The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial
Trajectory of Improvement in Children and Adolescents with Chronic Migraine: Results from the Cognitive Behavioral Therapy and Amitriptyline Trial.
We compared headache frequency trajectories between clinical trial participants who received cognitive-behavioral therapy (CBT) and amitriptyline (CBT+A) or headache education (HE) and amitriptyline (HE+A) to determine if there was a differential time course of treatment response between the groups. One hundred thirty-five patients (age 10-17 years) diagnosed with chronic migraine participated, attending 8 one-hour one-on-one CBT or HE sessions with a trained psychologist for 8 weekly sessions, 2 sessions at weeks 12 and 16, and a post-treatment visit at week 20. Participants kept daily headache diaries and completed take-home assignments between visits. ⋯ The CBT+A group had greater daily improvement than the HE+A group. A significantly greater proportion of the CBT+A group had a ≥50% reduction in headache days each month, and a significantly greater proportion of the CBT+A group had ≤4 headache days per month in months 3 through 5. Results indicate the trajectory of decrease in headache days is significantly better for patients receiving CBT+A versus HE+A.
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Most previous transient receptor potential vanilloid subtype 1 (TRPV1) antagonist programs have been put on hold, mainly because of on-target adverse events: hyperthermia and impaired noxious heat sensation. NEO6860 is a TRPV1 antagonist, blocking capsaicin activation of the target, with little or no effect against pH or heat activation. The hypothesis is that this pharmacological profile will translate into analgesia without undesired effects on the body temperature or heat-pain threshold. ⋯ Unlike other TRPV1 antagonists, no clinically significant increase in temperature or heat pain threshold/tolerance was noted despite thorough and specific monitoring of these parameters. At all doses, most subjects reported a sensation of "feeling hot," with a rapid onset and transient. NEO6860 showed an improvement in the pharmacodynamics parameters (evoked pain and secondary hyperalgesia) at 3 and 8 hours post NEO6860 dosing.
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Approximately 20% of children develop persistent pain after major surgery. Sleep disruption has been implicated as a predictor of children's acute postsurgical pain. However, perioperative sleep patterns have not been longitudinally assessed, and the role of sleep in persistence of postsurgical pain has not been explored. ⋯ Poorer night-time sleep quality was significantly associated with greater next day pain intensity (B = -.15, P = .005). Sleep duration and efficiency were not associated with subsequent pain; daytime pain was not associated with subsequent sleep. Findings suggest sleep quality may be an important target for intervention after surgery in children; research is needed to understand how other sleep parameters may relate to recovery.
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The current study sets forth to provide descriptive data for preschool vaccination pain responding as well as examine longitudinal relationships over early childhood. Growth mixture modeling was first used to describe stable subgroups of preschoolers on the basis of their pain response patterns over 2-minutes post-needle. Secondly, a parallel-process growth curve model was used to assess the stability of acute pain responding from 12 months of age to preschool age. ⋯ Growth mixture modeling analyses discerned 3 distinct groups of preschoolers, with an important minority not regulating to low-no pain by 2 minutes post-needle. There were no significant associations between 12-month and preschool pain responding. These results highlight the steep trajectory of development between these different stages of early childhood and the variability of pain responding at the preschool vaccination.
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Seeing one's own body has been reported to have analgesic properties. Analgesia has also been described when seeing an embodied virtual body colocated with the real one. However, there is controversy regarding whether this effect holds true when seeing an illusory-owned body part, such as during the rubber-hand illusion. ⋯ We observed a significantly higher heat pain threshold at colocation than at a 30-cm distance. The analgesic effects of seeing a virtual colocated arm were eliminated by increasing the distance between the real and the virtual arm, which explains why seeing an illusorily owned rubber arm does not consistently result in analgesia. These findings are relevant for the use of virtual reality in pain management.