The Clinical journal of pain
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Review
Effect of immunomodulating medications in complex regional pain syndrome: a systematic review.
Different mechanisms are involved in a complex network of interactions resulting in the painful and impairing disorder, complex regional pain syndrome (CRPS). There is convincing evidence that inflammation plays a pivotal role in the pathophysiology of CRPS. Immunomodulating medication reduces the manifestation of inflammation by acting on the mediators of inflammation. Therefore, as inflammation is involved in the pathophysiology of CRPS, immunomodulating medication in CRPS patients may prove beneficial. ⋯ Theoretically, the use of immunomodulating medication could counteract the ongoing inflammation and might be an important step in improving a disabled hand or foot, leading to further recovery. However, more high-quality intervention studies are needed.
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A systematic review of the literature. ⋯ The current review suggests that physicians need to improve their knowledge regarding options for modified work in the workplace, and about the management of LBP in general. The otherwise beneficial patient-physician relationship and physicians' care for their patients may be an obstacle to following guidelines on LBP management in the sick-listing process. Future studies should address these issues.
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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.
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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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Von Frey monofilaments (VFM) and Electronic von Frey are used as quantitative sensory testing to explore mechanical hyperalgesia. The aim of the study was to determine VFM and Electronic von Frey reproducibility and the time required for testing undamaged areas in volunteers and surgical in-hospital patients. ⋯ Exploration of mechanical allodynia in postoperative patients requires rapid and reliable quantitative sensory testing. Electronic von Frey was more reliable and rapid than VFM in exploring mechanical pain thresholds in undamaged areas in volunteers and patients. Further studies are required to confirm whether these results can be extrapolated to areas affected by surgery.