European journal of pain : EJP
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The present study investigated the effects of different doses of intrathecal lidocaine on established thermal hyperalgesia and tactile allodynia in the chronic constriction injury model of neuropathic pain, defined the effective drug dose range, the duration of pain-relief effects, and the influence of this treatment on the body and tissues. Male Sprague-Dawley rats were divided into five groups and received intrathecal saline or lidocaine (2, 6.5, 15, and 35 mg/kg) 7 days after loose sciatic ligation. Respiratory depression and hemodynamic instability were found to become more severe as doses of lidocaine increased during intrathecal therapy. ⋯ These findings indicate that intrathecal lidocaine has prolonged therapeutic effects on established neuropathic pain. The balance between sympathetic and parasympathetic nervous activities could be well preserved in most cases, except for 35 mg/kg. Considering the ratio between useful effects and side effects, doses of 15 mg/kg are suitable for intrathecal injection for relief of neuropathic pain.
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Response biases are systematic biases in responding to test items that are unrelated to the content of the items. Examples often reported in young children include choosing only the lowest or highest anchors of a scale, or choosing a left-to-right sequence of responses. We investigated the presence of response biases in young children's ratings of pain in hypothetical situations, as a way of gauging their developing understanding of a pain scale over the preschool years. ⋯ These results reveal that response biases are common in children under 5 years. Clinicians should consider self-report pain ratings from preschoolers with caution, seek complementary observational assessment, and investigate discrepancies between self-report and observational estimates of pain. Simplified forms, instructions, and methods of administration for self-report scales should be developed and validated for use with 3- and 4-year-olds.
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Review Meta Analysis
Medication adherence in patients with chronic non-malignant pain: is there a problem?
Health care providers, treating patients with chronic non-malignant pain, often experience that medication is not as effective as expected. It is important to realize that the effectiveness of a pharmacological treatment can be influenced by the way the medication is taken. Medication adherence is a topic that gains more attention, especially in chronic conditions, because it affects treatment outcome. ⋯ Both overuse and underuse of medication occurs. However, due to the scarce literature and important methodological limitations, it is not possible to make firm conclusions concerning the impact on outcome, influencing variables and optimal intervention strategies. This review highlights some important gaps in the adherence literature in a chronic non-malignant pain population and sets the stage for future research.
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The amygdala plays an important role in the processing of chronic pain and pain memory formation. Particularly, it is involved in the emotional and affective components of the pain circuitry. The role of kappa opioid receptors in these pain conditions is only partly known. The present study investigates the effect of kappa receptor activation on synaptic transmission and synaptic plasticity in the amygdala. ⋯ Kappa opioid receptor activation decreases synaptic transmission and inhibits the induction of LTP in the BLA of the mouse. These findings may be associated with the effects of kappa opioid agonists in chronic pain and pain memory formation.
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Review Multicenter Study
A structured review of the evidence for pacing as a chronic pain intervention.
Pacing as an intervention appears with great regularity in the chronic pain management literature and yet what service providers actually mean by pacing is unclear and poorly defined. This short communication reports the findings of a structured review of the literature which examined the strength of the evidence for pacing as an intervention for people with chronic pain. ⋯ Although background literature demonstrates that pacing is often one part of a multidisciplinary intervention program, the research conducted on these programs presents pacing itself as an ill- or undefined construct. It is evident from this review that "pacing," while a widely employed term, lacks consensus of definition and a demonstrable evidence-base.