Pain
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This study tested the hypothesis that fibromyalgia patients display hypervigilance for somatosensory signals. Hypervigilance was operationalized as the detection of weak electrocutaneous stimuli. Innocuous electrical stimuli gradually increasing in strength were administered to one of four different body locations. ⋯ No evidence for hypervigilance for innocuous signals was found: patients did not show superior detection of electrical stimuli either under single or dual task conditions. Also, no differences were found between patients and controls on the body vigilance questionnaire. Detection of electrical stimuli was, however, predicted by pain-related fear and pain vigilance.
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Pain is the major complaint of the estimated one million U. S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. ⋯ Six or more acupuncture treatments were significantly associated with positive outcomes (P=0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.
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Randomized Controlled Trial Clinical Trial
Assessment of the effect of EMLA during venipuncture in the newborn by analysis of heart rate variability.
The objective of this study was to investigate the effect of EMLA on the pain response when venipuncture was performed in 60 3-day-old healthy newborns. EMLA/placebo was applied to the back of the baby's hand, following a randomized, double-blind procedure. ECG and crying were recorded during the test. ⋯ The occurrence of crying during venipuncture did not differ significantly between the EMLA and the placebo groups. The placebo-treated group showed a statistically significant higher HR, and a decrease in variance (total power) and power in the low-frequency band (0.02-0.15 Hz) when compared with the EMLA group. We conclude that EMLA decreases the stress response during venipuncture in newborn infants.
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We examined the role of B1 and B2 bradykinin receptors in promoting neuropathic hypersensitivity following peripheral nerve injury. Forty eight-hours following chronic constriction injury to a rat sciatic nerve there was an increased expression of B2 receptor mRNA in the lumbar dorsal root ganglia ipsilateral to the site of nerve injury. ⋯ While HOE-140, a potent B2 receptor antagonist was analgesic at both time points tested, the B1 receptor antagonist des-Arg(9), [Leu(8)]-BK had an analgesic effect only at 14 days. The results support the concept that peripheral nerve injury is associated with local inflammation and that bradykinin, acting on both of its receptors promotes pain hypersensitivity.
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Clinical Trial
Towards an objective quantitative assessment of daily functioning in migraine: a feasibility study.
Migraine is a chronic disabling disorder, with migraine episodes significantly reducing quality of life and leading to impaired functioning (physically, socially, emotionally) both at home and at work. We explored whether ambulatory accelerometry can be used as an objective method to quantify the behavioral aspects of migraine-related disability. Four body mounted uni-axial piezo-resistive accelerometers were used to quantify the time spent in different body postures (lying, sitting, standing), physical activities (walking, cycling) and a general index of body motility during eight migraine attacks and subsequent recovery periods of six patients in their habitual environment. ⋯ Overall, the procedures functioned well, indicating that ambulatory accelerometry measurements before, during and after a migraine attack are feasible to perform. Furthermore, our quantitative data revealed that migraine always influenced behavior by reducing overall body motility and that, dependent upon the severity of the attack, the effectiveness of acute treatment and the time of day, the time spent in various body positions, dynamic activities, and the number of postural transitions were affected. This feasibility study showed that ambulatory accelerometry can provide the objective behavioral effect parameters for the evaluation of migraine and its treatment on daily functioning in the habitual environment of migraine patients.