European journal of pain : EJP
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The diagnosis Complex Regional Pain Syndrome type I (CRPS-I) is based on clinical symptoms, including motor symptoms. Histological changes in muscle tissue may be present in the chronic phase of CRPS-I. Aim of this study was to analyze skeletal muscle tissue from amputated limbs of patients with CRPS-I, in order to gain more insight in factors that may play a role in changes in muscles in CRPS-I. ⋯ Intrinsic and extrinsic muscles were affected equally. Our findings show that in the chronic phase of CRPS-I extensive changes can be seen in muscle tissue, not related to duration of CRPS-I symptoms. Signs of neurogenic myopathy were present in five patients.
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Chronic pelvic pain (CPP) in women is a long-lasting condition. ⋯ At a 3 year follow-up, improvement in pain intensity in women with CPP was not associated with baseline pain appraisals and coping strategies. A reduction in catastrophizing was related to better outcome in the long term.
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The aim of this study was to determine the analgesic effect of gabapentin and tiagabine - two antiepileptic drugs, administered alone and in combination at the fixed-ratio of 1:1, in two phases of the formalin test in mice. Log-probit analysis was used to evaluate dose-response effects and calculate the ED(50) values for gabapentin, tiagabine, and their combination at the fixed-ratio of 1:1 in the phases I and II of the formalin test in mice. The types of interactions between both antiepileptic drugs were characterized using the isobolographic analysis. ⋯ With isobolography, the ED(50 mix) values at the fixed-ratio combination of 1:1 were 7.30 mg/kg (phase I) and 0.48 mg/kg (phase II), indicating both additive and supra-additive (synergistic) interactions between gabapentin and tiagabine in the formalin test in mice. In conclusion, the combination of gabapentin with tiagabine at the fixed-ratio of 1:1 exerted additive interaction in the phase I and synergistic interaction in the phase II of the formalin test in mice. If the results from this study could be extrapolated to clinical settings, the combination of tiagabine with gabapentin might be beneficial in the pain relief in humans.
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Comparative Study
Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities.
Dysesthesias of the lower limbs are a common complaint of patients and may be indicative of peripheral neuropathy. Here we investigated the prevalence and type of neuropathy in patients presenting with this complaint and compared the diagnostic performance of different diagnostic modalities. Forty-two patients were recruited prospectively and underwent a clinical examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsy at the dorsum of the foot. ⋯ Decreased intraepidermal nerve fiber density (IENFD) was found in 37 patients (88.1%), including some patients with normal QST findings. Nearly all patients with pathological QST had a reduced IENFD, indicating a high positive predictive value (93%) of QST in screening for reduced IENFD as correlate for neuropathy. Therefore in all patients with lower limb dysesthesias of unknown origin, the non-invasive methods of NCS and QST should be used and potentially complemented by skin biopsy.
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Acceptance of pain and distress has lately appeared as an important factor in determining peoples' ability to restore functioning in the presence of chronic pain. Although treatments based on cognitive behaviour therapy are beginning to incorporate acceptance strategies, there is still a lack of reliable and valid instruments to assess relevant processes in such interventions. The Chronic Pain Acceptance Questionnaire (CPAQ) was originally constructed as part of the development of an acceptance oriented treatment approach for pain patients. ⋯ Hierarchical regression analyses illustrated strong relations with criteria variables (e.g. disability and life satisfaction). In general, the activities engagement subscale contributed more than pain willingness to the prediction of criteria variables. Furthermore, results illustrated that CPAQ explained more variance than the Tampa Scale of Kinesiophobia in pain intensity, disability, life satisfaction, and depression.