Pain
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Randomized Controlled Trial
Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release morphine for treatment of chronic nonradicular low-back pain.
Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief. Analgesic tolerance, and more recently opioid-induced hyperalgesia, have been invoked to explain such declines in opioid effectiveness over time. Because both phenomena result in inadequate analgesia, they are difficult to distinguish in a clinical setting. ⋯ The differences in visual analogue scale pain levels (P = .003) and self-reported disability (P = .03) between both treatment groups were statistically significant. After 1 month of oral morphine therapy, patients with chronic low-back pain developed tolerance but not opioid-induced hyperalgesia. Improvements in pain and functional ability were observed.
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Nerve growth factor (NGF) induces local hyperalgesia for a few days after intramuscular injection, but longer-lasting muscle pain upon systemic administration. As the muscle fascia is densely innervated by free nerve endings, we hypothesized a lasting sensitization of fascia nociceptors by NGF. We administered 1 μg NGF (dissolved in 100 μL saline) ultrasound-guided to the fascia of the Musculus erector spinae muscle at the lumbar level of 14 male volunteers and assessed hypersensitivity after 6 hours, and 1, 3, 7, 14, and 21 days. ⋯ Pain upon injected protons was significantly elevated (P<0.04) for 2 weeks. NGF induced a sensitization of the muscle fascia to mechanical and chemical stimuli lasting for up to 2 weeks. As nociceptors in the fascia appear to be particularly prone to sensitization, they may contribute to acute or chronic muscle pain.
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Comparative Study
A comparison of four self-report scales of pain intensity in 6- to 8-year-old children.
There are many different instruments for assessing pain intensity in children, but the agreement between them is unclear. The aims of this study were to determine the 1-dimensionality of 4 widely used self-report scales for measuring the intensity of pediatric pain, and the agreement between them. A sample of 126 school children between 6 and 8 years of age (mean = 6.87 years; SD = 0.68 year) were interviewed individually and asked to identify the most frequent pain that they had experienced in the 3 months before the interview, and to report their maximum pain intensity using all 4 scales (Visual Analogue Scale, Coloured Analogue Scale, Faces Pain Scale-Revised and Numerical Rating Scale-11). ⋯ Our data show the 1-dimensionality of the scales. The 95% limits of agreement between each pair of measures were as follows: VAS/CAS (-23.8, 23.4); VAS/NRS-11 (-41, 31.1); VAS/FPS-R (-38.3, 33.6); CAS/NRS-11 (-35.6, 26.2); CAS/FPS-R (-36.4, 32.1), and FPS-R/NRS-11 (-36.3, 31). Our data suggest that these 4 instruments measure 1 common factor but that they are not concordant.
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Multicenter Study
Parents who catastrophize about their child's pain prioritize attempts to control pain.
How parents respond to their child in pain is critically important to how both parent and child attempt to cope with pain. We examined the influence of parental catastrophic thinking about child pain on their prioritization for pain control. Using a vignette methodology, parents reported, in response to different pain scenarios, on their imagined motivation for 2 competing goals: to control their child's pain (ie, pain control) or to encourage their child's participation in daily activities (ie, activity engagement). ⋯ Furthermore, independently of parental catastrophic thoughts, heightened priority for pain control was observed in highly intense and chronic pain situations. Moreover, in highly intense pain, priority for pain control was stronger for mothers compared with fathers. Theoretical and clinical implications and directions for future research are discussed.
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Numerous behavioral pain measures have been validated for young children, but none is appropriate to assess pain in emergency departments (EDs), where caregivers need a simple, easily completed scale. Our objective was to elaborate and validate a tool, relevant in any painful situation, with agitation or prostration, and for any age under 7 years. Five items (scored 0 to 3) were developed by pediatric pain and emergency caregivers. ⋯ Interrater reliability was excellent between nurses and researcher (weighted kappa 0.7 to 0.9), and in a group of 6 nurses (simultaneous assessment of 122 videos). The treatment threshold was determined at 4 of 15. EVENDOL has excellent validity and can be used for all children under age 7 in EDs, for any age and any pain, acute as well as more prolonged.