European journal of pain : EJP
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Randomized Controlled Trial
Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain.
Why is this significant?
This is the first randomised controlled trial looking at the impact of perioperative ketamine on persistent post-surgical (PPS) pain 1 year after thoracic surgery. Thoracotomy is associated with both severe and a high incidence (up to 50% at 6 months) chronic pain.
Ketamine has important analgesic properties through NMDA blockade, and has been long thought (hoped) that via this it may modify chronic post-surgical pain. Nonetheless, many studies have been unable to show a benefit for ketamine in reducing PPS pain.
What did they show?
Chumbley et al. ran ketamine infusions at 0.1 mg/kg/hour for 96 hours in patients undergoing thoracotomy, starting with a 0.1 mg/kg bolus 10 minutes before surgery. Patients also received either an epidural or paravertebral infusion for post-operative analgesia.
Although there were small differences in acute pain (notably the ketamine group used less PCA morphine) there was no difference in persistent post-surgical pain at 12 months.
Bottom-line
The evidence continues to mount against perioperative ketamine, suggesting it does not reduce persistent post-surgical pain, not-withstanding its acute analgesia benefits. Await results of the ROCKet trial (Reduction Of Chronic Post-surgical Pain with Ketamine) to provide greater clarity...
An afterthought
Notably, the researchers did demonstrate a dramatically lower incidence of PPS pain than for similar studies (27%, 18%, 13% at 3, 6, 12 months) across both the ketamine and placebo group. This suggests that either the study participants were not representative of the typical thoracotomy patient (unlikely), or other care associated with the study had a beneficial effect on reducing PPS – perhaps even via a Hawthorne-like effect.
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Fibromyalgia represents a condition still controversial in its entity, pathophysiology, diagnosis and management (Figure ). In a world where everybody is connected, and everybody is sharing their own image, fibromyalgia (FM) represents the emblematic pathology of misconnection and lack of specific biomarker. ⋯ The concept of misconnection defines FM in a different and holistic view and proposes different views of assessment, management and representation: FM pathophysiology: the desynchronization of brain and body FM recognition: the broken link between patients and physicians FM assessment: merging the body and mind for an optimal diagnosis and management FM treatment: re-establishing the good connections at different levels We hope to reconnect FM patients with all healthcare providers, help FM patients reconnect with their painful body and integrate FM into regular medical practice. SIGNIFICANCE: The concept of misconnection defines FM in a different and holistic view, and propose different views of assessment, management and representation.
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Within the Fear Avoidance Model of pain, quantitative neurophysiological factors provide additional conceptual benefit when integrated along with traditional psychologically aspects of the FAM.
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Review Meta Analysis
The effectiveness of self-management interventions in adults with chronic orofacial pain: A Systematic review, Meta-analysis and Meta-regression.
Psychosocial risk factors associated with chronic orofacial pain are amenable to self-management. However, current management involves invasive therapies which lack an evidence base and has the potential to cause iatrogenic harm. ⋯ This systematic review provides clear evidence for effectiveness of combined biomedical and psychological interventions (incorporating self-management approaches) on long-term outcomes in the management of chronic orofacial (principally TMD) pain. Self-management should be a priority for early intervention in primary care in preference to invasive, irreversible and costly therapies. Further research is needed firstly to clarify the relative effectiveness of specific components of self-management, both individually and in conjunction, and secondly on outcomes in other types of chronic orofacial pains.
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Randomized Controlled Trial
Eye-movement behaviours when viewing real-world pain-related images.
Pain-related cues are evolutionarily primed to capture attention, although evidence of attentional biases towards pain-related information is mixed in healthy individuals. The present study explores whether healthy individuals show significantly different eye-movement behaviours when viewing real-world pain-related scenes compared to neutral scenes. The effect of manipulating via written information the threat value of the pain-related scenes on eye-movement behaviours was also assessed. ⋯ Healthy individuals show different eye-movement behaviours when viewing pain-related scenes than neutral scenes, supporting evolutionary accounts of pain. Implications for the onset and/or maintenance of chronic pain need to be explored.