Pain medicine : the official journal of the American Academy of Pain Medicine
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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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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.
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Randomized Controlled Trial Multicenter Study
A double-blind, randomized, placebo-controlled comparison of botulinum toxin type a injection sites and doses in the prevention of episodic migraine.
Several randomized, controlled studies have reported benefits of botulinum toxin type A (BoNTA; Allergan Inc., Irvine, CA, USA) over placebo in the treatment of migraine. Some studies reported significant benefits at dosages as low as 16 U, while other studies reported safety, tolerability, and efficacy at dosages up to 260 U. However, the optimal treatment paradigm and patient population have yet to be defined. ⋯ In this exploratory study of episodic migraine patients, low-dose injections of BoNTA into the frontal, temporal, and/or glabellar muscle regions were not more effective than placebo. BoNTA was safe and well tolerated. Future studies may examine higher BoNTA doses, flexible injection sites, multiple treatments, and disallow concomitant prophylactic medications.
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Randomized Controlled Trial Multicenter Study
An open-label 52-week clinical extension comparing duloxetine with routine care in patients with diabetic peripheral neuropathic pain.
To assess the safety of duloxetine at a fixed-dose of 60 mg twice daily (BID) for up to 52 weeks, and compare duloxetine with routine care in the management of patients with diabetic peripheral neuropathic pain (DPNP). ⋯ The results of this study provide support for the use of duloxetine in the long-term management of DPNP.