Articles: pain-clinics.
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Children and adolescents attending health care due to chronic pain commonly presents with insomnia. Previous research suggests that problems with sleep are associated with depression and functional disability. However, more research is needed to clarify the relationship between pain, insomnia and disability. ⋯ Insomnia is highly important in explaining depression and functional disability in paediatric chronic pain and can be adequately assessed using the ISI.
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Fibromyalgia syndrome (FMS) is a common and intriguing condition, manifest by chronic pain and fatigue. Although the pathogenesis of FMS is not yet completely understood, predicting the future development of FMS and chronic pain is a major challenge with great potential advantages, both from an individual as well as an epidemiological standpoint. Current knowledge indicates a genetic underpinning for FMS, and as increasing data are accumulated regarding the genetics involved, the prospect of utilizing these data for prediction becomes ever more attractive. ⋯ Functional neuroimaging may help to elucidate the neural processes involved in central sensitization, and may ultimately also evolve into markers of predictive value. Last but not least, obesity and disturbed sleep are clinical (inter-related) features relevant for this spectrum. Future efforts will aim at integrating genetic, clinical and physiological data in the prediction of FMS and chronic pain.
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Anesthesia and analgesia · Sep 2014
Observational StudyA Prospective Observational Study Evaluating the Ability of Prelabor Psychological Tests to Predict Labor Pain, Epidural Analgesic Consumption, and Maternal Satisfaction.
Psychological characteristics may affect interpretation and expression of pain. In this study, we sought to determine whether validated psychological tests predict the labor pain experience. ⋯ Personality traits (psychoticism, extroversion, and lying), as well as scaled ratings of anxiety, confidence, and analgesia expectations, show some potential to predict labor pain, epidural local anesthetic use, and time to epidural analgesia request. Although ASI was included in the final model for labor pain AUC, and FPQ and PCS were not, further study is required to determine whether ASI is a better predictor than FPQ or PCS.
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Peripheral nerve injury increases the excitability of primary sensory neurons. This triggers the onset of neuropathic pain and maintains its persistence. Because changes in hyperpolarization-activated cyclic nucleotide-gated cation (HCN) channels are implicated in this process, we examined the action of the heart-rate-reducing agent, ivabradine, a clinically approved HCN blocker, in the rat chronic constriction injury (CCI) model of neuropathic pain. ⋯ Because ivabradine is effective at an oral dose that produces only moderate pharmacological heart rate reduction, and this is known to be well tolerated in a clinical context, these results underline its possible use in neuropathic pain management.
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This review evaluates trials of antidepressants for acute and chronic postsurgical pain. ⋯ There is currently insufficient evidence to support the clinical use of antidepressants-beyond controlled investigations-for treatment of acute, or prevention of chronic, postoperative pain. Multiple positive trials suggest the therapeutic potential of antidepressants, which need to be replicated. Other nontrial evidence suggests potential safety concerns of perioperative antidepressant use. Future studies are needed to better define the risk-benefit ratio of antidepressants in postoperative pain management. Higher-quality trials should optimize dosing, timing and duration of antidepressant treatment, trial size, patient selection, safety evaluation and reporting, procedure specificity, and assessment of movement-evoked pain relevant to postoperative functional recovery.