European journal of pain : EJP
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Chronic pelvic pain (CPP) in women is a long-lasting condition. ⋯ At a 3 year follow-up, improvement in pain intensity in women with CPP was not associated with baseline pain appraisals and coping strategies. A reduction in catastrophizing was related to better outcome in the long term.
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Cutaneous C-fiber afferents show two distinct types of cold sensitivity corresponding to non-noxious and noxious cold sensations. Here, responses to cold stimulation of afferent fibers regenerating in the rat sural nerve were studied in vivo 7-14 days after nerve crush and compared with responses to mechanical and heat stimulation. The physiological stimuli were applied to the sural nerve at or distal to the lesion site. ⋯ They were also heat-sensitive (n=25) and/or mechanosensitive (n=20). These C-fibers were, apart from their cold sensitivity, functionally indistinguishable from C-fibers with mechano- and/or heat sensitivity only. Thus regenerating cutaneous C-fibers show two types of cold sensitivity similar to those observed in intact skin: fibers of one group are predominantly sensitive to cooling, whereas the others are polymodal.
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The aim of this study was to determine the analgesic effect of gabapentin and tiagabine - two antiepileptic drugs, administered alone and in combination at the fixed-ratio of 1:1, in two phases of the formalin test in mice. Log-probit analysis was used to evaluate dose-response effects and calculate the ED(50) values for gabapentin, tiagabine, and their combination at the fixed-ratio of 1:1 in the phases I and II of the formalin test in mice. The types of interactions between both antiepileptic drugs were characterized using the isobolographic analysis. ⋯ With isobolography, the ED(50 mix) values at the fixed-ratio combination of 1:1 were 7.30 mg/kg (phase I) and 0.48 mg/kg (phase II), indicating both additive and supra-additive (synergistic) interactions between gabapentin and tiagabine in the formalin test in mice. In conclusion, the combination of gabapentin with tiagabine at the fixed-ratio of 1:1 exerted additive interaction in the phase I and synergistic interaction in the phase II of the formalin test in mice. If the results from this study could be extrapolated to clinical settings, the combination of tiagabine with gabapentin might be beneficial in the pain relief in humans.
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Loss of function is usually considered the major consequence of spinal cord injury (SCI). However, pain severely compromises the quality of life in nearly 70% of SCI patients. The principal aim of this study was to assess the contribution of Tumor necrosis factor alpha (TNF-alpha) to SCI pain. ⋯ Furthermore, minocycline decreased the expression of noxious-stimulation-induced c-Fos, suggesting an effect on evoked neuronal activity. This study demonstrates that TNF-alpha plays an important role in the establishment of neuropathic pain following SCI, seemingly dependent on microglial activation. Pharmacological targeting of TNF-alpha may offer therapeutic opportunities for treating SCI pain.
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Randomized Controlled Trial Comparative Study
Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam.
The effects of nefopam and ketamine on pain control and rehabilitation after total knee replacement were compared in a prospective, double blinded study. Seventy-five patients were randomly assigned to receive a 0.2mg kg(-1) bolus of nefopam or ketamine, followed by a 120microg kg(-1) h(-1) continuous infusion until the end of surgery, and 60microg kg(-1) h(-1) until the second postoperative day, or an equal volume of saline considered as placebo. Pain scores measured on a visual analog scale at rest and on mobilization, and patient-controlled intravenous morphine consumption, were assessed during 48h. ⋯ Ketamine improved knee flexion on post operative day 3 (59 degrees [33-63] vs. 50 degrees [47-55] and 50 degrees [44-55] in ketamine, placebo and nefopam groups, respectively, p<0.0002) and decreased the delay to flex the knee at 90 degrees (9.1+/-4.2 vs. 12.3+/-4.0 days, in ketamine and placebo groups, respectively, p=0.01). Ketamine produces opioid-sparing, decreases pain intensity, and improves mobilization after total knee replacement. Nefopam achieves less significant results in that circumstances.