Pain practice : the official journal of World Institute of Pain
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Pain facilitation as well as pain inhibition might be present in chronic pain patients. A decreased efficacy of pain inhibition can be measured by conditioned pain modulation (CPM). The use of the CPM paradigm in scientific research has boosted over the last few years and is recognized for its high clinical relevance in chronic pain patients. It is, however, unclear whether the presence of pain and possible modulations of pain influences the efficacy of endogenous pain inhibition, measured by CPM. This systematic literature study aimed to provide an overview of the effects of clinical pain and experimental pain induction or pain reduction on CPM in adults. ⋯ Analgesic medication and oral contraceptives might inhibit the CPM response, whereas there is limited evidence that pain-relieving surgery improves CPM in chronic pain patients. However, the results merely suggest that decreased CPM values (as in chronic pain patients) can improve after elimination of pain.
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Comparative Study Clinical Trial
Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches.
Ultrasound-guided nerve root blocks and transforaminal injections are well established, and several procedural feasibility studies have been reported. However, the contrast dispersion pattern during ultrasound-guided pararadicular injection has not been reported. We hypothesized that the paramedian sagittal oblique approach provides a superior intraforaminal contrast-spread pattern compared to the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine. ⋯ The paramedian sagittal oblique approach delivered a superior intraforaminal contrast-spread pattern and significantly greater pain relief than the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine.
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The objective of this study was to evaluate whether patients with fibromyalgia FM need more oxygen and more time to complete a walking and stair-climbing task than healthy volunteers and perceive the performance of these tasks as more strenuous. Furthermore, it was evaluated whether a less efficient performance is more pronounced in patients reporting a higher level of fear of movement. ⋯ In conclusion, patients with FM perceive a walking and stair-climbing task as more strenuous than healthy controls, even though they walked slower and no differences in total O2 consumption during completion of both tasks were found.
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Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. ⋯ Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes.
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The aim of this study was to investigate the severity and the natural course of masticatory muscles weakness that developed after CT-guided percutaneous trigeminal radiofrequency thermocoagulation (PT-RFT) for the treatment of idiopathic trigeminal neuralgia (ITN). ⋯ CT-guided PT-RFT for ITN remains an effective and safe surgical procedure, but there is a high rate of temporary masticatory dysfunction during a short time after procedure, appearing to be reversible in a period of 12 months.