The journal of pain : official journal of the American Pain Society
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Pain epidemiologists have, thus far, devoted scant attention to geospatial analyses of pain. Both cross-national and, especially, subnational variation in pain have been understudied, even though geographic comparisons could shed light on social factors that increase or mitigate pain. This study presents the first comparative analysis of pain in the U. S. and Canada, comparing the countries in aggregate, while also analyzing variation across states and provinces. ⋯ PERSPECTIVE: This study documents the high pain burden in the U. S. versus Canada, and points to states in the Deep South, Appalachia, and parts of the West as having particularly high pain burden. The findings identify geographic areas with a high need for pain prevention and management.
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Studies indicate that classical and operant conditioning have potential to play a role in the formation of the allodynic effect. Only a few studies have examined the role of observational learning in pain induction. Due to some methodological challenges, evidence that the allodynic effect can be learned through observation is limited. ⋯ This research may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it. PERSPECTIVE: This article presents study results on the role of observational learning in allodynia induction without tissue injury. The results may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it.
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The spinal mechanisms of visceral hypersensitivity are poorly understood, particularly when there is an interaction with somatic systems. Recently we demonstrated that rats which were pretreated with neonatal bladder inflammation (NBI) and subsequently pretreated as adults with bladder re-inflammation had augmented reflex and neuronal responses to urinary bladder distension via a corticotropin-releasing factor receptor type II (CRFR2) mechanism. Another insult producing similar augmented responses is somatic inflammation induced by Complete Freund's Adjuvant (CFA) in the hindlimb. ⋯ PERSPECTIVE: Bladder hypersensitivity occurs following neonatal cystitis and an adult insult such as somatic inflammation. This paper demonstrates that CRFR2-related mechanisms are associated with this hypersensitivity. This supports the therapeutic value of these agents in the treatment of painful bladder disorders, particularly when triggered by somatic events.
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Although numerous studies have described botulinum toxin type A (BTX-A) efficacy against trigeminal neuralgia (TN), the underlying cellular mechanisms remain unclear. We have investigated cellular mechanisms that mediate the antinociceptive effect of BTX-A in a rodent model of TN produced by compression of the trigeminal nerve root (TNR). Anesthetized male Sprague-Dawley rats were fixed in a stereotaxic instrument and compression of the TNR was then achieved with a 4% agar solution. ⋯ These findings indicate that the antinociceptive effect of BTX-A is mediated via HIF-1α associated cytokines modulation in the TG and is therefore a potentially relevant treatment strategy for TN. PERSPECTIVE: The antinociceptive properties of BTX-A in a rat model of trigeminal neuralgia are mediated through the regulation of the HIF-1α associated cytokine pathway in the trigeminal ganglion. BTX-A is therefore a potentially effective treatment strategy for trigeminal neuralgia.
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Randomized Controlled Trial Observational Study
Applying the Rapid OPPERA Algorithm to Predict Persistent Pain Outcomes among a Cohort of Women Undergoing Breast Cancer Surgery.
Persistent postmastectomy pain after breast surgery is variable in duration and severity across patients, due in part to interindividual variability in pain processing. The Rapid OPPERA Algorithm (ROPA) empirically identified 3 clusters of patients with different risk of chronic pain based on 4 key psychophysical and psychosocial characteristics. We aimed to test this type of group-based clustering within in a perioperative cohort undergoing breast surgery to investigate differences in postsurgical pain outcomes. ⋯ Findings suggest that patient characteristic-based clustering algorithms, like ROPA, may generalize across diverse diagnoses and clinical settings, indicating the importance of "person type" in understanding pain variability. PERSPECTIVE: This article presents the practical translation of a previously developed patient clustering solution, based within a chronic pain cohort, to a perioperative cohort of women undergoing breast cancer surgery. Such preoperative characterization could potentially help clinicians apply personalized interventions based on predictions concerning postsurgical pain.