Pain
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The trapezius muscle often develops pain as the result of repetitive and stressful work tasks although it is unclear to what extent this pain is due to alterations in muscle concentrations of algesic/nociceptive substances. Twenty women with chronic neck- and shoulder pain (TM) whose work required highly repetitive work tasks and 20 pain-free female colleagues (CON) were studied during and after a full 8-hour workday. We collected microdialysates from their dominant/most painful trapezius muscle; concentrations of serotonin, glutamate, lactate, pyruvate, potassium, bradykinin, and cytokines and blood flow were determined. ⋯ No differences in EMG, task exposure level, mental stress, or urine-cortisol in the groups were found. These findings support the idea that peripheral nociceptive processes are activated in occupationally active subjects, who are diagnosed with trapezius myalgia. In contrast, no sign of low blood flow or increased stress or muscle activity markers were found in TM.
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A few experimental observations have suggested that diffuse noxious inhibitory control (DNIC)-type inhibition acts preferentially on the pain system if this is in a sensitised state, e.g. after slow temporal summation (wind-up). However, firm evidence is still missing. Furthermore, sex-related factors, which seem to affect temporal summation as well as DNIC effects, might thus also modulate the interaction of these two processes. ⋯ Sex differences were not observed for temporal summation, DNIC inhibition or for the interaction of the two processes, although women exhibited significantly lower pressure pain thresholds and higher ratings for the tonic heat stimuli. In conclusion, DNIC-type inhibition apparently does not preferentially act on a sensitised pain system after slow temporal summation. Considering the sex of the subjects does not change this insight.
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Patients who continue to suffer from lasting and severely disabling angina pectoris despite optimum drug treatment and who are not suitable candidates for invasive procedures, suffer from a condition referred to as "chronic refractory angina pectoris". Based on the available data, spinal cord stimulation, SCS, is considered as the first-line additional treatment for these patients by the European Society of Cardiology. However, no systematic review of randomised controlled studies has yet been published. ⋯ There is also a strong evidence that SCS can improve the functional status of these patients, as illustrated by the improved exercise time on treadmill or longer walking distance without angina. In addition, SCS does not seem to have any negative effects on mortality in these patients (limited scientific evidence). The complication rate was found to be acceptable.