Pain
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Review Meta Analysis
Adherence to CONSORT harms-reporting recommendations in publications of recent analgesic clinical trials: an ACTTION systematic review.
Although improving, 'harms reporting' in analgesic clinical trials is generally poor. On average the 101 studied analgesic trials met only 60% of harms reporting recommendations.
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Multicenter Study
Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study.
The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. ⋯ The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP.
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Randomized Controlled Trial
The hidden effects of blinded, placebo-controlled randomized trials: an experimental investigation.
The knowledge of having only a 50% chance of receiving an active drug can result in reduced efficacy in blinded randomized clinical trials (RCTs) compared to clinical practice (reduced external validity). Moreover, minor onset sensations associated with the drug (but not with an inert placebo) can further challenge the attribution of group differences to drug-specific efficacy (internal validity). We used a randomized experimental study with inert placebos (inert substance) vs active placebos (inducing minor sensations), and different instructions about group allocation (probability of receiving drug: 0%, 50%, 100%). ⋯ Moreover, minor drug onset sensations can challenge internal validity. Effect sizes for these mechanisms are medium, and can substantially compete with specific drug effects. For clinical trials, new study designs are needed that better control for these effects.
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Facial expressions during infancy are important to examine, as infants do not have the language skills to describe their experiences. This is particularly vital in the context of pain, where infants depend solely on their caregivers for relief. The objective of the current study was to investigate the development of negative infant facial expressions in response to immunization pain over the first year of life. ⋯ Instead, infants displayed a variety of generalized pain and distress faces aimed at gaining caregiver aid. The development of nonverbal communication in infants, particularly facial expressions, remains an important area of inquiry. Further study into accurately measuring infant negative emotions, pain, and distress is warranted.
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Peripheral nerve injury provokes heightened excitability of primary sensory afferents including nociceptors, and elicits ectopic activity in lesioned and neighboring intact nerve fibers. The major transmitter released by sensory afferents in the superficial dorsal horn of the spinal cord is glutamate. Glutamate is critically involved in nociceptive signaling and the development of neuropathic pain. ⋯ Treatment with the β-lactam antibiotic ceftriaxone increased the expression of glutamate transporter 1 (Glt1) in the dorsal horn after SNI, raised transmitter uptake, and lowered extracellular glutamate. Improving glutamate clearance prevented the facilitation of transmitter release by mGluR5 and attenuated neuropathic pain-like behavior. Balancing glutamate release and uptake after nerve injury should be an important target in the management of chronic neuropathic pain.