Pain
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Subcutaneous (s.c.) injection of formalin induces a rapid and prolonged hyperalgesia across widespread areas of the body. This hyperalgesic state involves a brain-to-spinal cord pathway, likely arising from the nucleus raphe magnus. The present study examined whether subsequent activation of spinal cord glia may be critical for the hyperalgesic state to be observed in rats. ⋯ Disruption appeared to be selective, as blockade of only select glial products was effective. That is, up to 120 microg of a functional antagonist of tumor necrosis factor-alpha (TNF binding protein) and 5 microl of an antibody against complement-3 produced no statistically reliable reduction in formalin-induced hyperalgesia. Taken together, the present series of experiments suggest an important role for spinal glial cells in the cascade of events that are initiated by descending signals following s.c. administration of formalin.
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Despite its importance in clinical practice, little research has examined memory for pain in children. This prospective study tried to justify the use of children's pain recall in clinical practice. The purpose of this study was to (a) investigate the accuracy of children's recall of their worst and average pain intensity when controlling for the effects of repeated pain measurement and (b) examine the influence of children's anxiety, age, general memory ability and pain coping strategies on this accuracy. ⋯ The accuracy of children's recalled pain intensities was high and showed little decrement over 1 week. Older children had more accurate recall of their worst pain intensity. Anxiety, general memory ability and pain coping strategies were not related to accuracy of recalled pain intensities.
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Randomized Controlled Trial Clinical Trial
Enhancing sensitivity to facial expression of pain.
Clinicians have long appreciated the information communicated by a patient's facial expression. Advances in the measurement of facial movements, using the Facial Action Coding System (FACS) have allowed for identification of a universal expression of pain, which is primarily encoded in four facial movements. While the FACS provides a rigorous assessment of facial expression, the time required to learn the system and to analyze the facial expression by use of slow motion video recording, makes its use impractical in the clinical setting. ⋯ Analyses indicated that the trained group was significantly more sensitive to subtle facial movements associated with low levels of pain. Relative to the patients' ratings, there was a tendency for raters to underestimate pain particularly when these were at a high level. The findings lend hope to the feasibility of developing a tool which would be clinically useful though this may be more difficult for observers judging more complex facial expressions associated with high levels of pain.
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Patients with reflex sympathetic dystrophy (RSD) often present with pain and disability that cannot be explained on the basis of objective physical findings. This has led some to speculate that RSD may be caused or mediated by non-organic factors. Unfortunately, there have been few studies using standardized measures of mood and illness behavior that have compared patients with RSD to patients with other chronic pain disorders. ⋯ In contrast to previous research using less stringent diagnostic criteria, there was no evidence of higher pain scores or lower levels of psychological distress among patients with RSD. In addition, a validated survey of childhood trauma found that sexual abuse, physical abuse, emotional abuse, and cumulative trauma were evenly distributed among all three diagnostic groups. The burden of proof would appear to be upon those who advocate the non-organic hypothesis to provide credible evidence of psychological involvement in the etiology of RSD.
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Randomized Controlled Trial Clinical Trial
The Chronic Pain Grade questionnaire: validation and reliability in postal research.
The Chronic Pain Grade questionnaire has been proposed as an interview-administered, multi-dimensional measure of chronic pain severity in selected populations with chronic pain in the United States of America. It has not previously been tested in the United Kingdom, in self-completion form or in an unselected general population. We undertook a postal survey to assess its reliability, validity and acceptability in these circumstances, using a general practice population in Scotland, with a practice population of 11202 patients. ⋯ Construct validity was confirmed by testing scores against duration of pain and treatment sought for pain. We concluded that the Chronic Pain Grade questionnaire is a useful, reliable and valid measure of severity of chronic pain. It translates well into UK English and is acceptable in general population postal research.