European journal of pain : EJP
-
Comparative Study
The Short-Form McGill Pain Questionnaire as an outcome measure: test-retest reliability and responsiveness to change.
Abilities of the Short-Form McGill Pain Questionnaire to assess change have scarcely been addressed in previous studies. The aim of the present study was to examine test-retest reliability, sensitivity to change and responsiveness to clinically important change using a Norwegian version (NSF-MPQ) in different groups of patients. ICC(1,1) values for test-retest reliability (relative reliability) assessed 1-3 days apart for total, sensory and affective scores were, respectively, 0.75, 0.76 and 0.62 in patients with musculoskeletal pain (n=58), and 0.93, 0.95 and 0.79 in patients with rheumatic pain (n=25). ⋯ Indication was provided that mean improvement of groups in NSF-MPQ total scores should be >5 on the 0-45 scale to demonstrate a clinically important change. Responsiveness to clinically important change by receiver operating characteristic curve analysis was modest, as area under the curve indicating ability to discriminate improved and not improved patients with musculoskeletal pain, was only 0.61. The study indicates mostly satisfactory test-retest reliability and responsiveness values of the NSF-MPQ, but shows that the measurement properties vary between groups of patients with pain.
-
Comparative Study
Preterm births: can neonatal pain alter the development of endogenous gating systems?
Prematurity is known to affect the development of various neurophysiological systems, including the maturation of pain and cardiac circuits. The purpose of this study was to see if numerous painful interventions, experienced soon after birth, affect counterirritation-induced analgesia (triggered using the cold pressor test) later in life. A total of 26 children, between the ages of 7 and 11 participated in the study. ⋯ Changes in heart rate and pain sensitivity in response to conditioning cold stimulation were not observed in preterm children that had been exposed to numerous painful procedures during the neonatal period. These results suggest that early pain does not lead to enhanced pain sensitivity when premature babies become children, but that their endogenous pain modulatory mechanisms are not as well developed as those of children not exposed to noxious insult at birth. Greater frequency of painful procedures also dampened the rise in heart rate normally observed when experimental pain is experienced.
-
Clinical Trial
Antinociceptive effects of high-dose remifentanil in male methadone-maintained patients.
The treatment of acute pain in patients maintained on methadone is difficult due to increased pain sensitivity (hyperalgesia) and cross-tolerance to other opioids. This study aimed to investigate whether remifentanil elicits antinociception in methadone-maintained subjects in a dose-dependent manner. Eight chronic methadone-maintained subjects attended the testing session approximately 20 h after their normal methadone dose (range 50-110 mgday(-1)). ⋯ Results showed dose-dependent increase in cold pressor tolerance time from baseline of 15.6+/-3.5 (mean+/-SEM)s up to 77.3+/-24.7s during this dosing protocol. During the infusion typical mu-opioid receptor agonist side effects were observed, but with no withdrawal. Methadone-maintained patients demonstrate significant tolerance to remifentanil and may require opioid doses 20-30 higher than required for the treatment of acute pain in opioid-naïve patients.
-
This is the first investigation of the central processing of itch in the brain in 8 subjects with atopic dermatitis (AD) in comparison to 6 healthy controls (HC), comparing histamine-induced itch related activations in the frontal, prefrontal, parietal, cingulate cortex, thalamus, basal ganglia and cerebellum. ⋯ We interpret our findings as possible central correlates of changes in the motor system in subjects with chronic itch, with activation of the basal ganglia possibly correlating to the vicious itch-scratch-circle in subjects with chronic itching skin diseases. However, further neuroimaging studies in healthy subjects and also in different skin diseases are needed to understand the complex mechanisms of the processing of itch.
-
To screen for the presence of latent and active myofascial trigger points (MTrPs) in patients with unilateral shoulder and arm pain and perform topographical mapping of mechanical pain sensitivity bilaterally in the infraspinatus muscles. ⋯ There exists bilateral mechanical hyperalgesia in patients with unilateral shoulder pain. Further, the association of multiple active MTrPs with unilateral shoulder pain and the heterogeneity of mechanical pain sensitivity distribution suggest a crucial role of peripheral sensitization in chronic myofascial pain conditions. Additionally, the locations of MTrPs identified with dry needling correspond well to PPT topographical mapping, suggesting that dry needling and PPT topographical mapping are sensitive techniques in the identification of MTrPs.