European journal of pain : EJP
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Injured sensory axons trapped in a neuroma or freely regenerating in the distal nerve stump, frequently display ectopic mechanosensitivity, spontaneous impulse discharge or both. This abnormal neural activity is thought to contribute to spontaneous and movement-evoked neuropathic paraesthesias, dysaesthesias and pain, as well as to allodynia and hyperalgesia. ⋯ This suggests that mechanosensitivity and spontaneous firing are aspects of a single underlying pathophysiological process. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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To elucidate neurophysiological mechanisms of persistent pain induced by tissue injury, the present study was designed to investigate the effects of s.c. bee venom injection on responses of the dorsal horn nociceptive neurons and those of behavior in anesthetized and awake cats, respectively. A parallel comparative study was also performed to compare the effects of s.c. bee venom and formalin injections on neuronal responses by using an extracellular single-unit recording technique. The present results showed that s.c. bee venom injection into the peripheral cutaneous receptive field resulted in a protracted, tonic monophase of increase in spike responses of wide-dynamic-range (WDR) neurons for more than 1 h, while injection of the same volume of vehicle did not have such an effect. ⋯ Comparative studies showed that the duration and frequency of the bee venom-induced neuronal responses were comparable to those induced by s.c. formalin; however, responses of WDR neurons to mechanical stimuli applied to the injection site of the two chemical agents were quite different. Bee venom produced a significant enhancement of mechanical responses of WDR neurons, while, on the contrary, formalin produced a desensitization of sensory receptors in the injection site, suggesting that the two tonic pain models may have different underlying mechanisms. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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This study investigates the relationship between depression and continuous pain after lumbar surgery by means of the Beck Depression Inventory (BDI). To assess the possibility that some somatic symptoms are confounded with pain, the items of the inventory were divided into a cognitive-affective and somatic subscale. Data analysis is based on two assumptions: (1) continuous pain after surgery is more closely related to the somatic subscale than to the cognitive-affective subscale of the BDI; and (2) postsurgical pain can be better predicted by the somatic than by the cognitive-affective subscale presurgery. ⋯ Regarding the subscales, the cognitive-affective scale, but not the somatic scale, was related to surgical outcome in this sample. The relationship between presurgical depression and pain at follow-up failed to reach statistical significance in the nucleotomy sample. It is concluded that lack of awareness of the confounding effects of somatic items in questionnaires for the assessment of mood may contribute to erroneous conclusions drawn from studies reported in the literature.
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Randomized Controlled Trial Clinical Trial
Comparison of topical anaesthesia methods for venous cannulation in adults.
A prospective, randomized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation. The study was double-blinded to the degree that the methodologies allowed. One hundred and fifty healthy adults undergoing elective surgery were allocated at random to five groups: EMLA cream, ethyl chloride spray, intracutaneous infiltration with 2% lidocaine, placebo cream and no treatment. ⋯ Spray did not significantly lower puncture pain (26.5) and, in addition, was associated with discomfort (10.5). In adults, EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation. Local lidocaine infiltration is impaired by applicational pain, whereas spraying the puncture site with ethyl chloride has no analgesic benefit.
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Randomized Controlled Trial Clinical Trial
Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial.
Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain, a multidisciplinary rehabilitation programme for an outpatient group setting was developed. The main treatment components address the patient's physical functional capacity (functional restoring), cognitive and affective processes (pain management strategies), and behavioural and ergonomical aspects (back school elements). Short-term (immediately after intervention) and long-term effects (at 6-months follow-up) of the intervention were assessed in a randomized controlled study. ⋯ In contrast to post-treatment results, there were also significant improvements in strength and endurance. Overall results testify to the effectiveness of the intervention programme. Future studies (with larger sample sizes) should aim at a further improvement of functional capacity and disability perception, an analysis of differential treatment effects, and strategies for an improved long-term maintenance of the changes induced by the programme.