Pain
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Multicenter Study
A cross-sectional study investigating frequency and features of definitely diagnosed diabetic painful polyneuropathy.
This cross-sectional multicentre study aimed at investigating frequency and features of painful diabetic polyneuropathy. We consecutively enrolled 816 patients attending hospital diabetic outpatient clinics. We first definitely diagnosed diabetic polyneuropathy and pure small-fibre polyneuropathy using clinical examination, nerve conduction study, and skin biopsy or quantitative sensory testing. ⋯ Of the 816 patients, 36% had a diabetic polyneuropathy associated with male sex, age, and diabetes severity; 2.5% of patients had a pure small-fibre polyneuropathy, unrelated to demographic variables and diabetes severity. Of the 816 patients, 115 (13%) suffered from a painful polyneuropathy, with female sex as the only risk factor for suffering from painful polyneuropathy. In this large study, providing a definite diagnosis of diabetic polyneuropathy and pure small-fibre polyneuropathy, we show the frequency of painful polyneuropathy and demonstrate that this difficult-to-treat complication is more common in women than in men.
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Review Meta Analysis
Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis.
Chronic pain remains a prevalent and disabling problem for people living with HIV in the current antiretroviral treatment era. Psychosocial treatments may have promise for managing the impact of this pain. However, research is needed to identify psychosocial processes to target through such treatments. ⋯ These findings can inform future research and psychosocial treatment development in this area. Greater theoretical and empirical focus is needed to examine the role of protective factors and social processes on pain outcomes in this context. The review protocol was registered with PROSPERO (CRD42016036329).
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Randomized Controlled Trial
Comparison of masseter muscle referred sensations after mechanical and glutamate stimulation: a randomized, double-blind, controlled, cross-over study.
Referred sensations (RS) are commonly found in various musculoskeletal pain conditions. Experimental studies have shown that RS can be elicited through glutamate injection and mechanical stimulation. Despite this, differences and similarities between these modalities in RS outcomes remain unclear. ⋯ Hence, RS does not seem to be modality-dependent, and only the painfulness of the stimulus caused an increase in frequency of RS. Finally, RS location for each participant was similar in both sessions possibly indicating a preferred location of referral. These findings may have implications for our understanding of RS in craniofacial pain conditions.
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Patellofemoral pain (PFP) is a common and recurrent knee condition in young females, characterized by pressure hyperalgesia and reduced pain inhibitory control. This study investigated antinociceptive and pronociceptive profiles in young females with long-standing (>5 years) PFP (current-PFP), those who recovered from adolescent PFP (recovered-PFP), and pain-free controls. This preregistered, assessor-blinded, cross-sectional study included 87 females younger than 25 years: 36 current-PFP, 22 recovered-PFP, and 29 pain-free controls. ⋯ Compared with controls, the recovered-PFP also had reduced pressure pain thresholds at the knee, which were higher than the current-PFP (mean difference: 110-225 kPa; P < 0.05). In conclusion, both current-PFP and recovered-PFP displayed altered pain mechanisms compared to controls with no history of knee pain, despite resolution of symptoms in the recovered-PFP group. The implications of these findings in the recurrent nature of PFP requires further studies.
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Conditioned pain modulation (CPM) and temporal summation of pain (TSP) are 2 experimental paradigms capturing endogenous pain modulation, which have repeatedly demonstrated clinical relevance. Conditioned pain modulation describes the inhibition of the pain response to a test stimulus (Ts) when a second noxious stimulus, the conditioning stimulus (CS), is concurrently applied. Temporal summation of pain describes the enhanced pain response to a series of stimuli compared with single stimuli. ⋯ Interestingly, this interaction was modality-dependent: TSP for heat Ts was completely abolished by CPM, whereas this was not the case for pressure Ts. Our findings suggest different forms of central sensitization induced by TSP using either heat or pressure stimuli, which differ in their susceptibility to CPM. Clinical implications and directions for future research are discussed.