The Clinical journal of pain
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Deep cross-friction pressure with a finger or an elbow in the proximal gluteal region causes a sciaticlike pain along the side of the thigh and the leg as a clinical presence of referred pain (RP) in patients with nonspecific low back pain (LBP). This study investigated the reliability and discriminative ability of experimentally provoked RP as a result of deep cross-friction with the aid of a Fischer algometer. The new clinical examination method measures the provoked RP threshold resulting in an outcome, expressed in kg/cm2. ⋯ This clinical study support the reliability and discriminative ability of a new method of experimentally provoked RP, using deep cross-friction pressure with the aid of a Fischer algometer in patients with LBP. The experimentally "provoked referred pain threshold" (PPT-RP) values lower than 6 kg/cm correspond clinically with the presence of a referred muscle pain area in the thigh and/or the leg. Further studies of a similar kind are nevertheless needed to confirm those conclusions and to assess the responsiveness of the provoked RP measurements in different treatment follow-up periods.
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The International Association for the Study of Pain defines allodynia as pain due to a stimulus that does not normally provoke pain and hyperalgesia as an increased response to a stimulus, which is normally painful. However, does "normally painful" mean "any stimulation of nociceptors" or "the subjective pain response?" We argue that "normally painful" should not mean "any stimulation of nociceptors," as Von Frey monofilaments may evoke a pricking sensation--which implies the involvement of nociceptors--without necessarily leading to a subjective pain perception. In this paper, we propose that the diagnosis of either allodynia or hyperalgesia should be based on the patient's report, that is, painful versus not painful, rather than on the (sub) type of afferent fiber involved.
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Randomized Controlled Trial
Multidisciplinary rehabilitation treatment of patients with chronic low back pain: a prognostic model for its outcome.
(1) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and (2) to explore the value of potentially prognostic factors further. ⋯ The results of this study do not support the construction of a clinical prediction model. Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors.
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The Depression, Anxiety, and Positive Outlook Scale (DAPOS) was designed to measure mood in pain populations without contamination from somatic items. ⋯ Responsiveness of the DAPOS should be reassessed in treatment targeting mood change explicitly. The DAPOS scales show acceptable clinimetric and psychometric properties, and add a measurement of positive outlook to create a more balanced indication of mood in pain patients.
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Randomized Controlled Trial
Ketamine does not reduce postoperative morphine consumption after tonsillectomy in children.
Tonsillectomy is one of the most frequently performed operations in children and frequently associated with moderate-to-severe pain. ⋯ The addition of ketamine 0.25 mg/kg at induction of anesthesia did not decrease postoperative morphine consumption in children undergoing tonsillectomy.