Articles: hyperalgesia.
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Clinical rheumatology · Jun 2015
Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia.
Chronic widespread pain is highly present in patients with the Ehlers-Danlos syndrome hypermobility type (EDS-HT), but up to now, evidence for generalized hyperalgesia is lacking. The aim of this study is to investigate whether pressure pain thresholds (PPTs) at both symptomatic and asymptomatic body areas differ in EDS-HT patients compared to healthy subjects. Twenty-three women with EDS-HT and 23 gender- and age-matched healthy controls participated. ⋯ In half of the patient group, a predominantly neuropathic pain component was likely present. This study provides evidence for the existence of hyperalgesia even in asymptomatic areas (generalized secondary hyperalgesia). The generalized hyperalgesia may represent the involvement of a sensitized central nervous system, which inquires an adapted pain management for this patient group.
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Damage on one side of the body can also result in pain on the contralateral unaffected side, called mirror-image pain (MIP). Currently, the mechanisms responsible for the development of MIP are unknown. In this study, we investigated the involvement of spinal microglia and interleukin-1β (IL-1β) in the development of MIP using a peripheral inflammatory pain model. ⋯ However, i.t. pretreatment with fluorocitrate, an astrocyte inhibitor, restored minocycline- or IL-1ra-induced contralateral MA. These results suggest that spinal IL-1β derived from activated microglia temporarily suppresses astrocyte activation, which can ultimately prevent the development of contralateral MA under inflammatory conditions. These findings imply that microglial IL-1β plays an important role in regulating the induction of inflammatory MIP.
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Patients receiving chronic opioid treatment who develop paradoxical pain sensations, as well as worsening existing pain, can be diagnosed as suffering from opioid-induced hyperalgesia (OIH). As the worldwide population expands so too does the proportion of patients who experience pain that requires a strong opioid. Recognizing the symptoms of OIH and optimizing the use of morphine in the hospital setting is imperative. This review focuses on clinical data relating to evidence of OIH at the bedside and the novel techniques employed by healthcare providers in order to improve the heightened pain sensations experienced by susceptible patients. ⋯ Looking to the future, improved clinician-patient communication, advanced diagnostic techniques and a refinement of prescribed adjunct pharmacotherapies will offer the most successful multimodal pain management approach to the problem of OIH.
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Randomized Controlled Trial
Evaluation of the effect of ketamine on remifentanil-induced hyperalgesia: a double-blind, randomized study.
Opioids are associated with hyperalgesia that can reduce their analgesic effect. The aim of this study was to determine whether the addition of ketamine reduces remifentanil-induced hyperalgesia; improves its analgesic effect; and alters interleukin 6 (IL-6), IL-8, and IL-10 levels. ⋯ It was not possible to demonstrate that the addition of ketamine (5 μg/kg per minute) is effective in preventing or reducing remifentanil-induced postoperative hyperalgesia in laparoscopic cholecystectomy.