Pain medicine : the official journal of the American Academy of Pain Medicine
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Comparative Study
Allodynia and descending pain modulation in migraine: a resting state functional connectivity analysis.
Most migraineurs develop cutaneous allodynia during migraines, and many have cutaneous sensitization between attacks. Atypical pain modulation via the descending pain system may contribute to this sensitization and allodynia. The objective of this study was to test the hypothesis that compared with non-allodynic migraineurs, allodynic migraineurs have atypical periaqueductal gray (PAG) and nucleus cuneiformis (NCF) resting-state functional connectivity (rs-fc) with other pain processing regions. ⋯ Atypical rs-fc of brainstem descending modulatory pain regions with other brainstem and higher order pain-modulating regions is associated with migraine-related allodynia.
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Opioid adverse events are widespread, and deaths have been directly attributed to opioids prescribed by medical professionals. Little information exists on the amount of opioids various medical specialties prescribe and the opioid fatality rate that would be expected if prescription opioid-related deaths were independent of medical specialty. ⋯ Primary care providers were the most frequent prescribers and the most often associated with opioid fatalities and should be targeted for education about safe prescribing along with specialties that prescribe less frequently but are associated with a positive AR for opioid fatality.
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The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities, and it is especially high among older adults who are unable to communicate due to cognitive impairments. Although validated assessment tools exist, pain detection in this population is often done by interdisciplinary evaluation (IE), which largely relies on the subjective impression of health care providers. The aim of this study was to examine the agreement between the IE and validated observational pain tools. ⋯ These results may be explained by an inability of IE to assess pain correctly or by instruments providing false positive results. Nevertheless, as detection of pain is difficult in this population, our research supports the use of validated tools to complement assessment of pain by the IE and make sure that no pain goes undetected.
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Pain medicine still lacks mechanism-specific biomarkers to guide diagnosis and treatment, and defective top-down modulation is an important factor in the pathophysiology of chronic pain conditions. Using modern analytical tools and advanced multivariate statistical analysis, the aim of this study was to revisit two classical potential biomarkers of pro- and anti-nociception in humans (substance P and beta-endorphin), focusing particularly on the cerebrospinal fluid (CSF). ⋯ Patients with chronic neuropathic pain due to trauma or surgery had low levels of beta-endorphin in the CSF. We speculate that this could indicate a defective top-down modulation of pain in chronic neuropathic pain. Our results also illustrate the importance of taking a system-wide, multivariate approach when searching for biomarkers.