The Clinical journal of pain
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Review
Headache continuum: concept and supporting evidence from recent study of chronic daily headache.
A headache continuum on the basis of the dynamic nature of headache is presented, with episodic headaches developing into daily headaches and vice versa. The concept is supported by evidence from recent study of (gradual-onset) chronic daily headache.
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Do physical findings that are used to indicate location and extent of tissue damage and a measure of the severity of initial pain predict subsequent reports of pain and of disability? ⋯ The studies provide moderate evidence (level 2) that reports of the intensity of pain in acute musculoskeletal injury predict subsequent reports of pain. There is limited evidence (level 3) that the location and extent of injury predict reports of pain and poor functional activity outcomes. There is moderate evidence (level 2) that physical symptoms and signs cannot be considered individual predictors of chronic pain disability as measured by participation outcomes. Instead, in the transition from subacute to chronic pain disability, functional disability and psychological distress play a more important role than pain intensity.
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The mechanisms underlying chronic pain after whiplash injury are usually unclear. Injuries may cause sensitization of spinal cord neurons in animals (central hypersensitivity), which results in increased responsiveness to peripheral stimuli. In humans, the responsiveness of the central nervous system to peripheral stimulation may be explored by applying sensory tests to healthy tissues. The hypotheses of this study were: (1) chronic whiplash pain is associated with central hypersensitivity; (2) central hypersensitivity is maintained by nociception arising from the painful or tender muscles in the neck. ⋯ The authors found a hypersensitivity to peripheral stimulation in whiplash patients. Hypersensitivity was observed after cutaneous and muscular stimulation, at both neck and lower limb. Because hypersensitivity was observed in healthy tissues, it resulted from alterations in the central processing of sensory stimuli (central hypersensitivity). Central hypersensitivity was not dependent on a nociceptive input arising from the painful and tender muscles.
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The purpose of this study was to assess relations and concordance between behavioral and physiologic reactivity to pain in preterm neonates at 32 weeks postconceptional age as a function of gestational age at birth. ⋯ The study findings confirm the value of measuring domains independently, especially in neonates born at a very young gestational age.