European journal of pain : EJP
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With 12-month prevalence rates of more than 70%, back pain is currently one of the major health problems for German adults and entails major economic consequences. The aim of this study was to estimate back pain-related costs from a societal perspective and to determine the impact of sociodemographic variables on costs. Based on back pain-related survey data of a large German adult sample (9267 respondents, response rate 60%), costs were assessed using a prevalence-based bottom-up approach. ⋯ Male gender, increasing age, single status, low education, unemployment, and increasing back pain grade had a significant positive impact on the cost magnitude in multivariate analysis. Despite several limitations, this study provides important information concerning the relevance of back pain as a health problem and its socioeconomic consequences. The information may be of value for decision-making and allocation of research fund resources.
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Walking is fundamental to many activities that are detrimentally affected by chronic pain. When in pain, people adapt how they walk. This article reports the development of an observational rating scale for the assessment of the quality of walking in adults with chronic pain called the Bath Assessment of Walking Inventory. ⋯ Validity was established in comparison with well-used measures of functioning. Further independent study is required to develop this instrument. A robust measure of walking will enable accurate clinical assessment, and the investigation of psychosocial and biomechanical influences on walking quality, and of the communicative function of pain related movement.
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Randomized Controlled Trial Multicenter Study
Efficacy and safety of morphine-6-glucuronide (M6G) for postoperative pain relief: a randomized, double-blind study.
The aim of the study was to assess analgesia and safety effects of a range of intravenous doses of M6G (10, 20 and 30 mg/70 kg), compared to placebo, in postoperative patients. ⋯ M6G induced long-lasting dose-related analgesic effects in postoperative patients with limited effects on cardiorespiratory systems or of opioid-like side-effects. M6G is an effective opioid for the treatment of moderate to severe postoperative pain.
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While neuroimmune interactions are increasingly recognized as important in nociceptive processing, the nature and functional significance of these interactions is not well defined. There are multiple reports that the activation of spinal microglia is a critical event in the generation of neuropathic pain behaviors but the mediators of this activation remain disputed. ⋯ An essential role for spinal CCL2 is demonstrated by the inhibition of neuropathic pain behavior and microglial activation by a specific neutralising antibody to CCL2 administered intrathecally. Thus, the neuronal expression of CCL2 provides a mechanism for immune activation, which in turn regulates the sensitivity of pain signaling systems in neuropathic pain states.
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Tibia fracture in rats evokes chronic hindpaw warmth, edema, allodynia, and regional osteopenia, a syndrome resembling complex regional pain syndrome (CRPS). Previous studies suggest that the pathogenesis of some of these changes involves an exaggerated regional inflammatory response to injury and we postulated that inflammatory cytokines contribute to the development of CRPS-like changes after fracture. ⋯ These results suggest that pro-inflammatory cytokines contribute to the nociceptive and vascular sequelae of fracture and that PTX treatment can reverse these CRPS-like changes.