European journal of pain : EJP
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Randomized Controlled Trial
Effects of low-dose intranasal (S)-ketamine in patients with neuropathic pain.
NMDA receptors are involved in the development and maintenance of neuropathic pain. We evaluated the efficacy and safety of intranasal (S)-ketamine, one of the most potent clinically available NMDA receptor antagonists. ⋯ Intranasal administration of low dose (S)-ketamine rapidly induces adequate plasma concentrations of (S)-ketamine and subsequently of its metabolite (S)-norketamine. The time course of analgesia correlated with plasma concentrations.
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Randomized Controlled Trial
The role of current mood and stop rules on physical task performance: an experimental investigation in patients with work-related upper extremity pain.
Patients with work-related upper extremity pain (WRUED) experience disability in daily life activities. The factors that influence levels of disability are still unclear. Both excessive avoidance and persistence have been suggested, but the affective and motivational processes that underlie these behaviours have not been scrutinized. ⋯ Results showed that physical task performance was predicted by pain-related fear, current mood, stop rule. However, the predicted moodxstop rule interaction was not found, and there was no influence of gender, pain severity, and pain catastrophizing on task performance. The findings suggest that not only pain-related fear, but current mood and goal context factors independently affect physical performance in patients with WRUED.
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Comparative Study
A comparison of anatomical pain sites from a tertiary care sample: evidence of disconnect between functional and perceived disability specific to lower back pain.
Heterogeneity has been identified within chronic musculoskeletal pain (CMP) patient samples; however, investigations have typically focused on psychological constructs or coping (e.g., pain-related anxiety, catastrophizing) in this regard. Furthermore, studies to date have included either samples presenting with a specific anatomical site (e.g., only lower back pain) or a mix of anatomical sites (e.g., lower back, shoulder, or leg pain) as the primary pain complaint, without making comparisons based on the anatomical site of reported pain. For example, patients with chronic lower back pain (CLBP) may differ from those with chronic upper or lower extremity pain (ULEP) in presentation, recovery trajectory, and psychological variables. ⋯ Specifically, CLBP patients reported increasing perceived disability despite improvements in functional deficit, whereas ULEP patients did not. These findings suggest a disconnect between perceived disability and function that may be specific to lower back pain. Implications and directions for future research are discussed.
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A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. ⋯ Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
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Recent studies indicate that adolescents often experience musculoskeletal pains in two or more body locations. However, previous studies have mainly focused on localized pains, and the determinants of multiple musculoskeletal pains in adolescents are not well known. The present study was set to evaluate the role of psychosocial, mechanical, and metabolic factors in adolescents' musculoskeletal pains in multiple locations. ⋯ A high number of psychosocial, mechanical and metabolic factors associated strongly with multiple pains. In conclusion, multiple musculoskeletal pains were strongly associated with psychosocial complaints, but also with mechanical and metabolic factors. Reported musculoskeletal pains in multiple locations in adolescence may have both peripheral (trauma, decreased regenerative ability) and central (sensitivity) causes.