The journal of pain : official journal of the American Pain Society
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Abdominal and pelvic pain are common symptoms prompting medical care, yet little is known about their associated medical expenditures in the U. S. This study estimated the overall and age-specific incremental medical expenditures associated with abdominal and pelvic pain, and compared if the incremental expenditures differ by sex and presence of comorbid overlapping pain conditions. ⋯ PERSPECTIVE: Our nationwide study quantified the economic burden of abdominal and pelvic pain in the U. S., identifying key demographic and clinical cost drivers. Findings highlight the significant lifetime burden, the importance of pain management, the need to reduce costs for patients with overlapping pain, and the necessity of ongoing cost surveillance.
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Working memory impairments are common in chronic low back pain and are linked to increased pain severity. Reduced working memory may contribute to chronic pain by disrupting the ability to contextualize threat and modulate pain. These processes involve the dorsolateral prefrontal cortex and its interaction with the periaqueductal gray. ⋯ This highlights cognitive-pain interactions and the potential of targeting working memory and this pathway for therapy. Perspective This article presents evidence that low working memory is associated with abnormalities in activations and connectivity in the pain modulation pathways in people with chronic low back pain. These changes predict chronic pain severity indicating a potential association between working memory, pain modulation pathways and chronic pain severity.
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Chemotherapy-induced peripheral neuropathy is a debilitating pathology affecting a majority of patients who are being treated with specific cytostatic compounds including oxaliplatin. Various in vitro, ex vivo and in vivo preclinical experiments indicate that transient receptor potential ankyrin 1 (TRPA1) plays a crucial role in the symptomatology of chemotherapy-induced peripheral neuropathy. However, it is unclear whether oxaliplatin also modulates the TRPA1 functionality in the skin of rodents or patients. ⋯ Likewise, also in patients with chronic chemotherapy-induced peripheral neuropathy after oxaliplatin, the response to cinnamaldehyde was significantly higher compared to sex- and age-matched healthy controls. Thereby, this study is the first to translate the evidence of increased TRPA1 functionality in vitro or ex vivo in rodents to in vivo conditions in human. The increased TRPA1 functionality in patients with chronic chemotherapy-induced peripheral neuropathy does not only confirm the potential of TRPA1 as target to hit to provide efficacious analgesia, it also paves the way for additional patient stratification on a molecular level and possible treatment response prediction.
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Chronic pain is an ill-defined disease with complex biopsychosocial aspects, posing treatment challenges. We hypothesized that treatment failure results, at least partly, from limited understanding of diverse patient subgroups. We aimed to identify subgroups using psychological variables, allowing for more tailored interventions. ⋯ PERSPECTIVE: Hierarchical clustering of chronic pain patients identified three subgroups with similar pain intensity and diagnoses but distinct psychosocial traits. One group with higher psychological burden showed poorer treatment outcomes. A web-based tool using this model could help clinicians tailor therapies by matching interventions to specific patient subgroups for improved outcomes.
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Millions of Americans live with chronic inflammatory pain conditions, and the prevalence of these conditions increases with age and is higher in females. Still, it is poorly understood how sex, age and peripheral gene expression affect the trajectory of chronic inflammatory pain conditions. We used the inflammatory agent, Complete Freund's Adjuvant (CFA), to systematically test sex and age effects on mechanical and thermal sensitivity in adolescent and adult male and female Wistar rats over 3 weeks (Experiment 1 [onset]) or 11 weeks (Experiment 2 [recovery]). ⋯ Our results demonstrate apparent sex and age differences in the trajectory of chronic inflammatory pain-related behavior and gene expression in the affected paw of rats. PERSPECTIVE: This article highlights sex and age differences in the trajectory of chronic inflammatory pain and possible peripheral mechanisms driving recovery in Wistar rats. This data could be used to better understand recovery patterns in patients with this type of pain and provides a starting point for assessment of novel treatments.