Pain
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Review Meta Analysis
Health care practitioners' attitudes and beliefs about low back pain: a systematic search and critical review of available measurement tools.
The attitudes and beliefs that health care practitioners (HCPs) hold about back pain have been shown to affect the advice they provide to patients seeking healthcare. In order to develop a questionnaire for a national survey of attitudes, beliefs and practice behaviour of HCPs about back pain, a systematic review of available measurement tools was undertaken. Measurement tools were identified from a systematic search of databases (Medline, Embase, CINAHL, Psychinfo, AMED and British Nursing Index) in the English language for papers published from January 1990 to October 2006. ⋯ PT have undergone the most thorough testing to date, but gaps in the properties of all the tools remain, particularly test-retest reliability and responsiveness. This review identified only five tools and demonstrated limited reporting of their validity and reliability. Further development and testing of existing tools should be a priority to ensure they are robust and valid measures of attitudes and beliefs of HCPs about back pain.
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Randomized Controlled Trial
The effects of the TRPV1 antagonist SB-705498 on TRPV1 receptor-mediated activity and inflammatory hyperalgesia in humans.
TRPV1 is a cation channel activated by a range of noxious stimuli and highly expressed in nociceptive fibres. TRPV1 receptors are involved in pain and sensitisation associated with tissue injury and inflammation; hence, TRPV1 antagonists are potentially useful for the treatment of such pain states. SB-705498 is a potent, selective and orally bioavailable TRPV1 antagonist with demonstrated efficacy in a number of preclinical pain models. ⋯ The magnitude of the pharmacodynamic effects of SB-705498 appeared to be related to plasma concentration. These results indicate that SB-705498, at a clinically safe and well-tolerated dose, has target-specific pharmacodynamic activity in humans. These data provide the first clinical evidence that a TRPV1 antagonist may alleviate pain and hyperalgesia associated with inflammation and tissue injury.
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Postherpetic neuralgia (PHN) is the most frequent complication of herpes zoster (HZ) and difficult to treat. Timely identification of high-risk HZ-patients enables physicians to focus on PHN prevention. To assess which simple to measure factors are independent predictors of PHN, and whether psychosocial and serological/virological parameters have additional predictive value, a prospective cohort study in primary care was conducted. ⋯ Of the five PCL scores, only factor V ('trust in healthcare') was an additional predictor (OR=1.01 per unit), though it increased the ROC area with only 0.01 to 0.78. The Spielberger's anxiety scores and serological and virological variables were no additional predictors. Thus, four simple variables can help physicians to timely identify elderly HZ-patients at risk of PHN.
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There are few studies on coping with fibromyalgia (FM). The aim of the present study was to assess the usefulness of a Spanish version of the Chronic Pain Coping Inventory-42 (CPCI-42) in patients with FM. A random sample (N=402) of patients with FM was obtained from the Fibromyalgia Association of Aragon, Spain. ⋯ Task persistence correlated with illness-focused strategies and negative outcomes, indicating that it should be included in the illness-focused group. However, other wellness-focused strategies, including relaxation, exercise, and coping self-statements, were correlated with each other, negatively correlated with depression, and positively correlated with quality of life. Future research directions and clinical implications are discussed.
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It has become increasingly apparent that women suffer a disproportionate amount of pain during their lifetime compared to men. Over the past 15 years, a growing number of studies have suggested a variety of causes for this sex difference, from cellular to psychosocial levels of analysis. From a biological perspective, sexual differentiation of pain appears to occur similarly to sexual differentiation of other phenomena: it results in large part from organizational and activational effects of gonadal steroid hormones. ⋯ For clinical pain, the review is limited to a few syndromes for which there is considerable evidence for estrogenic involvement: migraine, temporomandibular disorder (TMD) and arthritis. Because estrogens can modulate the function of the nervous, immune, skeletal, and cardiovascular systems, estrogenic modulation of pain is an exceedingly complex, multi-faceted phenomenon, with estrogens producing both pro- and antinociceptive effects that depend on the extent to which each of these systems of the body is involved in a particular type of pain. Forging a more complete understanding of the myriad ways that estrogens can ameliorate vs. facilitate pain will enable us to better prevent and treat pain in both women and men.