The Clinical journal of pain
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Randomized Controlled Trial
Allodynia in migraine: clinical observation and role of prophylactic therapy.
There is no study on the role of prophylactic therapy on allodynia in patients with migraine. We report the predictors of allodynia in migraine and the effect of divalproate or amitriptyline in alleviating allodynia. ⋯ 71.4% migraineurs had allodynia that was related to the duration, severity, frequency of migraine, and female gender. Divalproate and amitriptyline were equally effective in relieving allodynia.
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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.
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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.
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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.
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Case Reports
Transcranial direct current stimulation (tDCS) relieved itching in a patient with chronic neuropathic pain.
Itching is often called the second modality of nociception besides pain, and affects many chronic pain patients. ⋯ This case provides a rationale for future studies of neuromodulatory treatments for itch, and indicates a potential clinical use of neuromodulation in patients with unrelieved itching.