Pain
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Chronic pain is more prevalent in women than in men, with increasing differences between sexes in advanced age. This could be caused by differences in sex hormone levels. We therefore studied the relationship between sex hormones and the prevalence and incidence of chronic pain. ⋯ Lower sex hormone levels are associated with chronic musculoskeletal pain, independent from lifestyle and health-related factors, in community-dwelling elderly women. These results suggest that sex hormones play a role in chronic pain and should be taken into account when a patient presents with chronic pain. Therefore, sex hormones may be a potential treatment target for these patients.
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Observational Study
Trends in long-term opioid prescribing in primary care patients with musculoskeletal conditions: an observational database study.
Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). ⋯ This study has uniquely shown an increase in prescribing long-term opioids to 2009, gradually decreasing from 2011 in the United Kingdom. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required.
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Plasticity of inhibitory transmission in the spinal dorsal horn (SDH) is believed to be a key mechanism responsible for pain hypersensitivity in neuropathic pain syndromes. We evaluated this plasticity by recording responses to mechanical stimuli in silent neurons (nonspontaneously active [NSA]) and neurons showing ongoing activity (spontaneously active [SA]) in the SDH of control and nerve-injured mice (cuff model). The SA and NSA neurons represented 59% and 41% of recorded neurons, respectively, and were predominantly wide dynamic range (WDR) in naive mice. ⋯ Pharmacological blockade of spinal inhibition with a mixture of GABAA and glycine receptor antagonists significantly increased responses to innocuous mechanical stimuli in SA and NSA neurons from sham animals, but had no effect in sciatic nerve-injured animals, revealing a dramatic loss of spinal inhibitory tone in this situation. Moreover, in nerve-injured mice, local spinal administration of acetazolamide, a carbonic anhydrase inhibitor, restored responses to touch similar to those observed in naive or sham mice. These results suggest that a shift in the reversal potential for anions is an important component of the abnormal mechanical responses and of the loss of inhibitory tone recorded in a model of nerve injury-induced neuropathic pain.
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The impact of chronic musculoskeletal complaints (CMSC) and chronic widespread chronic musculoskeletal complaints (CWMSC) on mortality is controversial. The aim of this study was to investigate the relationship between these conditions and mortality. In this prospective population-based cohort study from Norway, baseline data from the second Nord-Trøndelag Health Survey (HUNT2, performed 1995-1997) were linked to the comprehensive National Cause of Death Registry in Norway with follow-up through the year 2011. ⋯ In the multivariate-adjusted analyses, there was no difference in all-cause mortality between individuals with or without CMSC (HR 1.01, confidence interval, 0.97-1.05) and CWMSC (HR 1.01, confidence interval, 0.96-1.05). Similarly, there was no association between CMSC or CWMSC and cardiovascular mortality, mortality from cancer, or mortality from all other causes. Therefore, from this study, we conclude that there is no evidence for a higher mortality rate among individuals with CMSC or CWMSC.