European journal of pain : EJP
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Pain behaviour can hamper rehabilitation. The aim of this study was to explore the phenomenon of pain behaviour in an unselected group of immigrant patients on >6 weeks of sick leave before and after a transcultural treatment programme in primary care. Anxiety about pain and pain behaviour-i.e. > or = 1.5 points on the University of Alabama in Birmingham (UAB) scale with scores of 0-10-were noted before and after treatment. ⋯ After treatment, only persons reporting persistent anxiety about pain showed a significant OR for pain behaviour (OR 3.05; 95% CI 1.49-6.23, adjusted for sex). In conclusion, pain behaviour was common in this group of immigrant patients < or = 45 years of age on long-term sick leave. Anxiety about pain and full-time sick leave for more than 1 year significantly predicted pain behaviour.
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To examine the cognitive processing differences in chronic and episodic pain sufferers, auditory event-related potentials (P300 or P3) were recorded in two consecutive trials from 23 chronic lower back pain patients, 22 episodic tension-type headache sufferers, and from 23 age- and sex-matched healthy persons. P3 latency and amplitude showed no difference between groups at first trial. Considering P3 latency habituation, healthy controls and episodic tension-type headache sufferers showed a significant change of P3 latency whereas lower back pain sufferers failed. ⋯ These results may point to a disturbed attentional processing in chronic pain sufferers. Our findings suggest that in spite of a similar cortical information processing, the neurocognitive networks related with decision making and memory processing seem to work differently in chronic pain sufferers from those in episodic pain sufferers in repeating tasks. Taking into consideration the reported P3 habituation abnormalities in chronic migraine patients we can say that not the location of pain but rather its temporal pattern may have a role in disturbed attentional processing.
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Meta Analysis
Efficacy of spinal cord stimulation: 10 years of experience in a pain centre in Belgium.
Spinal cord stimulation is a minimally invasive mode of treatment in the management of certain forms of chronic pain that do not respond to conventional pain therapy. Several authors have reported encouraging findings with this technique. Over a 10-year period in a single centre, 254 patients were subjected to a trial period of spinal cord stimulation with an externalized pulse generator. ⋯ The aim of this study was to evaluate the efficacy of an implanted spinal cord stimulation system in terms of pain relief and quality of life and to assess the accuracy of the patient selection criteria. The results of this study demonstrate a high success rate as evaluated by the patients' own assessments--68% of the patients rated the result of the treatment as excellent to good after an average follow-up of almost 4 years. The resumption of work by 31% of patients who had been working before the onset of pain supports these positive findings.
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Review
The truth about pain management: the difference between a pain patient and an addicted patient.
Pain is undertreated in all parts of the world. Multiple barriers exist that prevent valid treatment of the pain patient. ⋯ The physiological benefits of using long- versus short-acting opioids will be presented. With proper education of the medical community, patients should receive humane and compassionate treatment of their chronic pain syndromes.
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We have examined a hemispherectomized patient who complained of touch-evoked pricking and burning pain in her paretic hand, especially when the hand was cold. Psychophysical examination showed that for the paretic side she confused cool and warm temperatures, and confirmed that she had a robust allodynia to brush stroking that was enhanced at a cold ambient temperature. ⋯ The fMRI findings thus indicate that the central pain in this patient was served by brain structures implicated in normal pain processing. Possible pathophysiological mechanisms include plasticity as well as thalamic disinhibition.