The Clinical journal of pain
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To examine the development of fear avoidance behaviours following whiplash injury using two different measures of fear avoidance, the Pictorial Fear of Activities Scale-Cervical (PFActS-C), and the Tampa Scale of Kinesiophobia (TSK-17). Secondarily we assessed the capacity of these measures to predict recovery status at long term follow up and initial cervical range of movement (ROM). ⋯ Fear avoidance beliefs and behaviours develop quickly following whiplash injury and influence both the initial physical presentation and long term outcome of patients with WAD. The PFActS-C may provide a measure of fear of movement which is more specific to the cervical spine in patients with WAD in comparison to the TSK-17.
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To explore the role of neuropathy in persistent pain after thoracotomy, combining a clinical follow-up and a psychophysical examination of the operated area. ⋯ Peripheral neuropathy is common after thoracotomy, with variant characteristics, ranging from subclinical disturbances to severe pain. The process seems to develop between the discharge from hospital and the sixth week after thoracotomy.
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This study was designed to investigate whether the PainDETECT Questionnaire (PDQ) classification was predictive of outcomes at 3 and 12 months follow-up in low back pain (LBP) patients with associated leg pain. Identification of clinically important subgroups and targeted treatment is believed to be important in LBP care. The PD-Q is designed to classify whether a person has neuropathic pain, based on their self-reported pain characteristics. However, it is unknown whether this classification is a prognostic factor or predicts treatment response. ⋯ The PDQ classification was a prognostic factor but was not predictive of response to treatment that was not targeted to neuropathic pain. Further studies should investigate whether PD-Q groups are predictive of treatment response when targeted to neuropathic pain.
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Spinal cord stimulation (SCS) is the most commonly used implantable neurostimulation modality for management of pain syndromes. We present a patient with history of right facial pain successfully treated for refractory angina with SCS and had coincident near resolution of facial pain. ⋯ SCS is one of the most promising treatment options for refractory angina. Numerous randomized, controlled trials have demonstrated efficacy in increasing exercise duration and time to angina, decreasing number of angina attacks, sublingual nitrate consumption, and number of ischemic episodes. Reductions in pain, sympathetic tone, and myocardial oxygen demand as well as improvement in coronary microcirculatory blood flow have all been proposed as beneficial outcomes of stimulation. AFP is a poorly understood condition, often without etiology, and most commonly treated symptomatically. The resolution of our patient's AFP is secondary to unclear mechanism(s). We propose SCS may have altered central processing or spinal trigeminal nucleus fibers; additionally, the pain may have been sympathetically mediated and altered by SCS.
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Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash-associated disorders (WADs). Pressure pain thresholds (PPTs) close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. PPTs over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with WAD. ⋯ The competing explanations for these findings are that either PPTs provide a poor marker of peripheral and central sensitivity or that these processes are only weakly related to the day-to-day pain experienced by patients with WAD. The latter explanation is supported by the confounding effect of psychological factors on pain score.