Pain
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Case Reports
Intrathecal morphine and clonidine in the management of spinal cord injury pain: a case report.
Neuropathic pain following spinal cord injury (SCI) can be difficult to manage using currently available pain management techniques. We describe a case of chronic pain following SCI which failed to respond to a variety of approaches including intrathecal administration of morphine. Use of clonidine in addition to the morphine resulted in a marked decrease in pain. The use of intrathecal clonidine with or without opioids may present an effective alternative in the management of intractable SCI pain and other forms of neuropathic pain.
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Clinical Trial
Catastrophizing, depression and the sensory, affective and evaluative aspects of chronic pain.
Research has shown that catastrophizing is related to increased depression and chronic pain. However, some researchers have questioned the utility of catastrophizing as a separate construct, suggesting that it may just be a symptom of depression. The present investigation used path analysis to determine if catastrophizing was related to McGill Pain Questionnaire scores when controlling for depression as assessed by the Beck Depression Inventory in a group of 85 chronic pain patients. ⋯ The resulting path coefficients appear to support these predictions. The results suggest that catastrophizing is a separate construct which may impact on pain perception and treatment. The data also provide some support for Field's neurobiological model of the relationship between depression and pain.
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The rat foot withdrawal response to noxious radiant heat has been used as a model of nociception that is particularly useful for measurements of unilateral changes in nociceptive responses. The purpose of these studies was to characterize the foot withdrawal response to graded rates of noxious skin heating. Response latencies and both surface and subsurface temperatures produced by 6 different intensities of radiant heat were measured to determine whether response latency is an appropriate measure of nociceptive threshold. ⋯ These results and published reports of nociceptive afferent recordings which used similar skin heating parameters, indicate that nociceptive foot withdrawal responses occur at about the same skin temperature as the activation of nociceptors. These results also indicate that since constant intensity heating produces linear increases in the subsurface temperature, then response latency can be used as an accurate measure of changes in nociceptive threshold produced by drug treatments. These observations lead to the conclusion that the foot withdrawal response latency is a valid and useful measure of nociceptive threshold in rodents.
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Comparative Study
On the absence of correlation between responses to noxious heat, cold, electrical and ischemic stimulation.
Is a person's response to one noxious stimulus similar to his/her responses to other noxious stimuli? This long-investigated topic in pain research has provided inconclusive results. In the present study, 2 samples were studied: one using 60 healthy volunteers and the other using 29 patients with coronary artery disease. Results showed near-zero correlations between measures of heat, cold, ischemic, and electrical laboratory pains, as well as between these laboratory pains and an idiopathic pain, the latency to exercise-induced angina in the patients. ⋯ Reliability analyses indicated retest correlations on the order of 0.60 for these measures, indicating that the lack of correlation between modalities was not due to unreliability within a measure. These studies fail to demonstrate alternate-forms reliability among these tests, and also fail to support the notion that a person can be characterized as generally stoical or generally complaining to any painful stimulus. In practice, this implies that a battery of tests should generally be used to assess pain sensitivity and also that assessments of one pain modality are not generally useful for making inferences about another.