European journal of pain : EJP
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Mechanical hyperalgesia and allodynia incidence varies considerably amongst neuropathic pain patients. This study explored whether sensory or psychological factors associate with mechanical hyperalgesia and brush allodynia in a human experimental model. ⋯ We evaluated differential relationships of psychological and perceptual sensitivity to the development of capsaicin-induced mechanical allodynia and hyperalgesia. Fifty percent of healthy volunteers failed to develop mechanical allodynia. Baseline pain sensitivity was greater in those developing allodynia and was related to the magnitude and area of hyperalgesia. State psychological factors, whilst unrelated to allodynia, were related to mechanical hyperalgesia. This supports that the intensity of peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, whilst psychological factors play a lesser role.
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Review Meta Analysis
Placebo effects in low back pain; a systematic review and meta-analysis of the literature.
The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP. ⋯ This systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.
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Individuals' perceptions of back pain may shape what they do in response to manage their pain, for example, self-care, medication and seeking healthcare. Illness perceptions encompass a variety of beliefs such as how long pain is expected to last and whether treatments are perceived to control pain. Whether these beliefs meaningfully cluster and whether these clusters are associated with how people manage their back pain are currently unknown. ⋯ Within a general population setting, we identified four clearly distinct groups of people based on the perceptions they held about their back pain. These groupings seemed to reflect meaningful characterisations as they differed based on the characteristics of their pain (e.g., severity and duration) and, after adjustment for these characteristics, were associated with different ways of managing pain. Interventions which focus on targeting the sets of illness perceptions that people hold may be effective in influencing how individuals manage back pain.
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The longitudinal association between persistent moderate to severe pain and subsequent long-term cognitive decline remains inconclusive. ⋯ Persistent moderate to severe pain in adults age 50 and older was associated with accelerated cognitive decline over a median follow-up of 12 years. More severe pain was associated with faster cognitive decline in a dose-response pattern, and the relationship was demonstrated throughout multiple cognitive domains. While the overall effect was subtle, clinicians should be aware that older adults with persistent pain are at risk of faster cognitive decline.
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Previous studies have indicated a negative correlation between GRK2 expression and pain development and transmission. Here, we investigated whether G-protein-coupled receptor kinase 2 (GRK2) was involved in regulating diabetic mechanical hyperalgesia (DMH). ⋯ GRK2 expression regulated DMH progression and is expected to play a role in the development of targeted therapy for DMH. GRK2 and Epac1 expressions play a vital role in maintaining pain in DMH rats.