European journal of pain : EJP
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Low back pain (LBP) in older adults is poorly understood because the vast majority of the LBP research has focused on the working aged population. The aim of this study was to compare older adults consulting with chronic LBP to middle aged and young adults consulting with chronic LBP, in terms of their baseline characteristics, and pain and disability outcomes over 1 year. ⋯ Small baseline differences exist in older people with chronic low back pain compared to middle aged and younger adults referred to secondary care for chronic low back pain. Older adults present with slightly less intense low back pain but slightly more intense leg pain. Changes in pain intensity and disability over a 12 month period were similar across all age groups.
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Few studies have examined the potentially reduced life expectancy associated with spinal pain (i.e. low back and neck pain) in an ageing population, particularly after controlling for familial factors, including genetics. ⋯ Older people reporting spinal pain have 13% increased risk of mortality per year lived. However, this association is not likely to be causal, with the relevant confounders contributing to this relationship. Thus, pain in the spine may be part of a pattern of poor health, which increases mortality risk in the older population.
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In addition to inhibition of muscle and glandular hyperactivity, botulinum neurotoxin (BoNT) type A also interferes with pain processing. Previously, in a rat model of paclitaxel-induced polyneuropathy, abobotulinumtoxinA (aboBoNT-A) elicited analgesic effects not only in the injected paw, but also in the contralateral, non-injected paw. ⋯ The results expand evidence on bilateral analgesic effects of aboBoNT-A following unilateral administration across pain modalities, as the phenomenon is seen in more than one model of polyneuropathy as well as in a model of chronic inflammatory pain when the latter is rendered bilateral. The mechanism of bilateral analgesic effects of aboBoNT-A may require activation of the peripheral sensory neurons and involve retrograde axonal transport of the toxin into the spinal cord.
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The complex regional pain syndrome (CRPS) is characterized by distal generalisation of pain beyond the initial trauma. This might be the result of impaired endogenous pain inhibition. ⋯ Conditioned pain modulation (CPM) is not impaired in the early phase of complex regional pain syndrome (CRPS) and neuralgia. Only in CRPS higher CPM was associated with lower cold pain thresholds.
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Quantitative sensory testing (QST) relies on psychophysical techniques and instructions to test subjects. This study examined the effect of different verbal instructions for mechanical pain thresholds (MPTs) using two different stimulation techniques; weighted pinprick stimulators and an electronic von Frey device (EvF). The test-retest reliability and within session variability in the MPTs for each verbal instruction were compared in addition. ⋯ Quantitative sensory testing (QST) is a widely accepted tool for somatosensory testing and the reliability and variability in the QST test battery has been found to be acceptable. Changing minor details in the wording of standardized QST verbal instructions resulted in significant differences in mechanical pain thresholds. This emphasizes the importance of careful standardization of QST instructions in addition to standardization of the stimulus application.