Pain
-
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.
-
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.
-
Mitochondria are present at high concentration at the site of sensory transduction in the peripheral terminals of nociceptors. Because nerve growth factor (NGF), which induces nociceptor sensitization by acting on the high-affinity tropomyosin receptor kinase A (TrkA) receptor, also produces local recruitment of mitochondria in DRG neurons, we evaluated the role of mitochondria in NGF-induced mechanical hyperalgesia. ⋯ Disruption of microtubules, which are required for the trafficking and subcellular localization of mitochondria, also attenuated NGF-induced hyperalgesia. Our results suggest a contribution of mitochondrial localization and function to NGF-dependent pain syndromes.