European journal of pain : EJP
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Comparative Study Clinical Trial
Differences in perception and brain activation following stimulation by large versus small area cutaneous surface electrodes.
Application of electrical stimulation through conventional surface electrodes activates both non-nociceptive and nociceptive fibres. To encompass this problem, electrical stimulation through small area pin electrode was introduced where subjective description of stimulation quality indicated preferential activation of nociceptors. The present study aimed to show that brain areas involved in nociceptive processing are activated by stimulation through cutaneous pin electrode (CPE) to a larger extent than conventional surface electrodes. ⋯ The current study gives evidence that CPE activates the nociceptive brain areas to a greater extent than conventional surface electrode. Therefore, CPE should preferentially be utilized in future studies where electrical stimuli are used to study nociception.
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Numerous studies have demonstrated the capacity of music to modulate pain. However, the neurophysiological mechanisms responsible for this phenomenon remain unknown. ⋯ The RIII reflex and pain ratings were increased during the listening of unpleasant music compared with pleasant music, suggesting the involvement of descending pain-modulatory mechanisms in the effects of musical emotions on pain. There were no significant differences between the pleasant-stimulating and pleasant-relaxing musical condition, indicating that the arousal of music had little influence on pain processing.
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Randomized Controlled Trial
A randomized, placebo-controlled trial of levetiracetam in central pain in multiple sclerosis.
Levetiracetam is an anticonvulsant which is assumed to act by modulating neurotransmitter release via binding to the vesicle protein SV2A. This could have an impact on signalling in the pain pathway. The aim of this study was to test the analgesic effect of levetiracetam in central pain in multiple sclerosis. ⋯ There were no differences in the ratings of pain relief (levetiracetam 2.4 vs. placebo 2.1, p = 0.169), total pain intensity (levetiracetam 5.3 vs. placebo 5.7, p = 0.147) or any of the other outcome measures (p = 0.086-0.715) in the total sample of patients. However, there was significant reduction of pain, increased pain relief and/or more favourable pain relief with levetiracetam than with placebo in patients with lancinating or without touch-evoked pain (p = 0.025-0.046). This study found no effect of the anticonvulsant levetiracetam in non-selected patients with central pain in multiple sclerosis, but an effect in subgroups with specific pain symptoms was indicated.
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Studies relating occupational psychological and social factors to back pain have traditionally investigated a small number of exposure factors. The current study explored longitudinally a comprehensive set of specific psychological/social and mechanical work factors as predictors of back pain severity (defined as the product of back pain intensity and duration). Employees from 28 organizations in Norway, representing a wide variety of occupations, were surveyed with a follow-up period of 2 years. ⋯ After adjustment for age, sex, skill level, back pain severity at T1 and other exposure factors estimated to be potential confounders, the most consistent predictors of back pain were the protective factors decision control [lowest OR 0.68; 99% confidence interval (CI): 0.49-0.95], empowering leadership (lowest OR 0.59; 99% CI: 0.38-0.91) and fair leadership (lowest OR 0.54; 99% CI: 0.34-0.87). Some of the most important predictors included in this study were factors that have previously received little attention in back pain research. This emphasizes the importance of extending the list of factors possibly contributing to back pain.
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Previous studies suggest that pain management by analgesic medications may be low among children. This study aims to investigate analgesic use and its correlates among children in Germany. ⋯ Analgesic use appears to be low among children in Germany, reflecting largely the fact that pain perceived among children under ambulant care may be mild to moderate and does not need analgesic medications. As the majority of paediatric analgesics were self-medicated, use of analgesics still should be closely monitored particularly among specific subpopulations such as adolescents to avoid potential abuse.