Pain
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Multicenter Study
Multinomial logistic regression analysis for differentiating 3 treatment outcome trajectory groups for headache-associated disability.
Growth mixture modeling (GMM) identified latent groups based on treatment outcome trajectories of headache disability measures in patients in headache subspecialty treatment clinics. Using a longitudinal design, 219 patients in headache subspecialty clinics in 4 large cities throughout Ohio provided data on their headache disability at pretreatment and 3 follow-up assessments. ⋯ Three-fourths of patients who initiated treatment with elevated disability levels did not report reductions in disability after 5 months of treatment with new preventive pharmacotherapies. Preventive headache agents may be most efficacious for patients with moderate levels of disability and for patients with high disability levels who attend all treatment appointments.
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Clinical studies have revealed that up to 92% of major depressed patients report pain complaints such as back or abdominal pain. Furthermore, patients suffering from depression exhibit increased superficial pain thresholds and decreased ischemic (deep) pain thresholds during experimental pain testing in comparison to healthy controls. Here, we aimed to investigate a putative role of Aδ- and C-fibre activation in altered pain perception in the disease. ⋯ Thus, Aδ-LEP might reflect the physiological correlate of the augmented superficial pain thresholds during depression. On the contrary, the C-fibre component mediates the facets of pain processing, outlasting the stimulation period, and has been shown to be exaggerated in chronic pain states. Therefore, the functional over-representation of the C-fibre component found in our study might be a possible link between depression and associated pain complaints.
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Chronic opioid exposure is known to produce neuroplastic changes in animals; however, it is not known if opioids used over short periods of time and at analgesic dosages can similarly change brain structure in humans. In this longitudinal, magnetic resonance imaging study, 10 individuals with chronic low back pain were administered oral morphine daily for 1 month. High-resolution anatomical images of the brain were acquired immediately before and after the morphine administration period. ⋯ The results add to a growing body of literature showing that opioid exposure causes structural and functional changes in reward- and affect-processing circuitry. Morphologic changes occur rapidly in humans during new exposure to prescription opioid analgesics. Further research is needed to determine the clinical impact of those opioid-induced gray matter changes.
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Comparative Study
A comparison of pain measures in newborn infants after cardiac surgery.
Accurate pain assessment tools to evaluate pain in critically ill neonates in the postoperative period are lacking. Therefore, we compared a number of potentially useful indices of pain in critically ill neonates following cardiac surgery. Eighty-one full-term infants were studied during the first 48 postoperative hours and the following indices were measured: heart rate, mean arterial blood pressure, heart-rate variability, urinary and plasma cortisol, and 4 composite pain measurement scales: Children's and Infants' Postoperative Pain Scale (CHIPPS), CRIES, COMFORT, and Premature Infant Pain Profile (PIPP). ⋯ The factor structure of the COMFORT score revealed that both behavioural and physiological variables account for a significant proportion of the variance (45% and 15%, respectively; P<0.001). Plasma concentrations of cortisol increased postoperatively but urinary cortisol excretion did not change significantly. Of the pain indices studied, the COMFORT score performed best, with both behavioural and physiological components providing significant contributions.
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Pain after brachial plexus avulsion (BPA) is generally characterized by 2 main different components: paroxysmal (electrical shooting-like) pain, and continuous (burning) pain. Dorsal root entry zone (DREZ) lesioning, namely, the microsurgical DREZotomy (MDT) used in our practice, has proved to be a worthwhile neurosurgical treatment for this indication. However, according to previous studies, the method does not seem to demonstrate as good effectiveness in patients in whom the continuous background of pain was predominant as in patients with the paroxysmal component predominating. ⋯ Kaplan-Meier prediction of lasting global pain control at 120 months of follow-up was calculated at 41.1%. Comparison of the 2 corresponding Kaplan-Meier curves at long term, namely, pain control in 76.2% for the paroxysmal component and in 43.1% for the continuous component, showed a statistically significant difference (P=.038). Hypotheses for this relative differential effect are discussed.