European journal of pain : EJP
-
Many chronic low back pain (cLBP) patients do not satisfactorily respond to treatment. The knowledge of responders and non-responders before initiating treatment would improve decision making and reduce health care costs. The aims of this exploratory prediction study in cLBP patients treated with tapentadol were to identify predictors of treatment outcome based on baseline characteristics, to evaluate quality-of-life and functionality as alternative outcome parameters and to develop nomograms to calculate the individual probability of response. ⋯ Predictors for treatment response of tapentadol were identified in patients with chronic low back pain based on clinical pre-treatment characteristics that can guide personalized treatment. Quality-of-life and functionality were the most relevant outcomes for response prediction.
-
Multiple mechanisms contribute to the stimulus-evoked pain hypersensitivity that may be experienced after peripheral inflammation. Persistent pathological stimuli in many pain conditions affect the expression of certain genes through epigenetic alternations. The main purpose of our study was to investigate the role of epigenetic modification on potassium-chloride co-transporter 2 (KCC2) gene expression in the persistence of inflammatory pain. ⋯ Persistent pain suppresses KCC2 expression through HDAC-mediated histone hypoacetylation and consequently impairs the inhibitory function of inhibitory interneurons. Drugs such as HDAC inhibitors that suppress the influences of persistent pain on the expression of KCC2 may serve as a novel analgesic.
-
Expectations can dramatically influence the perception of pain, as has been shown in placebo analgesia or nocebo hyperalgesia. Here, we investigated the role of expectation on the interruptive function of pain - the negative consequences of pain on cognitive task performance - in 42 healthy human subjects. ⋯ We show that the interruptive function of pain on concurrent visual task performance is influenced by expectation. Positive expectation can abolish the detrimental effects of pain on cognition. These expectancy effects on the interruptive function of pain are mediated by changes in functional connectivity between rostral ACC, posterior fusiform cortex and the hippocampus.
-
The aim was to determine the prospective association between use of pain medication - due to musculoskeletal pain in the low back, neck/shoulder and hand/wrist - and long-term sickness absence. ⋯ Use of medication due to musculoskeletal pain is prospectively associated with long-term sickness absence even when adjusted for pain intensity. Use of pain medication can be a red flag to be aware of in the prevention of sickness absence.
-
Patients with fibromyalgia (FM) exhibit significant clinical heterogeneity, in terms of physical, social and psychological functions, as well as therapeutic responses. Here, we examined FM patients in terms of pain, physical, social and psychological variables to identify clinical subgroups that may be predictive of treatment patterns. ⋯ FM patients can be clustered into four distinct subgroups based on clinically measurable variables - pain, physical involvement, psychological function and social support. These subgroups had different clinical symptoms and medication profiles.