Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain.
The utility of randomised, double-blind, controlled, comparative local anaesthetic blocks for the diagnosis of cervical, zygapophysial joint pain was studied in 47 patients with chronic neck pain following whiplash injury. Each patient was investigated with radiologically controlled blocks of the medial branches of the cervical, dorsal rami to anaesthetise the target cervical, zygapophysial joint. The blocks were performed using either lignocaine or bupivacaine, randomly allocated, and the patients' responses were assessed in a double-blind fashion. ⋯ The durations of pain relief obtained from the anaesthetics were consistent with the known characteristics of these drugs with bupivacaine lasting significantly longer than lignocaine (P = 0.0003). A subgroup of 13 patients were identified with unexpected, prolonged responses to one or both of the anaesthetics. Comparative, diagnostic blocks are a valid technique in the identification of painful zygapophysial joints, and constitute an implementable alternative to normal saline controls.
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A 2-part study in which memory for everyday pains was investigated is reported. The first part compared ratings of vivid, 'flashbulb' memories of pain and non-pain events. Memories of pain events were rated as having been more surprising, having induced more negative emotional change, and having provoked greater change in ongoing activity than their non-pain event counterparts. ⋯ It is concluded that memories of painful events are readily retrievable and that the memory for a pain event, the sensory and affective qualities of pain experience and somatosensory component of pain are separated in their encoding and/or retrieval. The possible mechanisms whereby pain memories are encoded and retrieved are discussed. The clinical implications of the data concerning how judgements of past pain are made and the possible role of memory in coping are also noted.