Pain medicine : the official journal of the American Academy of Pain Medicine
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An extensive neuroimaging literature on chronic pain demonstrates increased cerebral blood flow and metabolism consistent with increased neuronal activity in the structures comprising the "pain matrix"; furthermore, some of these regions have been shown to encode pain intensity. It is the objective of this study to demonstrate the feasibility of using quantitative electroencephalography (EEG) source localization to reflect and to quantify activity in the pain matrix. ⋯ The areas that were activated in the high pain state localized to the same regions reported by other neuroimaging methods and with frequency specificity. The frequency and regionally specific activation may indicate distinctive patterns of pathophysiology underlying the pain matrix. Although in a small number of patients, this work suggests that QEEG may be a useful tool in the exploration and quantification of the pain matrix in a clinical setting.
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Case Reports
Pregabalin assay in a patient with widespread neuropathic pain and late onset gluten intolerance.
The aim of this study was to determine the pharmacokinetics of pregabalin in a patient with malabsorption secondary to celiac disease and compare the findings with the data available from pre-existing studies in healthy volunteer controls. ⋯ Although the results obtained are encouraging, the wide spectrum of effects and interactions of various drugs in malabsorption would suggest that therapy of any kind should be considered at individual level and monitored with blood assays.
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Randomized Controlled Trial
Intra- and postoperative very low dose intravenous ketamine infusion does not increase pain relief after major spine surgery in patients with preoperative narcotic analgesic intake.
This study aims to demonstrate the analgesic efficacy and opioid-sparing effect of low dose ketamine in patients with preoperative narcotic intake undergoing major spine surgery. ⋯ The addition of IV very low dose ketamine infusion regimen did not improve postoperative analgesia. Side effects were not increased with low dose ketamine.
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Randomized Controlled Trial
Efficacy of subcutaneous methylnaltrexone in the treatment of opioid-induced constipation: a responder post hoc analysis.
Methylnaltrexone, a selective peripherally acting mu-opioid receptor antagonist, effectively treats opioid-induced constipation (OIC) in patients with advanced illness and shows efficacy in patients with chronic nonmalignant pain. The objective was to identify patients who achieved maximal treatment effect based on response to initial four methylnaltrexone doses. ⋯ Early response to ≥2 of first four doses of methylnaltrexone identified patients who demonstrated a particularly robust effect of treatment over the duration of use.
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Review
An evolutionary stress-response hypothesis for chronic widespread pain (fibromyalgia syndrome).
The study aimed to seek a unifying biological basis for the phenomena encompassed in fibromyalgia syndrome (chronic widespread pain and associated morbidities). ⋯ Drawing on diverse findings in neurobiology, immunology, physiology, and comparative biology, we suggest that the form of central sensitization that leads to the profound phenomenological features of chronic widespread pain is part of a whole-organism stress response, which is evolutionarily conserved, following a general pattern found in the simplest living systems.