Pain medicine : the official journal of the American Academy of Pain Medicine
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Case Reports
Meningitis after percutaneous radiofrequency trigeminal ganglion lesion. Case report and review of literature.
A 79-year-old man with severe trigeminal neuralgia presented to the pain clinic, and was offered a radiofrequency trigeminal ganglion lesion. He had only partial response to the first procedure, so a second was undertaken. The following day he presented with signs of meningitis and the diagnosis was confirmed on lumbar puncture. He was treated with appropriate antibiotics, and recovered well. ⋯ If breach of the oral mucosa has occurred, then antibiotic prophylaxis should be administered.
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There is growing interest in the impact of aging on the plasticity of pain responses. Up-regulation characterizes pain responses in clinical situations, and consequently aging effects on the development and resolution of increased sensitivity have important implications for the experience of pain in those older age groups who are more likely to suffer from chronic conditions. This study examined temporal summation of pain at different stimulus frequencies to gain further insights into the effect of age on pain plasticity. ⋯ The temporal summation of low-frequency stimuli in the older subjects suggests that aging impacts on the capacity of the nociceptive system to down-regulate subsequent to sensitization.
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Clinical Trial
The role of tooth-grinding in the maintenance of myofascial face pain: a test of alternate models.
While mechanisms of myofascial face pain are poorly understood, bruxism has been implicated in the maintenance of this painful disorder. This study evaluates whether evidence of one aspect of bruxism, tooth-grinding, is positively associated with pain severity, as predicted by a psychophysiological model, or negatively associated, as predicted by an adaptation model of face pain. ⋯ While these data do not address the role of clenching, they cast serious doubt on the theory that myofascial face pain is maintained by tooth-grinding.
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Editorial Comment
What do experimental pain models tell us about aging and clinical pain?
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Review Meta Analysis
Duloxetine and other antidepressants in the treatment of patients with fibromyalgia.
To review the use of duloxetine, a new selective serotonin and norepinephrine reuptake inhibitor (SNRI), and other antidepressants in the treatment of patients with fibromyalgia. ⋯ Antidepressants play an important role in the treatment of patients with fibromyalgia. Agents with dual effects on serotonin and norepinephrine appear to have more consistent benefits than selective serotonin antidepressants for the treatment of persistent pain associated with fibromyalgia.