European journal of pain : EJP
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We describe the changing pattern of analgesic and new central acting drug (NCAD) use (pregabalin, duloxetine, milnacipran) in fibromyalgia and measure NCAD effectiveness in clinical practice. ⋯ There is a changing pattern of drug treatment in fibromyalgia, consisting mostly of decreased NSAID and amitriptyline use and an increase in NCAD. Drug costs are substantially higher because of NCAD use, but we found no evidence of clinical benefit for NCAD compared with prior therapy.
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Pain is a major ailment that motivates individuals to look for treatment. Despite its enormous clinical relevance, very little is known about the factors that influence our preference of an analgesic (or pain-relieving treatment). The current study investigated the influence of the information regarding the probability and the magnitude of the expected analgesic effect on preference of analgesic options. ⋯ Our findings revealed that preference of analgesic options is mediated by the overall probability of analgesic effect and the relative potency of analgesics. The expected relief one imagines to obtain from analgesics would guide preference. The findings highlight the importance for clinicians to understand how patients subjectively frame the probability and magnitude factors related to decision making in medical context.
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Osteoarthritis (OA) is a highly prevalent, age-related pain condition that poses a significant clinical problem. Here, in the monosodium iodoacetate (MIA) model of OA, we have characterized pain behaviours and associated changes at the first pain synapse in the dorsal horn of the spinal cord. ⋯ Intra-articular MIA is associated with referred mechanical hypersensitivity and increased release of CGRP from primary afferent fibres in the dorsal horn where second-order neuron activation is associated with a microglial response. Antagonism of CGRP receptor activation provides a therapeutic avenue for the treatment of pain in OA.
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Spinal cord stimulation (SCS) is used for the management of chronic intractable neuropathic pain. While used clinically, it is unclear if SCS produces its effects by activation of opioid receptors. The current study aimed to determine if endogenous opioids mediate the analgesia produced by SCS at different frequencies of stimulation in rats with neuropathic pain [spared nerve injury (SNI) model]. ⋯ These results suggest that both 4- and 60-Hz SCS, in part, work through opioid receptor mechanisms, with 4-Hz SCS activating μ-opioid receptors while 60-Hz SCS activated δ-opioid receptors.
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Some recent studies have provided evidence that alteration in central motor control may have causative impact on the emergence and sustenance of chronic pain. We hypothesized that comparison of postural control between patients with high (HP) and low pain (LP) level would display intergroup differences in favour of the LP group lending support for the postulated relationship between altered cortical function and pain. ⋯ Body balance measurements seemed to confirm the hypothesized role of the altered executive function in the CLBP problems, with a further support from pain assessment that indicated central sensitization. Patients with higher self-reported pain level displayed deficit in the postural adaptability to environmental challenge and lower level of postural automaticity.