The Clinical journal of pain
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Measures of central pain processing like conditioned pain modulation and suprathreshold heat pain response (SHPR) have been described to assess different components of central pain modulatory mechanisms. Central pain processing potentially plays a role in the development of postsurgical pain, however, the role of conditioned pain modulation and SHPR in explaining postoperative clinical pain and disability is still unclear. ⋯ The present study suggests that baseline measures of central pain processing were not predictive of 6-month postoperative pain outcome. Instead, the 3-month change in SHPR might be a relevant factor in the transition to an elevated 6-month postoperative pain and disability outcomes. In patients with shoulder pain, the 3-month change in a measure of central pain processing might be a relevant factor in the transition to elevated 6-month postoperative pain and disability scores.
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Comparative Study
Comparison of location, depth, quality, and intensity of experimentally induced pain in 6 low back muscles.
The pattern of pain originating from experimentally induced low back pain appears diffuse. This may be because sensory information from low back muscles converges, sensory innervation extends over multiple vertebral levels, or people have difficulty accurately representing the painful location on standardized pain maps. ⋯ Depth and lateral position may be the most critical descriptors to determine the source of acute lumbar muscular pain. Overlapping regions of pain may be explained by convergence of receptive fields, innervation of multifidus fascicles at multiple lumbar segments, and convergence of sensory input from different muscles to the same sensory cell bodies as demonstrated in the lumbar spine of animal preparations.
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Randomized Controlled Trial Observational Study
Pain and Recovery After Total Knee Arthroplasty: A Twelve Months Follow-up After a Prospective Randomized Study Evaluating Nefopam and Ketamine for Early Rehabilitation.
Ketamine and nefopam has been documented to decrease pain intensity and improve rehabilitation after total knee arthroplasty (TKA). We conducted a follow-up study of a previously randomized clinical trial to determine the prevalence and risk factors of chronic pain 1 year after TKA and to assess the role of perioperative administration of ketamine and nefopam. ⋯ After TKA, the intensity of postoperative pain is a risk factor of chronic pain on movement. Intraoperative ketamine seems to improve long-term results of rehabilitation in this setting.
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Pain diaries are important tools for clinical trials and optimal assay sensitivity of outcomes derived from these diaries is a worthwhile goal. Jensen and colleagues recently reported results suggesting that single-day diary-based outcomes could possibly be as psychometrically sound as outcomes based on taking the average of many diaries. ⋯ We come to a different conclusion than that advanced by Jensen and colleagues and conclude that their results were unusual in that very high test-retest reliability among days was found. With our 4 diary data sets we find that aggregating multiple diaries yields more reliable outcomes and improved sensitivity. We suggest that using single-day diaries will often lead to underpowered studies and that pretesting is advised before adopting single-day diaries. We also suggest that other researchers replicate these findings within their diary-based clinical trials.