The Clinical journal of pain
-
Randomized Controlled Trial
Peripheral neurostimulation and specific motor training of deep abdominal muscles improve posturomotor control in chronic low back pain.
Chronic low back pain (CLBP) is associated with an impaired control of transversus abdominis/internal oblique muscle (TrA/IO), volitionally and during anticipatory postural adjustment (delay) along with maladaptive reorganization of primary motor cortex (M1). Specific training of deep trunk muscles and repetitive peripheral magnetic stimulation (RPMS) improve motor control. We thus tested whether RPMS over TrA/IO combined with training could promote TrA/IO motor control and decrease pain beyond the gains already reached in CLBP. ⋯ This study supports that peripheral neurostimulation (adjuvant to training) could improve TrA/IO motor learning and pain in CLBP associated with motor impairment. Testing of enlarged samples over several sessions should question the long-term influence of this new approach in CLBP.
-
Neuropathic pain is often worse at night; however, little is known about pain rhythmicity during waking hours. We aimed to replicate previous observations of diurnal pain progression, evaluate associations between diurnal rhythmicity and clinical factors, and evaluate the impact of diurnal rhythmicity on treatment response. ⋯ These observations suggest that neuropathic pain progressively increases throughout the day with clinically relevant morning-evening differences and further indicate that sex and underlying etiology may be important determinants of diurnal rhythmicity in neuropathic pain. Consideration of these patterns may guide improved therapeutic strategies and stimulate new directions of research that will improve our understanding and treatment of neuropathic pain.
-
In specialized pain clinics there is an increasing number of patients with severe chronic noncancer pain (CNCP) despite long-term opioid medication. Few clinical studies show short-term pain relief after opioid withdrawal (OW). We have evaluated the relation between pain intensity after OW and long-term opioid nonuse. ⋯ In many patients with severe CNCP, despite opioid medication, sustainable pain relief can be achieved if OW is included in the rehabilitation program. Consequently, we recommend OW for opioid-resistant CNCP before any opioid escalation. Lower pain intensity shortly after OW may predict the long-term opioid nonuse probability.
-
Persistent postoperative pain is an acknowledged entity that reduces daily activities. Evaluation of the post-thoracotomy pain syndrome (PTPS) is often measured using traditional pain scales without in-depth questions on pain impairment. Thus, the purpose was to create a procedure-specific questionnaire for assessment of functional impairment due to PTPS. ⋯ This study presents method, results and validation of a new unidimensional scale measuring procedure specific functional impairment due to PTPS following open surgery and VATS. Procedure specific tools such as this could provide important outcomes measures for future trials on persistent postsurgical pain states allowing better assessment of interventions (250).
-
The concept of mental defeat (MD) has been applied to describe the deeper impact of pain on the person's sense of self. It describes an intense psychological reaction to pain, whereby people feel that pain has taken away their autonomy and identity. Although MD has been found to characterize Western individuals who are most distressed and disabled by CP, it is debatable whether the concept can be generalized to the experience of CP patients in other cultures. The present study examined whether MD contributed to the prediction of distress and disability among Hong Kong (HK) Chinese reporting CP. ⋯ These findings provide further evidence that MD is a factor that differentiates treatment-seeking from nontreatment-seeking individuals with CP. They also highlight the potential value of applying this psychological concept to the understanding and treatment of CP in HK Chinese.