The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial Comparative Study Clinical Trial
Psychophysical outcomes from a randomized pilot study of manual, electro, and sham acupuncture treatment on experimentally induced thermal pain.
In this pilot study comparing the analgesic effects of three acupuncture modes--manual, electro, and placebo (with Streitberger placebo needles)--in a cohort of healthy subjects, we found that verum acupuncture treatment, but not placebo, lowered pain ratings in response to calibrated noxious thermal stimuli. This finding was mainly the result of highly significant analgesia in 5 of the 11 subjects who completed the 5-session study. Of the 5 responders, 2 responded only to electroacupuncture and 3 only to manual acupuncture, suggesting that acupuncture's analgesic effects on experimental pain may be dependent on both subject and mode. We developed a simple quantitative assessment tool, the Subjective Acupuncture Sensation Scale (SASS), comprised of 9 descriptors and an anxiety measure to study the relationship between the deqi sensation induced by acupuncture and the putative therapeutic effects of acupuncture. The SASS results confirm that the deqi sensation is complex, with all subjects rating multiple descriptors during each mode. We found significant correlations of analgesia with SASS ratings of numbness and soreness, but not with ratings of stabbing, throbbing, tingling, burning, heaviness, fullness, or aching. This suggests that attributes of the deqi sensation may be useful clinical indicators of effective treatment. ⋯ The results of this study indicate the existence of both individual subject and acupuncture mode variability in the analgesic effects of acupuncture. This suggests that switching acupuncture mode may be a treatment option for unresponsive patients.
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Randomized Controlled Trial Clinical Trial
Preparing for pain management: a pilot study to enhance engagement.
A significant proportion of individuals fail to engage in cognitive-behavioral treatments for pain. The aim of this pilot study was to develop and evaluate a Preparation for Pain Management Intervention administered before community-based therapy (CBT) pain management workshops. Participants (N = 78) were randomly assigned to a treatment group receiving a 2-session intervention including assessment and feedback based on the Preparation for Pain Management Profile (PPMP) or to a control group receiving assessment (treatment as usual) and an attention placebo interview in place of the feedback session. The interviews were conducted with both groups before patients were offered participation in pain management workshops. Results demonstrate that participants in the treatment group were significantly more likely to attend workshops than were participants in the control group (P < .01). ⋯ This paper describes a randomized controlled trial assessing a brief motivational intervention aimed at increasing engagement in community-based pain management workshops.
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The zinc finger transcription factor Egr1 is critical for coupling extracellular signals to changes in cellular gene expression. Expression of Egr1, as well as other immediate early genes, is up-regulated in response to a number of noxious stimuli. Activity-dependent activation of Egr1 has been reported in forebrain regions, including the anterior cingulate cortex (ACC), after peripheral injury. However, no study has reported a direct contribution of Egr1 to behavioral nociceptive responses. Here, we use Egr1 knockout mice to show that Egr1 is selectively required for behavioral responses to persistent inflammatory pain. Behavioral responses to peripheral inflammation were significantly reduced in Egr1 knockout mice, whereas responses to acute noxious stimuli were normal. In addition, inflammation triggered an up-regulation of Egr1 expression in the ACC of wild-type mice. Last, synaptic potentiation induced by theta (theta) burst stimulation in the ACC was significantly reduced or blocked in Egr1 knockout mice. Our study suggests that the transcription factor Egr1 plays a selective role in nociceptive behavioral responses to persistent inflammatory pain but not to acute noxious stimuli. ⋯ Chronic pain diminishes the quality of life. Here, we show that the immediate early gene Egr1 plays a role in chronic inflammatory, but not acute, pain. Egr1 knockout mice showed reduced nociceptive behaviors to persistent inflammatory pain and inflammation increased Egr1 expression in the anterior cingulate cortex of wild-type mice.
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We investigated how a general population treat their pain and determined factors affecting use of different pain management strategies. From the respondents of a cross-sectional postal survey we selected those who had experienced pain during the past 7 days (n = 3641) and analyzed how they had tried to manage their pain during the past 6 months. The most common pain management strategies were use of over-the-counter medicines (53% of 3641 respondents), physical exercise (52%), prescription medicines (35%), and visiting a physician (33%). The location of pain was related to which pain management strategy was chosen. Use of multiple (>4) treatments was related to prolonged pain, having several (>3) painful locations, high intensity and frequency of pain. ⋯ This study indicates that people with pain are active in trying different treatments. Self-care strategies, especially over-the-counter medicines and physical exercise, are common ways to manage pain at the population level.