The Clinical journal of pain
-
Review
Central sensitization and altered central pain processing in chronic low back pain: fact or myth?
The purpose of this narrative review is to analyze the available literature concerning central sensitization and altered central pain processing in patients with chronic low back pain (LBP). ⋯ It tempting to speculate that ongoing nociception is associated with cortical and subcortical reorganization and may play an important role in the process of the chronification of LBP. Future prospective research should explore to what extent these changes are reversible and if this reversibility is associated with improved functioning of patients.
-
Clinical Trial
A multidimensional approach to pain assessment in critically ill infants during a painful procedure.
Inferring the pain level of a critically ill infant is complex. The ability to accurately extract the appropriate pain cues from observations is often jeopardized when heavy sedation and muscular blocking agents are administered. Near-infrared spectroscopy is a noninvasive method that may provide the bridge between behavioral observational indicators and cortical pain processing. We aimed to describe regional cerebral and systemic hemodynamic changes, as well as behavioral reactions in critically ill infants with congenital heart defects during chest-drain removal after cardiac surgery. ⋯ We demonstrated with a multidimensional pain assessment approach that significant cerebral, physiological, and behavioral activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Considering that the sedating agent significantly dampened pain behaviors, assessment of cerebral hemodynamic in the context of pain seems to be an important addition.
-
Randomized Controlled Trial
Specificity and time-course of attentional bias in chronic headache: a visual-probe investigation.
The specificity and time-course of attentional bias in chronic headache were investigated. Individuals with chronic headache, compared with healthy controls, were hypothesized to show significant attentional bias towards disorder-relevant headache-related images. ⋯ Individuals with chronic headache demonstrate attentional bias towards pain information, which is most prominently shown towards stimuli relevant to their specific disorder. Biases are also more pronounced at longer stimuli presentation times associated with maintained attention. Future research should investigate the clinical implications of attentional bias in chronic headache, and further explore the benefits of attentional bias modification upon patient functioning.
-
The noble gas xenon has been known for >50 years in the field of anesthesia with an emerging series of favorable features; several clinical and preclinical studies performed over the last years reveal a renewed interest because they substantially agree on attributing relevant analgesic properties to xenon. The main mechanism of action is the inhibition of N-methyl-D-aspartate receptors of glutamate; it involves the blocking of painful stimuli transmissions from peripheral tissues to the brain and it also avoids the development of pain hypersensitivity. ⋯ Several forms of pain share such mechanisms in their maintenance, and xenon can be successfully used at low dosages, which have no effects on vital parameters. The literature shows that analgesic features could also emerge outside the field of anesthesia; thus, this could permit xenon to have a larger usage according to local availability.
-
Prescription opioid diversion and abuse are becoming increasingly prevalent in many regions of the world, particularly the United States. One method advocated to assess compliance with opioid prescriptions is occasional "pill counts." Shortly before a scheduled appointment, a patient is notified that they must bring in the unused portion of their opioid prescription. It has been assumed that if a patient has the correct number and strength of pills that should be present for that point in a prescription interval that they are unlikely to be selling or abusing their opioids. ⋯ Pill counts do not assure non-diversion of opioids and provide additional cash flow to illicit opioid dealers.