Pain
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Comment Letter Case Reports
Intrathecal S(+)-ketamine in refractory neuropathic cancer pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Loss of expectation-related mechanisms in Alzheimer's disease makes analgesic therapies less effective.
Expectation/placebo-related mechanisms and specific effects of therapies show additive effects, such that a therapy is less effective if the placebo component is absent. So far, the placebo component has been disrupted experimentally by using covert administrations of treatments. Here, we show for the first time that disruption of expectation/placebo-related analgesic mechanisms may occur in a clinical condition, Alzheimer's disease (AD). ⋯ We also found that the disruption of the placebo component occurred when reduced connectivity of the prefrontal lobes with the rest of the brain was present. Remarkably, the loss of these placebo-related mechanisms reduced treatment efficacy, such that a dose increase was necessary to produce adequate analgesia. These findings highlight the active role of cognition and prefrontal lobes in the therapeutic outcome and underscore the need of considering a possible revision of the therapeutic approach in Alzheimer patients in order to compensate for the loss of the endogenous expectation and placebo mechanisms.
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Comparative Study
Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory.
The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39-58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. ⋯ Internal consistency reliability was excellent, ranging from .86 to .91. Validity was supported by significant correlations of child- and parent-report FDI scores with measures of school-related disability, pain, and somatic symptoms. Study results add to a growing body of empirical literature supporting the reliability and validity of the FDI for functional assessment of pediatric patients with chronic pain.
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Comparative Study
Localization of touch versus heat pain in the human hand: a dissociative effect of temporal parameters on discriminative capacity and decision strategy.
We studied the influence of temporal parameters on localization of monofilament-evoked touch versus thulium laser-induced and C fiber-mediated pain in human subjects. Stimuli were applied at interstimulus intervals (ISIs) varying from 1 to 9 s to determine discrimination between successive stimulus sites in the palmar skin. Localization threshold was about two times higher for heat pain than touch. ⋯ Additionally, temporal factors dissociatively influence the response strategy in the tactile versus pain localization task with the prolongation of the ISI from 1 to 9 s. Due to this strategy change, localization threshold for touch remains constant at prolonged ISIs, in spite of a decrease in discriminative capacity. In a cutaneous localization task, the subject's accuracy and response strategy vary with the modality and temporal parameters of sequential test stimulation.
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Randomized Controlled Trial Comparative Study
Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience.
Chronic subthreshold stimulation of the contralateral precentral gyrus is used in patients with intractable neuropathic pain for more than 15 years. The aim of this study was to analyse retrospectively our own patient group with long term follow-up of 10 years. Seventeen patients with chronic neuropathic pain were treated with contralateral epidural stimulation electrodes. ⋯ Double-blind testing can identify non-responders. Patients with TNP profit more than patients with PSP. The positive effect can last for ten years in long-term follow-up.