European journal of pain : EJP
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Randomized Controlled Trial
Comparison of efficacy of diclofenac and tramadol in relieving pain in patients of acute pancreatitis: A randomized parallel group double blind active controlled pilot study.
Opioids and non steroidal anti inflammatory drugs (NSAIDs) are commonly used for pain relief in acute pancreatitis (AP). Opioids carry risk of sphincter of oddi constriction. Although diclofenac prevents post endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis, few reports of diclofenac associated AP are also present. Although, both tramadol and diclofenac are commonly used for pain relief in AP, no study has evaluated their comparative efficacy and safety. ⋯ There are no studies that have compared the safety and efficacy of two commonly used analgesics for pain relief in patients with AP. We found that both diclofenac and tramadol are equally effective in decreasing the pain associated with AP. There is also no significant difference in the incidence of side effects between both the groups. Hence both diclofenac and tramadol can be used safely and effectively for pain control in AP.
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Osteoporotic thoraco-lumbar burst fractures with serious pain are very common, and the optimal treatment of burst fractures without any neurological deficits has not yet been properly codified. The objective of this study was to evaluate prospectively the clinical effects and pain relief of unilateral percutaneous kyphoplasty (PKP) on osteoporotic thoraco-lumbar burst fractures. ⋯ Our present results showed that unilateral PKP was an effective method to obtain satisfactory pain relief in the management of osteoporotic thoraco-lumbar burst fractures. It may a good indication for the patients with osteoporotic thoraco-lumbar burst fractures, and the patients could not tolerate the serious acute pain by conservative treatment.
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Pain ratings are almost ubiquitous in pain assessment, but their variability is high. Low correlations of continuous/numerical rating scales with categorical scales suggest that individuals associate different sensations with the same number on a scale, jeopardizing the interpretation of statistical results. We analysed individual conceptions of rating scales and whether these conceptions can be utilized in the analysis of ratings of experimental stimuli in pain-free healthy individuals and people with reoccurring/persistent pain. ⋯ The present results provide a novel approach to incorporate individual conceptualizations of pain descriptors, which can induce large distortions in the analysis of pain ratings, in pain assessment. The approach can be used to achieve better pain estimates, representing individual conceptions of pain and achieving a better comparability between individuals but also between pain-free persons and patients with chronic pain. Particularly, in clinical settings this could improve quantification of perceived pain and the patient-clinician communication.
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In experimental placebo and nocebo studies, neutral control treatments are often administered for comparison with active treatments, but are of little interest, as, on average, they result in little change. Yet, when considered at an individual level, they fluctuate between baseline and subsequent measurements and may reveal important information about participants' placebo/nocebo responding tendencies. ⋯ Pre-post changes in pain ratings in neutral conditions are modulated by amygdala activity and connectivity and can be used to predict placebo/nocebo responses.
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The phenomenon of exercise-induced hypoalgesia and concomitant mood changes is well-established. How exercise-induced hypoalgesia and affective responses are shaped by the intensity of an acute exercise bout and individual fitness levels is as yet not well-understood. This study investigates whether heat pain threshold (PTh), pain tolerance (PTol) and affective parameters are modulated by the intensity of an acute exercise bout and/or individuals' fitness level. Stronger analgesic responses are hypothesized after high-intensity exercise in physically fitter subjects, possibly in sync with concomitant mood changes. ⋯ Antinociceptive effects can be elicited by physical exercise and have been extensively investigated in the literature. However, the relation between exercise intensity, fitness status, and the degree of antinociception is not well-understood. This randomized intervention provides novel evidence that antinociceptive effects indeed depend on exercise intensity, but also on general fitness status. Data extend the existing literature by highlighting aspects of exercise behaviour that promote antinociception. Effects do not simply mirror positive affective responses induced by exercise, hence, indicating partially distinct underlying mechanisms.