European journal of pain : EJP
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The present study investigated the effects of different doses of intrathecal lidocaine on established thermal hyperalgesia and tactile allodynia in the chronic constriction injury model of neuropathic pain, defined the effective drug dose range, the duration of pain-relief effects, and the influence of this treatment on the body and tissues. Male Sprague-Dawley rats were divided into five groups and received intrathecal saline or lidocaine (2, 6.5, 15, and 35 mg/kg) 7 days after loose sciatic ligation. Respiratory depression and hemodynamic instability were found to become more severe as doses of lidocaine increased during intrathecal therapy. ⋯ These findings indicate that intrathecal lidocaine has prolonged therapeutic effects on established neuropathic pain. The balance between sympathetic and parasympathetic nervous activities could be well preserved in most cases, except for 35 mg/kg. Considering the ratio between useful effects and side effects, doses of 15 mg/kg are suitable for intrathecal injection for relief of neuropathic pain.
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Electrical low-frequency stimulation (LFS) of spinal afferents induces long-term depression (LTD) of nociceptive processing in rodents. LTD and its parameters in man are largely unknown. This study addresses the hypothesis that LTD of spinal nociception and pain in man depends on LFS frequency (0.5, 1, 2 Hz), number of electrical pulses (300, 600, 1200), intensity (relating to pain threshold I(P): 1 x I(P), 2 x I(P), 4 x I(P)), and on LFS repetition. ⋯ LFS with intensities 2 x I(P) and 4 x I(P) evoked sustained depression of SEP and pain perception in comparison to Control and 1 x I(P) LFS. Established LTD after single LFS was amplified by an additional second LFS. Hence this study provides electrophysiological and psychophysical evidence for LTD of spinal nociceptive processing and pain perception in man and indicates appropriate LFS parameters 1 Hz, 1200 pulses and 4 x I(P) for future studies on human LTD.
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Review Multicenter Study
Biphosphonates for the therapy of complex regional pain syndrome I--systematic review.
Several studies found that biphosphonates counteract locally increased bone resorption and associated pain in patients with complex regional pain syndrome I (CRPS I). We performed a systematic review of all randomised controlled trials to assess the benefit of biphosphonates in the treatment of CRPS I patients with bone loss. ⋯ The very limited data reviewed showed that bisphosphonates have the potential to reduce pain associated with bone loss in patients with CRPS I. However, at present there is not sufficient evidence to recommend their use in practice.
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Comparative Study
A comparison of the knowledge of chronic pain and its management between final year physiotherapy and medical students.
The scientific literature reveals a surprising lack of knowledge of chronic pain mechanisms and its management amongst health care professionals, including physicians and physiotherapists. There is little information directly related to a comparison between medical and physiotherapy students' knowledge of chronic pain. This study aimed to determine and compare the level of knowledge of chronic pain and its management between final year medical (n=126) and physiotherapy students (n=62). ⋯ This will offer students from different disciplines opportunities to understand their different roles and enhance each others' learning base so that a biopsychosocial framework of care can be implemented. In this way, physiotherapists could learn more about the drug management of chronic pain and medical students could explore more collaborative patient-centred paradigms that address issues such as self-efficacy, self-management and patient empowerment. More focus needs to be paid to the education of the health professionals regarding their assumptions and understanding what 'vulnerable' means in a tissue in comparison to a person.
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Previously, it was shown that school-aged (9-14 yr) preterm and fullterm children with neonatal pain exposure exhibit elevated heat pain thresholds and heightened perceptual sensitization to tonic painful heat when tested under standard conditions [Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H. Long-term alteration of pain sensitivity in school-aged children with early pain experiences. Pain 2006;125:278-85]. ⋯ Control children habituated significantly more to tonic heat when their mother was present. The NICU children showed overall significantly less habituation than the controls; there was no modulating effect of maternal presence. Especially in highly vulnerable children such as preterms, neonatal pain exposure and prolonged hospitalization may, aside from neuronal plasticity, promote maladaptive pain-related cognitions and foster parental behavior that reinforces the child's pain response.