Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal, but not intravenous adenosine reduces allodynia in patients with neuropathic pain.
Intrathecal adenosine reduces allodynia from intradermal capsaicin in human volunteers, and reduces hypersensitivity to mechanical stimuli in animals with nerve injury. Although both intrathecal and intravenous adenosine have been reported to relieve pain in patients with neuropathic pain, there are no controlled trials of this therapy. In order to determine the effect of adenosine, seven patients with chronic neuropathic pain and stable areas of mechanical hyperalgesia and allodynia were recruited. ⋯ Intrathecal, but not intravenous adenosine, caused backache in five of seven patients, lasting 6 h. These results indicate that intrathecal adenosine reduces allodynia and pain from stimulation in the area of allodynia, whereas the same dose of adenosine intravenously was ineffective. Given the modest effect and common side effects, the role for intrathecal adenosine as a sole agent for the treatment of neuropathic pain may be limited.
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Randomized Controlled Trial Comparative Study Clinical Trial
The contributions of suggestion, desire, and expectation to placebo effects in irritable bowel syndrome patients. An empirical investigation.
In order to investigate external factors that may influence the magnitude of placebo analgesia as well as psychological factors that mediate placebo analgesia, 13 irritable bowl syndrome (IBS) patients rated evoked rectal distension and cutaneous heat pain under the conditions of natural history (NH), rectal placebo (RP), rectal nocebo (RN), rectal lidocaine (RL) and oral lidocaine (OL). Patients were given verbal suggestions for pain relief and rated expected pain levels and desire for pain relief for both evoked visceral and cutaneous pain, respectively. Large reductions in pain intensity and pain unpleasantness ratings were found in the RP, RL and OL condition as compared to the natural history condition, whereas no significant difference in pain reduction between the three treatment conditions was found. ⋯ Since IBS patients rate these stimuli as much higher than do normal control subjects and since placebo effects were very large, they probably reflect anti-hyperalgesic mechanisms to a major extent. Expected pain levels and desire for pain relief accounted for large amounts of the variance in visceral pain intensity in the RP, RL, and OL condition (up to 81%), and for lower amounts of the variance in cutaneous pain intensity. Hence, the combination of expected pain levels and desire for pain relief may offer an alternative means of assessing the contribution of placebo factors during analgesia.
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Randomized Controlled Trial Clinical Trial
Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy.
Painful neuropathy is one of the most common long-term complications of diabetes mellitus and often proves difficult to relieve. ⋯ CR oxycodone is effective and safe for the management of painful diabetic neuropathy and improves QOL.
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Randomized Controlled Trial Clinical Trial
Effects of low-power laser exposure on masseter muscle pain and microcirculation.
One possible cause of the reported positive treatment effect by low-power laser exposure in muscle pain conditions could be that it increases the local microcirculation. The aim of this study was therefore to investigate the immediate effects on masseter muscle blood flow by low-power laser exposure in patients with chronic orofacial pain of muscular origin in comparison to healthy individuals. Twelve patients with myofascial pain of orofacial muscles and 12 age and gender matched healthy individuals participated in the study. ⋯ The blood flow did not change significantly in the patients, but increased after active laser exposure and decreased after placebo exposure in the healthy individuals. The difference between active laser and placebo was significant. In conclusion, the results of this study do not support an effect of low-power laser exposure on masseter muscle microcirculation in patients with chronic orofacial pain of muscular origin.
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Randomized Controlled Trial Clinical Trial
Potential utility of the peripheral analgesic properties of morphine in stomatitis-related pain: a pilot study.
To determine the potential clinical utility of peripheral opioid action using a clinical model of cancer treatment-induced inflammation and pain that allowed for topical application of morphine in the damaged tissue (oral mucosa). This pilot study followed a two blocks design. Ten patients with painful oral mucositis were enrolled in the first block (dose-response relationship finding) and randomized in two groups to receive oral rinses with 15 ml of either 1 per thousand or 2 per thousand morphine solution. ⋯ During our experiment no systemically active detectable concentrations of morphine were found (GC-MS analysis). The most important side effect attributable to morphine mouthwashes was burning/itching sensation (very mild to mild intensity). Patients with painful chemoradiotherapy-induced stomatitis could be alleviated using topical morphine mouthwashes.