Pain
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Cavernous hemangiomas (cavernomas) of the spinal cord are rare congenital malformations that comprise less than 5% of all intramedullary lesions. Despite this rarity, we describe the third case of central neuropathic itch associated with intramedullary cavernoma. Since fewer than 10 cases of central spinal itch from all causes have been published, this concurrence suggests the possibility of a specific association. ⋯ Such rats develop unilateral dermatomal hyperalgesia and self-injurious scratching and biting (autotomy). Although this pathological grooming is currently interpreted as a response to chronic pain, we propose that it more likely models scratching provoked by central neuropathic itch, as seen in our patient and others. Study of quisqualate-injected rats may provide leads towards new treatments for neuropathic itch.
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Review Comparative Study
Opioids in chronic non-cancer pain: systematic review of efficacy and safety.
Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in chronic non-cancer pain. ⋯ The short-term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions. However, only a minority of patients in these studies went on to long-term management with opioids. The small number of selected patients and the short follow-ups do not allow conclusions concerning problems such as tolerance and addiction.
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Comparative Study
Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain.
Patients with chronic low back pain (LBP) frequently demonstrate high scores for fear-avoidance beliefs and distress. We need better knowledge about fear-avoidance beliefs and distress in early stages of LBP. The objectives of this study were to compare the level of fear-avoidance beliefs and distress in patients with acute LBP to patients with chronic LBP, and to assess the relationship of fear-avoidance beliefs and distress to disability in acute and chronic LBP. ⋯ In addition, several of the pain and clinical variables were significantly associated with the Oswestry Disability Index and fingertip-floor distance was associated with work loss. In conclusion, fear-avoidance beliefs and distress influence pain-related disability both in early acute and long-term chronic LBP. The results replicate previous reports on the association between pain experience, fear-avoidance beliefs, distress, and disability in chronic LBP, and extend the findings to patients at an early stage of acute LBP.
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Comparative Study
Social networks and pain interference with daily activities in middle and old age.
Social networks have emerged as important in the development and progression of disability in aging cohorts. We have previously reported that pain that interferes with daily activities is common and increases incrementally from middle age into later life. The current study has investigated whether pain interference in this age group is related to social network characteristics. 5215 community-dwelling adults aged 50 years and over participating in the North Staffordshire Osteoarthritis Project (NorStOP) and identified as currently experiencing pain formed the sample for the present analysis. ⋯ The associations with close friends and children were reduced but remained significant after adjusting for sociodemographic factors. The association with close friends became non-significant after adjusting for depression suggesting this may form part of the pathway linking close friends networks and pain interference. Pain-related interference shows similar associations with social networks as all-cause disability and may benefit similarly from a public health perspective.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.
The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. ⋯ However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition.