Pain
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Opioids are widely prescribed for chronic pain, including neuropathic pain despite growing evidence of long-term harm. Previous preclinical studies have documented exacerbation of nociceptive hypersensitivity, including that induced by peripheral nerve injury, by morphine. The present series of behavioral studies sought to replicate and extend our prior research, which demonstrated a multi-month exacerbation of nociceptive hypersensitivity by a 5-day course of morphine initiated 10 days after nerve injury. ⋯ Furthermore, enduring exacerbation of nociceptive hypersensitivity is also observed when the same dosing regimen for either morphine, fentanyl, or oxycodone begins 1 month after nerve injury. Lastly, a striking result from these studies is that no such exacerbation of nociceptive hypersensitivity occurs when either morphine, fentanyl, or oxycodone dosing begins at the time of nerve injury. These results extend our previous findings that morphine exacerbates nociceptive hypersensitivity to the clinically relevant opioids fentanyl and oxycodone when administered after the development of nociceptive hypersensitivity, while also providing possible clinically-relevant insight into when these opioids can be safely administered and not exacerbate neuropathic pain.
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In this randomized clinical trial, we examined whether the effect of true acupuncture can be differentiated from sham acupuncture (pain and functionality) by analyzing quantitative sensory testing (QST) profiles in chronic pain participants. We recruited 254 healthy or chronic back and neck pain participants. Healthy subjects were included to control for a possible effect of acupuncture on baseline QST changes. ⋯ We found no QST profile changes among three groups (P = 0.533 and P = 0.549, Likelihood-ratio tests) in either healthy or chronic pain participants. In chronic back and neck pain participants, true acupuncture reduced pain [visit 4: DIM (difference in mean) = -0.8, 95% CI: -1.4 to -0.1, adjusted P = 0.168; visit 7: DIM = -1.0, 95% CI: -1.7 to -0.3, adjusted P = 0.021) and improved functional status including physical functioning (DIM = 14.21, 95% CI: 5.84 to 22.58, adjusted P = 0.003) and energy/fatigue (DIM = 12.28, 95% CI: 3.46 to 21.11, adjusted P = 0.021) as compared to routine care. Our results indicate that QST was not helpful to differentiate between true acupuncture and sham acupuncture (primary outcome) in this study, although true acupuncture reduced pain and improved functionality (secondary outcomes) when compared with routine care.
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Articulating positive expectations of analgesia efficacy preoperatively improves postoperative pain scores and analgesia satisfaction.
pearl -
Chronic pain affects 1 in 5 people and has been shown to disrupt attention. Here, we investigated whether pain disrupts everyday decision making. In study 1, 1322 participants completed 2 tasks online: a shopping-decisions task and a measure of decision outcomes over the previous 10 years. ⋯ In study 2, 44 healthy participants completed the shopping-decisions task with and without experimentally induced pain. Participants made more errors while in pain than while pain-free. We suggest that the disruptive effect of pain on attending translates into poorer decisions in more complex and ecologically valid contexts, that the effect is causal, and that the consequences are not only attentional but also financial.