Pain
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Randomized Controlled Trial Clinical Trial
The effects of disclosure on pain during dental hygiene treatment: the moderating role of catastrophizing.
Catastrophizers and non-catastrophizers were asked to disclose about their dental worries prior to undergoing dental hygiene treatment. It was hypothesized that the effects of emotional disclosure would vary as a function of the level of catastrophizing; where catastrophizers would be more likely than non-catastrophizers to show reductions in pain and emotional distress. The study also examined whether emotional disclosure influenced subsequent levels of catastrophizing and dental anxiety. ⋯ The interaction between condition and level of catastrophizing remained significant even when controlling for emotional distress and the emotional content of the thought records. While catastrophizers benefited from disclosure in regard to their immediate physical and emotional experience, their levels of catastrophizing and dental anxiety remained essentially unchanged. Theoretical and clinical implications of the findings are discussed.
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Anatomical and physiological studies in animals, as well as functional imaging studies in humans have shown that multiple cortical areas are activated by painful stimuli. The view that pain is perceived only as a result of thalamic processing has, therefore, been abandoned, and has been replaced by the question of what functions can be assigned to individual cortical areas. The following cortical areas have been shown to be involved in the processing of painful stimuli: primary somatosensory cortex, secondary somatosensory cortex and its vicinity in the parietal operculum, insula, anterior cingulate cortex and prefrontal cortex. ⋯ The affective-motivational component is close to what may be considered 'suffering from pain'; it is clearly related to aspects of emotion, arousal and the programming of behaviour. This dichotomy, however, has turned out to be too simple to explain the functional significance of nociceptive cortical networks. Recent progress in imaging technology has, therefore, provided a new impetus to study the multiple dimensions of pain.
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The L5 spinal nerve ligation model of neuropathic pain in rats has been proposed as a model for sympathetically maintained pain (SMP) based on the effects of surgical or chemical sympathectomy on nerve injury induced behavior. In an attempt to confirm that the lesion produces an animal model of SMP, surgical sympathectomies were independently conducted in two different laboratories (Johns Hopkins and University Kiel) using male Sprague-Dawley (n = 30) or Wistar rats (n = 14). The L5 spinal nerve was ligated or cut and ligated. ⋯ Experiments in Wistar and Sprague-Dawley rats yielded the same results. Potential reasons for the discrepancies between the present study and earlier reports are discussed. These results indicate that an L5 spinal nerve injury rat model is not a reliable model for SMP.
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Randomized Controlled Trial Clinical Trial
Spatial and temporal summation of sensory and affective dimensions of deep somatic pain.
There is considerable evidence in support of differential information processing of the sensory-discriminative and motivational-affective meanings of pain. The purpose of this work was to examine whether temporal (acute, tonic, persistent) and spatial (local, regional, widespread) aspects of deep somatic pain influence the sensory and affective dimensions of pain. Acute pain consisted of a short bout of pain, lasting about 100 s. ⋯ Affective scores showed the most significant increases from acute to tonic pain, particularly with greater spatial involvement. The significant increases in sensory scores observed when contrasting persistent facial pain alone and in combination with widespread musculoskeletal pain was attributed to the broader body experience. Because the perceptual correlates of tonic and matched persistent (chronic) pain states were similar, we concluded that it does not require months for the development of the sensory and affective meaning of persistent pain as assumed.
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Case Reports
A case of reflex sympathetic dystrophy (complex regional pain syndrome, type I) resolved by cerebral contusion.
We present a case of refractory reflex sympathetic dystrophy (RSD) (complex regional pain syndrome, type I) whose symptoms (ongoing pain, allodynia, hyperhydrosis and temperature abnormalities) were resolved after the patient suffered a traumatic cerebral contusion in the left temporal lobe, which caused no neurological deficit. This case suggests that symptoms of some RSD patients may largely sustained by a complex network involving the brain.