Pain
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Meta Analysis
Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies.
Both persistent pain and cognitive decline prevalence increase with advancing age and are associated with functional decline. However, the association of pain and cognitive decline has not been evaluated yet by a systematic assessment of longitudinal studies. We aimed to assess the association of persistent pain as a risk factor for cognitive decline in community older adults, using data from longitudinal studies in a systematic review and meta-analysis. ⋯ Persistent pain at baseline was not associated with the development of cognitive decline during the follow-up (pooled RR = 1.05, 95% confidence interval = 0.92-1.21). In sensitivity analyses, only length of follow-up time ≤4.5 years was associated with a higher risk of cognitive impairment (pooled RR = 1.19, 95% confidence interval = 1.10-1.28). Persistent pain was not associated with the incidence of cognitive decline.
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The opioid epidemic has plagued the United States with high levels of abuse and poor quality of life for chronic pain patients requiring continuous use of opioids. New drug discovery efforts have been implemented to mitigate this epidemic; however, new medications are still limited by low efficacy and/or high side effect and abuse potential. Intermittent fasting (IF) has recently been shown to improve a variety of pathological states, including stroke and neuroinflammation. ⋯ Seeking a mechanism for these improvements, we found that the mu-opioid receptor showed enhanced efficacy and reduced tolerance in the spinal cord and periaqueductal gray, respectively, from IF mice using a S-GTPγS coupling assay. These improvements in receptor function were not due to changes in mu-opioid receptor protein expression. These data suggest that a daily IF diet may improve the therapeutic index of acute and chronic opioid therapies for pain patients in the clinic, providing a novel tool to improve patient therapy and reduce potential abuse.
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This article is the first to present the Graphical Index of Pain (GRIP), a new user-friendly web-based method for high-throughput screening of pain. The long-term goal of the method is to improve global standardization of pain measurements. GRIP consists of a hierarchical body map with 10 first-tier body regions, and a second tier with multiple pain loci (167 among men, 168 among women), which provides detailed information about pain location and distribution. ⋯ Pain intensity at first-tier regions and pain location and distribution at second-tier regions are in this article presented by sex-stratified customized heat maps showing large sex difference. Mean time to mark the first- and second-tier regions was 74 seconds. In conclusion, GRIP allows for high-resolution assessment and presentation of pain location and distribution with minimal use of time.