The Clinical journal of pain
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Randomized Controlled Trial Multicenter Study
Acupuncture in migraine: investigation of autonomic effects.
A dysregulation of the autonomic nervous system is discussed as a pathogenetic factor in migraine. As acupuncture has been shown to exhibit considerable autonomic effects, we tested whether the clinical effects of acupuncture in migraine prophylaxis are mediated by changes of the autonomic regulation. ⋯ The data indicate, that VA and SA acupuncture might have a beneficial influence on the autonomic nervous system in migraineurs with a reduction of the LF power of HRV related to the clinical effect. This might be due to a reduction of sympathetic nerve activity. VA and SA induce different effects on the high-frequency component of HRV, which seem, however, not to be relevant for the clinical outcome in migraine.
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To explore clinical findings in men with chronic pain after falanga torture as compared with controls, and to try to understand the nature of the pain mechanisms responsible. ⋯ We found clear clinical signs of nerve injury in the feet. The sensory findings indicated 2 neuropathic pain mechanisms, one dominated by a peripheral pain generator and other by irritative phenomena (dysesthesia, allodynia), indicating central sensitization. It is reasonable to assume that these changes are due to the falanga exposure. A nociceptive contribution cannot be excluded. It is important to perform an individual diagnostic analysis to facilitate adequate treatment.
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Randomized Controlled Trial
Acupuncture in migraine prevention: a randomized sham controlled study with 6-months posttreatment follow-up.
To assess the efficacy of acupuncture in migraine prophylaxis. ⋯ Individualized treatment based on traditional Chinese medicine plays a role in preventing migraine attacks. Nevertheless, sham acupuncture had similar effects. Major conclusions were limited by the small sample sizes however the observed trends may contribute to design future trials.
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Review Case Reports
Buprenorphine: new tricks with an old molecule for pain management.
Sublingual buphrenorphine is a unique opioid medication based on its pharmacokinetics and pharmacodynamic properties. It may be used "on label" as an alternative choice to methadone for the treatment of opioid addiction or "off-label" for the treatment of both acute and chronic pain. Because of high mu receptor affinity and resultant blockade, it has been suggested that this might interfere with the management of moderate to severe pain in patients on opioid agonist treatment. The following article will offer strategies and approaches to address some of these real and perceived challenges.
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The inflammatory cytokine tumor necrosis factor-alpha has been shown to play a pivotal role in the development and maintenance of a wide variety of neuropathic pain conditions. Not surprisingly, systemic treatment with drugs that block tumor necrosis factor have been demonstrated to alleviate pain and pain-related behaviors in clinical and preclinical studies, respectively. Despite evidence that local administration of this drug class may be more efficacious than systemic administration, there are no clinical studies to support or refute this assertion. ⋯ These findings support preclinical evidence that the local administration of tumor necrosis factor inhibitors may prove to be a safe and effective treatment for challenging pain conditions.