European journal of pain : EJP
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Comparative Study
Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: an fMRI analysis.
The neuropsychological status of pain conditions such as fibromyalgia, commonly categorized as 'psychosomatic' or 'functional' disorders, remains controversial. Activation of brain structures dependent upon subjective alterations of fibromyalgia pain experience could provide an insight into the underlying neuropsychological processes. Suggestion following a hypnotic induction can readily modulate the subjective experience of pain. ⋯ Our results thus provide evidence for the greater efficacy of suggestion following a hypnotic induction. They also indicate direct involvement of a network of areas widely associated with the pain 'neuromatrix' in fibromyalgia pain experience. These findings extend beyond the general proposal of a neural network for pain by providing direct evidence that regions involved in pain experience are actively involved in the generation of fibromyalgia pain.
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Randomized Controlled Trial
Perioperative ketamine does not prevent chronic pain after thoracotomy.
Thoracotomy is often responsible for chronic pain, possibly of neuropathic origin. To confirm preclinical studies, the preventive effects of perioperative ketamine were tested in a randomized, double-blind, placebo-controlled clinical trial on persistent neuropathic pain after thoracotomy. Eighty-six patients scheduled for thoracotomy under standardised general anaesthesia were randomised to receive either ketamine (1 mg kg(-1) at the induction, 1 mg kg(-1) h(-1) during surgery, then 1 mg kg(-1) during 24 h; n=42) or normal saline (n=44). ⋯ Ketamine improved immediate postoperative pain, but the groups were similar in terms of neuropathic pain and intake of analgesics, 6 weeks (NPSI score: ketamine: 1.25 [0-4.125]; placebo: 1 [0-4]) and 4 months after surgery. Thus, ketamine given in 24-h infusion failed to prevent chronic neuropathic pain after thoracotomy. Other perioperative preventive long-lasting treatments or techniques could be tested in this context.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of a behaviour graded activity program versus conventional exercise for chronic neck pain patients.
Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to physiotherapy and, nowadays, are mostly treated with exercise therapy. It is, however, unclear which type of exercise therapy is to be preferred. ⋯ In both BGA and CE some patients reported recovery from complaints and daily function but the proportion of recovered patients did not exceed 50% during the 12-month follow-up period. Both groups showed clinically relevant improvements in physical secondary outcomes. International Standard Randomised Controlled Trial Number: ISRCTN88733332.
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To investigate self-reported chronic pain and other sequelae in a nationally representative sample of long-term breast cancer survivors (BCS). ⋯ Chronic pain was more prevalent in BCS compared to the general population. Significant predictors for sequelae related to breast cancer were radiotherapy and younger age. Future research should therefore prioritize sequelae prevention.
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Comparative Study
Ultraviolet-B induced inflammation of human skin: characterisation and comparison with traditional models of hyperalgesia.
The effect on human skin of over-exposure to solar ultraviolet radiation (UVR) has been well described. The erythema produced is commonly referred to as 'sunburn'. Recently UVR induced inflammation has been utilised as a human model of sub-acute pain. ⋯ Both thermal burns and topical capsaicin produced large areas of flare, indistinguishable in character from the primary lesions. Moreover, UVB inflammation induced large reductions in mechanical pain threshold restricted to the primary lesion site, whereas the more established inflammatory pain models produced not only primary hypersensitivity but also significant areas of secondary mechanical hypersensitivity. Taken together these findings suggest that UVB inflammation, at least using moderate doses produces sensory changes primarily by sensitising peripheral pain processing in the relative absence of alterations in central pain processing.