European journal of pain : EJP
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The effect of the alpha(1)-adrenoceptor agonist phenylephrine on sensitivity to heat was investigated at three sites of mild burn injury in the cutaneous forearm of 19 healthy participants. Two of the sites were pre-treated with the alpha(1)-antagonist terazosin, to determine whether the effect of phenylephrine was mediated by alpha(1)-adrenoceptors. Terazosin was administered before the burn injury at one site, and after the burn injury at the other site. ⋯ However, neither alpha(2)-adrenoceptor stimulation nor blockade affected sensitivity to heat in the mildly burnt skin. These findings suggest that stimulation of cutaneous alpha(1)-adrenoceptors increased the excitability of heat-sensitized nociceptive afferents. As terazosin was more effective when administered in burnt skin, an inflammatory response induced by the burn injury may have facilitated access of adrenergic agents to alpha(1)-adrenoceptors.
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Walking is fundamental to many activities that are detrimentally affected by chronic pain. When in pain, people adapt how they walk. This article reports the development of an observational rating scale for the assessment of the quality of walking in adults with chronic pain called the Bath Assessment of Walking Inventory. ⋯ Validity was established in comparison with well-used measures of functioning. Further independent study is required to develop this instrument. A robust measure of walking will enable accurate clinical assessment, and the investigation of psychosocial and biomechanical influences on walking quality, and of the communicative function of pain related movement.
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Review Meta Analysis
Medication adherence in patients with chronic non-malignant pain: is there a problem?
Health care providers, treating patients with chronic non-malignant pain, often experience that medication is not as effective as expected. It is important to realize that the effectiveness of a pharmacological treatment can be influenced by the way the medication is taken. Medication adherence is a topic that gains more attention, especially in chronic conditions, because it affects treatment outcome. ⋯ Both overuse and underuse of medication occurs. However, due to the scarce literature and important methodological limitations, it is not possible to make firm conclusions concerning the impact on outcome, influencing variables and optimal intervention strategies. This review highlights some important gaps in the adherence literature in a chronic non-malignant pain population and sets the stage for future research.
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Review Multicenter Study
A structured review of the evidence for pacing as a chronic pain intervention.
Pacing as an intervention appears with great regularity in the chronic pain management literature and yet what service providers actually mean by pacing is unclear and poorly defined. This short communication reports the findings of a structured review of the literature which examined the strength of the evidence for pacing as an intervention for people with chronic pain. ⋯ Although background literature demonstrates that pacing is often one part of a multidisciplinary intervention program, the research conducted on these programs presents pacing itself as an ill- or undefined construct. It is evident from this review that "pacing," while a widely employed term, lacks consensus of definition and a demonstrable evidence-base.
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Activation of spinal cord microglia and astrocytes is a common phenomenon in nerve injury pain models and is thought to exacerbate pain perception. Following a nerve injury, a transient increase in the presence of microglia takes place while the increased numbers of astrocytes stay elevated for an extended period of time. It has been proposed that activated microglia are crucial for the development of neuropathic pain and that they lead to activation of astrocytes which then play a role in maintaining the long term pathological pain sensation. ⋯ We found that two different types of cancer induced pain resulted in severe spinal astrogliosis without activation of microglia. In contrast, sciatic nerve injury led to a transient activation of microglia and sustained astrogliosis. These results show that development of hypersensitivity and astrocyte activation in pain models can take place independent of microglial activation.