demand, and decision control are predictors of chronic shoulder pain at work. Interventions designed to reduce the incidence of chronic shoulder pain must include both mechanical and psychological factors.