The Clinical journal of pain
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We investigated the influence of paired-pulse transcranial magnetic stimulation (ppTMS) of the motor cortex (M1) on perception of noxious electrical stimuli. The nociceptive flexion reflex response was assessed to determine spinal effects. ⋯ The facilitatory component of ppTMS led to increased pain perception when applied during the cortical process of Adelta fiber-mediated input, whereas the subsequent inhibitory component may lead to the opposite effect on the subsequent noxious stimulation.
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Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD). ⋯ Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.
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Intrathecal granuloma associated to the tip of catheters implanted in patients receiving long-term spinal infusion to alleviate chronic pain is a rare but potentially catastrophic complication. Its formation seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency. ⋯ This case report highlights the incomplete knowledge about the mechanism of granuloma formation and discuss the alternatives in the management of catheter-tip granulomas. This is the first case report of a patient in whom an intrathecal granuloma reoccurred twice after initial surgical removal. We also present and discuss a potential management strategy to avoid further surgery and resume intrathecal therapy early.
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Long-term social assistance recipients (LTRs) struggle with numerous health issues. However, no data are available on the prevalence of chronic pain in these individuals. The purpose of this study was to determine the prevalence and characteristics of chronic pain (ie, pain >3 mo) among LTRs in Norway compared to the general population (GP). ⋯ The fact that 44.0% of the LTRs reported chronic pain, compared to only 23.9% of the GP suggests that chronic pain is a significant problem for LTRs in Norway. Additional research is warranted to determine the exact etiologies for and the impact of chronic pain on LTRs.