European journal of pain : EJP
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Randomized Controlled Trial
Absence of long-term analgesic effect from a short-term S-ketamine infusion on fibromyalgia pain: a randomized, prospective, double blind, active placebo-controlled trial.
To assess the analgesic efficacy of the N-methyl-D-aspartate receptor antagonist S(+)-ketamine on fibromyalgia pain, the authors performed a randomized double blind, active placebo-controlled trial. Twenty-four fibromyalgia patients were randomized to receive a 30-min intravenous infusion with S(+)-ketamine (total dose 0.5mg/kg, n=12) or the active placebo, midazolam (5mg, n=12). Visual Analogue Pain Scores (VAS) and ketamine plasma samples were obtained for 2.5-h following termination of treatment; pain scores derived from the fibromyalgia impact questionnaire (FIQ) were collected weekly during an 8-week follow-up. ⋯ Side effects as measured by the Bowdle questionnaire (which scores for 13 separate psychedelic symptoms) were mild to moderate in both study groups and declined rapidly, indicating adequate blinding of treatments. Efficacy of ketamine was limited and restricted in duration to its pharmacokinetics. The authors argue that a short-term infusion of ketamine is insufficient to induce long-term analgesic effects in fibromyalgia patients.
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Review
Understanding fear of pain in chronic pain: interoceptive fear conditioning as a novel approach.
The current review deals with interoceptive conditioning as a viable mechanism maintaining fear of pain: The available literature suggests that interoceptive - i.e., internal bodily - sensations may become predictors of pain and will subsequently elicit fear of pain. After a short overview of interoceptive (fear) conditioning and its role in the maintenance of panic disorder, the existing literature on conditioning in the field of pain and fear of pain is reviewed. Next, the authors propose an interoceptive fear conditioning model of fear of pain, suggesting that bodily sensations can function as predictors of pain and as conditioned stimuli become endowed with the capacity to elicit an (anticipatory) fear response. The review concludes with a number of theoretical and clinical considerations, introducing interoceptive exposure as a potentially effective treatment for fear of pain.
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The long-term course of long-standing low back pain is largely unknown since long-term data are scarce. ⋯ Low back pain in the population is characterized as very dynamic which challenges epidemiological studies highly. Long-term information on the course of back pain is needed to define severe subgroups.
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Although women report feeling more pain than men their pain is often under-valued as compared to men's pain. We argue that such biases are not universal, being either enhanced or suppressed by context-related variables pertaining to the situation, the patient and the perceiver. Consequently, we aimed at understanding the effects of pain duration, patient's distress and the judge's sex on sex-related biases in pain judgements. ⋯ Moreover, only the judgments on the woman's pain were moderated by such contextual variables. Finally, male students were more biased than females. Implications for gender equality in pain treatments are drawn.
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Despite the increased recognition of paediatric chronic pain, centres for providing appropriate treatment are scarce, and much remains unknown about optimal treatment approaches. The purpose of this study was to investigate effectiveness of multimodal outpatient treatment (MOT) through the examination of treatment pathways and long-term outcomes. ⋯ MOT appears to be beneficial for children with chronic pain. A short intensive intervention (comprising of a total of 2.5-h) can lead to substantial improvements even for severely affected children.