The journal of pain : official journal of the American Pain Society
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Acute pain after breast surgery decreases the quality of life of cancer survivors. Previous studies using a variety of definitions and methods report prevalence rates between 10% and 80%, which suggests the need for a comprehensive framework that can be used to guide assessment of acute pain and pain-related outcomes after breast surgery. ⋯ PERSPECTIVE: The AAAPT provides a framework to define and guide improved assessment of acute pain after breast surgery, which will enhance generalizability of results across studies and facilitate meta-analyses and studies of interindividual variation, and underlying mechanism. It will allow researchers and clinicians to better compare between treatments, across institutions, and with other types of acute pain.
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Pain intensity ratings are subject to various cognitive modulations - yet the mechanisms underlying this influence are still not understood. In a conditioning protocol, pain-related expectations were induced through pairing predefined movements with a noxious or innocuous stimulus in either a predictable or unpredictable fashion. Healthy volunteers (N = 37) categorized the stimuli as either painful or nonpainful and rated its perceived intensity. ⋯ As such, changes in pain ratings could be based in either of these processes, which may require a different approach when targeted as part of psychological pain treatment. PERSPECTIVE: Changes in reported pain levels were linked to two distinct mechanisms, suggesting that increased pain reports could be attributed to either enhanced sensory processing or biased inferences. Our results might contribute to the development of person-tailored treatments based on the identification of latent mechanisms using computational models.
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Review Meta Analysis
Botulinum toxin type A for painful temporomandibular disorders: systematic review and meta-analysis.
This systematic review investigated the effectiveness and safety of botulinum toxin type A (BTX-A) for painful temporomandibular disorders. We searched for randomized controlled trials (RCTs) in 10 databases, from inception to February 12, 2019 (MEDLINE, EMBASE, CENTRAL, LILACS, BBO, Web of Science, Scopus, ClinicalTrials.gov, WHO and OpenGrey). We included 12 RCTs that compared BTX-A versus inactive or active interventions. ⋯ PERSPECTIVE: BTX-A for painful temporomandibular disorders appears to be well tolerated. For pain reduction, BTX-A is slightly more effective than placebo only at 1 month; conventional treatment and low-level laser at 1, 6, and 12 months. Low-quality evidence limits the applicability of these findings and precludes recommendations for practice.
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Mechanisms of below-level pain are discoverable as neural adaptations rostral to spinal injury. Accordingly, the strategy of investigations summarized here has been to characterize behavioral and neural responses to below-level stimulation over time following selective lesions of spinal gray and/or white matter. Assessments of human pain and the pain sensitivity of humans and laboratory animals following spinal injury have revealed common disruptions of pain processing. ⋯ Additional questions are raised about demyelination, epileptic discharge, autonomic activation, prolonged activity of C nocireceptive neurons, and thalamocortical plasticity in the generation of below-level pain. PERSPECTIVE: An understanding of mechanisms can direct therapeutic approaches to prevent development of below-level pain or arrest it following spinal cord injury. Among the possibilities covered here are surgical and other means of attenuating gray matter excitotoxicity and ascending propagation of excitatory influences from spinal lesions to thalamocortical systems involved in pain encoding and arousal.