The Clinical journal of pain
-
Quantitative sensory testing (QST) is used to assess sensory dysfunction and nerve damage by examining psychophysical responses to controlled, graded stimuli such as mechanical and thermal detection and pain thresholds. In the breast cancer population, 4 studies have used QST to examine persistent pain after breast cancer treatment, suggesting neuropathic pain being a prominent pain mechanism. However, the agreement and reliability of QST has not been described in the postsurgical breast cancer population, hindering exact interpretation of QST studies in this population. The aim of the present study was to assess test-retest properties of QST after breast cancer surgery. ⋯ The QST protocol reliability allows for group-to-group comparison of sensory function, but less so for individual follow-up after breast cancer surgery.
-
Multicenter Study
Pain Catastrophizing Differs Between and Within Whympi Pain Adjustment Classifications: Theoretical and Clinical Implications from Preliminary Data.
Pain catastrophizing is associated with multiple pain outcomes, and is differentially associated with the adaptive coping (AC), dysfunctional (DYS), and interpersonally distressed (ID) coping classifications of the West Haven-Yale Multidimensional Pain Inventory (MPI). We examined how catastrophizing, and the underlying components of magnification, rumination, and helplessness, may relate to MPI classifications and differentially relate to pain outcomes across classification groups to inform clinical treatment planning. ⋯ Our findings suggest a continued need for targeting catastrophizing and negative affect among pain patients. However, our data suggest that even among relatively well-adjusted patients, there may be clinical utility in assessing catastrophic thinking given the associations of it with pain-related outcomes. The present findings additionally support the value of enlisting multiple theoretical perspectives such as the stress appraisal and attentional models in future research and clinical applications.
-
Neonates cared for in neonatal intensive care units are exposed to many painful and stressful procedures that, cumulatively, could impact later neurodevelopmental outcomes. However, a systematic analysis of these effects is yet to be reported. ⋯ For infants born preterm, neonatal pain-related stress was associated with alterations in both early and in later developmental outcomes. Few longitudinal studies examined the impact of neonatal pain in the long-term development of children born preterm.
-
Randomized Controlled Trial Multicenter Study
A Randomized, Placebo-controlled Trial of the Analgesic Efficacy and Safety of the p38 MAP Kinase Inhibitor, Losmapimod, in Patients With Neuropathic Pain From Lumbosacral Radiculopathy.
Preclinical studies have demonstrated involvement of p38 mitogen-activated protein kinase signaling pathways in the development of persistent pain after peripheral nerve injury. A double-blind, randomized, placebo-controlled study was undertaken to evaluate the analgesic efficacy of losmapimod (GW856553), a novel p38α/β inhibitor, in patients with chronic neuropathic pain due to lumbosacral radiculopathy. ⋯ Losmapimod could not be differentiated from placebo in terms of analgesia. The lack of response could reflect insufficient losmapimod levels in the spinal cord or differences between lumbosacral radiculopathy and animal models of neuropathic pain.
-
Review
The Shared Neuroanatomy and Neurobiology of Comorbid Chronic Pain & PTSD: Therapeutic Implications.
Chronic pain and posttraumatic stress disorder (PTSD) are disabling conditions that affect biological, psychological, and social domains of functioning. Clinical research demonstrates that patients who are affected by chronic pain and PTSD in combination experience greater pain, affective distress, and disability than patients with either condition alone. Additional research is needed to delineate the interrelated pathophysiology of chronic pain and PTSD, with the goal of facilitating more effective therapies to treat both conditions more effectively; current treatment strategies for chronic pain associated with PTSD have limited efficacy and place a heavy burden on patients, who must visit various specialists to manage these conditions separately. ⋯ The potential contribution of opioid and cannabinoid system factors also will be discussed. Finally, we address potential novel methods to restore the normal function of these systems. Such novel perspectives regarding disease and disease management are vital to the pursuit of relief for the many individuals who struggle with these disabling conditions.