European journal of pain : EJP
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This study aimed to characterize and compare the efficacy profile on six fibromyalgia syndrome (FM) core symptoms associated with pharmacologic and non-pharmacologic treatments. We screened PubMed, Embase and the Cochrane Library for FM articles from 1990 to September 2012 to analyse randomized controlled trials comparing pharmacologic or non-pharmacologic treatments to placebo or sham. Papers including assessments of at least 2 of the 6 main FM symptom domains - pain, sleep disturbance, fatigue, affective symptoms (depression/anxiety), functional deficit and cognitive impairment - were selected for analysis. ⋯ Differences between pharmacologic and non-pharmacologic approaches may be related to different modes of action, tolerability profiles and study designs. Very few drugs in well-designed clinical trials have demonstrated significant relief for multiple FM symptom domains, whereas non-pharmacologic treatments with weaker study designs have demonstrated multidimensional effects. Future therapeutic trials for FM should prospectively examine each of the core domains and should attempt to combine pharmacologic and non-pharmacologic therapies in well-designed clinical trials.
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Randomized Controlled Trial
Predicting rapid recovery from acute low back pain based on the intensity, duration and history of pain: A validation study.
Clinical prediction rules can assist clinicians to identify patients with low back pain (LBP) who are likely to recover quickly with minimal treatment; however, there is a paucity of validated instruments to assist with this task. ⋯ The results suggest that the rule can be used to provide accurate information about expected recovery from acute LBP, within the first few weeks of patients presenting to primary care. Impact analysis to determine if the rule influences clinical behaviours and patient outcomes is required.
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A 50% reduction in pain intensity difference (50%PID) between baseline and follow-up evaluation is commonly accepted as adequate pain relief in emergency departments (EDs). However, 50%PID seems to be problematic with the 11-point numerical rating scale (NRS) since even baseline values are more divisible by 2 (50% reduction) than odd baseline values. This study evaluated the impact of this bias and integrated time between baseline and follow-up measurements, hypothesizing that the slope of relative pain intensity difference (SRPID) is a more accurate gauge of pain relief that can decrease bias and incorporate the time component of pain relief. ⋯ The 50%PID method with an 11-point NRS for assessing adequate pain relief is significantly biased for specific baseline pain intensity level. In the particular context of ED acute pain, the SRPID seems less biased.
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We have previously synthesized three esterified endomorphin-2 (EM-2) analogues 1-3 by substitution of C-terminus with methyl, ethyl and tert-butyl ester, respectively. Interestingly, the increase of EM-2 in bulkness of the esterified group decreased the μ-opioid receptor affinity but increased the δ-affinity. Presently, we extended our studies to investigate the antinociceptive potencies of these esterified analogues given intrathecally in the mouse tail-flick test. Also, the specific opioid receptor antagonists and antibodies against endogenous opioid peptides were used to determine whether there are any differential mechanisms on the antinociception produced by these analogues. ⋯ Our results demonstrated that EM-2 and its analogues 1-3 produced differential antinociceptive effects when administered intrathecally. We concluded that C-terminal amide to esterification conversion changed the antinociceptive potencies and properties of EM-2.
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Children and adolescents attending health care due to chronic pain commonly presents with insomnia. Previous research suggests that problems with sleep are associated with depression and functional disability. However, more research is needed to clarify the relationship between pain, insomnia and disability. ⋯ Insomnia is highly important in explaining depression and functional disability in paediatric chronic pain and can be adequately assessed using the ISI.