The Clinical journal of pain
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The cortisol awakening response (CAR) is related to psychosocial factors and health in potentially significant ways, suggesting that it may be a distinctive marker of hypothalamic-pituitary-adrenal axis function and dysfunction. This study sought to expand upon previous work that examined the association between CAR and ratings of laboratory-evoked acute pain stimulation. In addition to evoked pain ratings, this study also tested whether CAR was prospectively related with salivary cortisol and soluble tumor necrosis factor-α receptor II responses to acute pain stimulation. ⋯ CAR may be a marker for stress sensitivity and/or the anticipation of impending stress, which could explain why the increased CAR cohort reported greater acute pain ratings.
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Venous blood sampling is one of the most common diagnostic medical procedures performed in clinical practice. It has been shown that negatively loaded words may result in negative affective reactions and, consequently, in an increased perception of pain. We aimed to evaluate whether common warnings before venous blood sampling might induce unnecessary pain. ⋯ Words associated with pain increase the perception of pain during venous blood sampling. Omitting these words may be a simple and essential method by which to avoid unnecessary pain.
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Patients with medication overuse headache (MOH) experience decreased quality of life (QoL) and increased psychiatric comorbidity. We performed an observational study in patients with MOH to assess whether QoL (primary outcome parameter), depression, and anxiety (secondary outcome parameters) improve after inpatient withdrawal therapy. ⋯ QoL is impaired in patients with MOH, and many patients are depressed and anxious. Inpatient withdrawal therapy lead to a statistically significant improvement of QoL, depression, and anxiety. Poor baseline mental QoL as well as depression and anxiety are associated with poor outcome in terms of headache frequency.
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Opioid-induced constipation persists as a challenge in the management of chronic pain treated with opioid therapy. Multiple opioid antagonists have been applied in attempt to combat the gastrointestinal side effects of opioid analgesia, however their lipid-soluble nature allows passage into the central nervous system and consequent antagonism of centrally mediated analgesia. In contrast, methylnaltrexone offers the advantage of peripheral receptor-specific opioid antagonism due to chemical alterations conferring greater polarity and less lipid solubility. We present use of enteral methylnatrexone to treat severe opioid-induced constipation in a young boy who had failed treatment with the non-specific opioid antagonist, naloxone. This case reports describes the safe transition from enteral naloxone to enteral methylnaltrexone and discusses the potential risk of relative opioid toxicity during the transition. ⋯ Our case report demonstrates safe transition from enteral naloxone to enteral methylnaltrexone in a pediatric patient, avoiding the serious consequences of relative opioid toxicity. This patient experienced significant improvement of opioid-induced constipation and reduction in opioid requirements and it is possible that other patients would benefit as well. The role of enteral methylnaltrexone deserves further investigation.
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The relationship between chronic pain and sleep disturbances is not yet fully understood, despite much evidence linking them. Polysomnography is the gold standard for assessing sleep architecture, and in this naturalistic study, we wanted to compare both macrostructure and microstructure sleep variables in older chronic pain patients with healthy older persons using polysomnography. ⋯ The chronic pain group spent significantly longer time in bed and had poorer sleep than the control group in terms of sleep onset latency, sleep latency to N2, sleep efficiency, wake time after sleep onset, and number of awakenings. However, sleep duration and time spent in each sleep stage did not differ between the 2 groups. The composition of power spectrum frequencies revealed that older people with chronic pain have lower intensity in the δ frequencies (0.5 to 1.99 Hz and 2 to 4 Hz) throughout the whole night, especially in the first 6 hours. The findings are in accordance with the idea that the quality of sleep while in chronic pain is particularly characterized by difficulties with the wake-sleep transition and a lower intensity of the deep restorative sleep throughout the night.