Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Differential effect of intravenous S-ketamine and fentanyl on atypical odontalgia and capsaicin-evoked pain.
Atypical odontalgia (AO) is an intraoral pain condition of currently unknown mechanisms. In 10 AO patients and 10 matched healthy controls, we examined the effect of intravenous infusion of an N-methyl-D-aspartate (NMDA) receptor antagonist S-ketamine and a mu-opioid agonist fentanyl on spontaneous AO pain and on an acute intraoral nociceptive input evoked by topical application of capsaicin. The drugs were administered in a randomized, placebo-controlled, cross-over manner. ⋯ No side-to-side differences in QST measures were found in AO patients. The present study demonstrates that AO is unlikely to be primarily due to a persistent afferent barrage from the peripheral region. Furthermore, in contrast to studies on various neuropathic pain conditions, fentanyl and S-ketamine in the present doses failed to attenuate AO pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash?--A preliminary RCT.
Patients with chronic whiplash associated disorders present with varied sensory, motor and psychological features. In this first instance it was questioned whether a multimodal program of physical therapies was an appropriate management to be broadly prescribed for these patients when it was known that some would have sensory features suggestive of a notable pain syndrome. A randomised controlled trial was conducted with 71 participants with persistent neck pain following a motor vehicle crash to explore this question. ⋯ Even with the presence of sensory hypersensitivity in 72.5% of subjects, both groups reported some relief of neck pain and disability (Neck Disability Index) and it was superior in the group receiving multimodal physiotherapy (p=0.04). Post-hoc observations however suggested that relief was marginal in the subgroup with both widespread mechanical and cold hyperalgesia. Further research is required to test the validity of this sub-group observation and to test the effect of the intervention in the long term.