Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Effects of Different Anesthetics on Pain Processing in an Experimental Human Pain Model.
After surgical procedures, anesthesia itself may affect pain perception. Particularly, there is increasing evidence that opioids not only have analgesic effects but also provoke pronociceptive changes, that is, opioid-induced hyperalgesia. We investigated the effect of different anesthetic regimens on pain processing in volunteers using a transdermal electrical pain model. In this model, stimulation of epidermal nerve fibers representing mainly peptidergic C-nociceptors leads to secondary hyperalgesia and habituation to the stimulus. ⋯ The results suggest a short-term analgesic effect of general anesthesia. Furthermore, the conditioning stimulation over several days induced differential modulation of pro- and antinociceptive systems.
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Randomized Controlled Trial
Feasibility of Contralateral Oblique Fluoroscopy-guided Cervical Interlaminar Steroid Injections.
Cervical epidural steroid injection (CESI), given in conjunction with local anesthetics, is a common remedy for cervical radicular pain and is generally performed under c-arm fluoroscopic guidance, computed tomography (CT), or ultrasound. Interlaminar procedures, such as CESI, typically rely on anteroposterior and lateral (APL) views during needle placement. However, lateral views may be obscured by body habitus in certain individuals. Swimmer's view or contralateral oblique (CLO) view may be used to avoid this. ⋯ CLO fluoroscopy-guided CESI is feasible and safe, comparing favorably with CT-guided CESI.
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Complex regional pain syndrome (CRPS) is a disorder that is often challenging to treat and can be associated with a prolonged course of severe pain. Therapy of CRPS remains controversial; the pain often can be very difficult to control, and treatment includes medications, physical therapy, regional anesthesia, and neuromodulation. ⋯ We conclude that ST may offer a therapeutic opportunity for patients with neuropathic pain resulting from CRPS, without side effects and with minimal discomfort during treatment. The observed pain relief indicates that ST could be an effective option for such patients.
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This study aimed to identify the following: (1) the proportion of the defensive high-anxious personality type in a chronic pain population; (2) whether personality type affects the relationships between cognitive factors and disability. ⋯ The interaction between defensiveness and anxiety plays an important role in patients' perceptions of, and outcomes from, chronic pain. Differentiating the defensive high-anxious group revealed different patterns of relationship between a range of cognitive factors and disability. This highlights the necessity of assessing personality characteristics that include defensiveness in order to identify those individuals who may be more vulnerable to cognitive factors influencing their perceptions of disability. If personality type is identified as a predictor of poor adjustment, interventions could be customized to the unique needs of this group (eg. high defensive and anxious individuals).