The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
The relationship between plasma beta-endorphin, opioid receptor activity, and silent myocardial ischemia.
To investigate the role of the opioid system in the pathophysiology of silent ischemia through opiate antagonism with naloxone, and to determine the reproducibility of resting and postexercise beta-endorphin levels in predominantly asymptomatic patients with coronary artery disease. ⋯ (a) naloxone failed to precipitate angina in this population of patients with silent ischemia; (b) naloxone appears to exert an analgesic effect at low doses; and (c) a variability of 5 pM at rest and 13 pM after exercise might be expected in predominantly asymptomatic patients due to random variation, which is comparable with results found in normal subjects.
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To examine the literature for evidence that psychological factors predispose certain individuals to development of reflex sympathetic dystrophy (RSD). ⋯ The data reviewed are consistent with a theoretical model in which depression, anxiety, or life stressors may influence development of RSD through their effects on alpha-adrenergic activity. However, conclusions regarding etiological significance of these factors are not possible due to the dearth of high-quality studies. Suggestions for prospective research are described.
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Randomized Controlled Trial Clinical Trial
Intrathecal baclofen suppresses central pain in patients with spinal lesions. A pilot study.
To assess the efficacy of acute intrathecal (i.t.) baclofen on chronic, dysesthetic, and spasm-related pain (SRP) among patients with spinal spasticity [i.e., multiple sclerosis (MS), spinal cord injury (SCI), transverse myelitis (TMy)]. ⋯ The suppressive action of i.t. baclofen on spontaneous and evoked (allodynia) dysesthetic pain suggests that a dysfunctional spinal gamma-aminobutyric acidB receptor system, including functional supersensitivity, is associated with the phenomenon of central pain among patients with spinal lesions. Temporal dissociation regarding the action on dysesthetic pain and SRP suggests that disparate central mechanisms subserve the two clinical states.
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Phantom breast syndrome after mastectomy has already been reported by us and other authors. The temporal course, character, and extent of these phenomena, however, have not yet been elucidated. ⋯ The present incidence of phantom-related phenomena is close to the incidence reported by others. However, persistent phantom pain after mastectomy may be more common than usually expected. Also, the persistence of pain in the scar seems to be more common than generally expected.