The Clinical journal of pain
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To investigate integrative thermal perception in a patient with multiple sclerosis. ⋯ The absence of thermal grill-evoked pain is consistent with the hypothesis that in some cases of central pain the loss of the thermosensory pathway results in disruption of the normal cold inhibition of burning pain.
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Comparative Study
A comparison of modality-specific somatosensory changes during menstruation in dysmenorrheic and nondysmenorrheic women.
The objective was to evaluate somatosensory thresholds to a multimodality stimulation regimen applied both within and outside areas of referred menstrual pain in dysmenorrheic women, over four phases of confirmed ovulatory cycles, and to compare them with thresholds in nondysmenorrheic women during menstruation. ⋯ The results show reduced somatosensory pain thresholds during menstruation to heat and pressure stimulation, both within and outside areas of referred menstrual pain in dysmenorrheic women. Dysmenorrheic women showed a lower HPT at the control sites and a lower PPT at all the sites than those for nondysmenorrheic women in the menstrual phase. The altered somatosensory thresholds may be dependent on a spinal mechanism of central hyperexcitability, induced by recurrent moderate to severe menstrual pain.
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The objective was to investigate, in two community samples of people with spinal cord injuries, the frequency of use of different pain treatments and the perceived helpfulness of these treatments. ⋯ This survey of two large samples of community-dwelling individuals with spinal cord injury-related chronic pain indicates that multiple pain treatments are tried but only a few are rated as more than somewhat helpful. Furthermore, the treatments that are most commonly reported are not always those that are rated as most helpful. The findings point to a number of potentially fruitful directions for future research.
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Sexual dysfunction and low testosterone levels have been observed previously in males with chronic noncancer pain treated with intrathecal opioids. To investigate the hypothesis that intrathecal opioids suppress the hypothalamic-pituitary-gonadal axis, a prospective nonrandomized investigation of the function of this axis was undertaken. ⋯ Administration of intrathecal opioids may result in hypogonadotrophic hypogonadism. As part of the consent for therapy process, patients should be informed about this effect and its management. With long-term intrathecal opioid administration, the hypothalamic-pituitary-gonadal axis should be monitored. Where indicated, testosterone replacement should be undertaken to improve sexual function and prevent the potential metabolic effects of hypogonadism, in particular, osteoporosis.
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Abnormalities of central sensory processing may play a role in the pathogenesis of chronic pain. The Chiari I malformation is a congenital hindbrain anomaly characterized by protrusion of the cerebellar tonsils into the upper cervical canal, with variable effects on the lower brain stem and cervical cord. The purpose of this study was to compare sensory function and pain among patients with chronic pain who had these disorders incidentally diagnosed, to assess the effect on pain in these patients in comparison with those without central nervous system disease. ⋯ Quantitative sensory analysis indicates sensory dysfunction associated with Chiari I malformation and cervical cord compression. The pattern of sensory abnormality is consistent with medullary dysfunction among the patients with Chiari I malformation and cervical cord dysfunction among cord compression patients. There were differences in the types and extent of pain and the associated disorders of mood observed among the cohorts defined above. These differences may be partly due to the presence and location of central sensory dysfunction.