Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
A new muscle pain detection device to diagnose muscles as a source of back and/or neck pain.
Trigger point (TrPs) identification has become the mainstay of diagnosis for the treatment of Myofascial Pain Syndrome; however, manual pressure (MP) to identify TrPs by determining low-pressure pain threshold has low interrater reliability and may lack validity since it is done on inactive muscles. To elicit contractions and mimic an active muscle or movement that "causes" pain, a Muscle Pain Detection Device (MPDD) has been developed. A selected muscle is stimulated and painful muscles are precisely detected, allowing distinctions between primary and referred muscle pain as well as distinguishing other functional muscle pain thought to cause MPS. ⋯ Using the MPDD appears to be more valid and potentially more reliable than palpation to identify muscles causing regional pain that could benefit from injections.
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The present study builds on research to model abusers' perceptions of particular analgesics' attractiveness for abuse and extends these methods to derive an estimate of attractiveness for abuse of a not-yet-marketed abuse-deterrent formulation (ADF) of a prescription opioid (Remoxy), Pain Therapeutics, Inc., San Mateo, CA, and King Pharmaceuticals, Inc., Bristol, TN). In a previous study, the Opioid Attractiveness Technology Scaling (OATS) method identified, from a drug abuser's point of view, the particular features of a prescription opioid relevant to its attractiveness for recreational use. A second online sample rated the extent to which these features applied to particular products they had actually used/abused. These data were used to model the abusers' overall preference for prescription opioids they had used/abused. ⋯ The OATS method shows promise for providing pre-marketing estimates of attractiveness for abuse of not-yet-marketed ADFs.
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We report a case of central pain successfully treated by epidural placement of spinal cord stimulator electrodes. Neuromodulation of primary afferent fibers and the underlying dorsal root entry zone provided effective analgesia whereas traditional lead placement over the dorsal columns on a prior occasion had not been effective. The rationale for this technique based on current understanding of the mechanisms of central pain and the risk/benefit considerations are discussed. ⋯ Lateral-lead spinal cord stimulation may be effective for some central pain syndromes through a partial restoration of homeostatic small-fiber signaling. Neuroanatomical and physiological data in a larger population of patients will be required to predict the best responders to this therapeutic modality.
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To determine whether ranolazine, a new anti-angina medication, could be an effective analgesic agent in complete Freund's adjuvant-induced inflammatory pain. ⋯ Ranolazine's potential as a new option for managing both angina and chronic inflammatory pain warrants further study.
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Comparative Study
An open pilot study assessing the benefits of quetiapine for the prevention of migraine refractory to the combination of atenolol, nortriptyline, and flunarizine.
Migraine is a prevalent neurological disorder. Although prevention is the core of treatment for most, some patients are refractory to standard therapies. Accordingly, the aim of this study was to evaluate the use of Quetiapine (QTP) in the preventive treatment of refractory migraine, defined as previous unresponsiveness to the combination of atenolol, nortriptyline, and flunarizine. ⋯ Although limited by the open design, this study provides pilot data to support the use of QTP in the preventive treatment of refractory migraine. Controlled studies are necessary to confirm these observations.