The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
Interaction of fentanyl and buprenorphine in an experimental model of pain and central sensitization in human volunteers.
: There is controversy about combining opioids with different receptor affinities. We assessed the analgesic and antihyperalgesic effects of the μ-agonist fentanyl and the partial μ-agonist/κ-antagonist buprenorphine in a human pain model, when given alone or in combination. ⋯ : For the doses administered in this study, buprenorphine and fentanyl showed an additive interaction.
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Randomized Controlled Trial
Modification of experimental, lower limb ischemic pain with transcutaneous electrical nerve stimulation.
Transcutaneous electrical nerve stimulation (TENS) has been shown to be effective for the reduction of experimentally induced ischemic pain in the upper limb. No studies have been published on the effects of TENS for lower limb ischemic pain. ⋯ HF-TENS had stronger modifying effects on several aspects of laboratory-induced ischemic pain than did P-TENS. HF-TENS delayed the onset of pain, reduced pain levels, and delayed the onset of extreme pain over a period of several minutes.
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Functional reorganization in the somatosensory network after peripheral nerve lesions has been suspected to modify the clinical expression of symptoms. However, no conclusive evidence exists to support this notion. We addressed this question by investigating the topographic distribution of the subjective sensory report in various chronic human mononeuropathies. ⋯ In human neuropathies, the projected sensory symptoms are restricted to the innervation territories of the affected nerves, with no extraterritorial spread. Thus, the somatosensory localization function remains accurate, despite the central reorganization that presumably occurs after nerve injury. We conclude that reorganization of the sensory connections within the central nervous system after peripheral nerve injury in humans is a clinically silent adaptive phenomenon.
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Randomized Controlled Trial
Pain coping but not readiness to change is associated with pretreatment pain-related functioning.
The purpose of the present study was to determine if readiness to use adaptive and avoid maladaptive pain-coping skills before initiation of psychosocial treatment for chronic pain was related to reports of present coping, and whether those variables, together or separately, explained variance in pain, pain interference, and symptoms of depression. ⋯ Overall, the results indicate that adaptive coping is associated with better pain-related functioning and maladaptive coping is associated with poorer functioning, whereas readiness appears to not play a significant role in patient functioning before psychosocial pain treatment. The findings support the discriminant validity of the coping and readiness measures and inform treatment conceptualization.
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Comparative Study
Comparison of a novel direct measure of rapid pain intensity change to traditional serial 100 mm VAS measurement of pain intensity.
Key diagnostic decisions often turn on measurement of change in pain intensity after diagnostic anesthetic blocks. This study aimed to introduce a new direct measure pain intensity change and compare it with percent change as calculated from the traditional preprocedure and postprocedure pain visual analog scales. ⋯ The 2 methods are not interchangeable. The new method measures the pain intensity change dimension directly, whereas the traditional method estimates change indirectly by calculation. Face validity is better served by adopting the new method for decisions regarding whether a patient is a "responder" or "nonresponder" to diagnostic blocks. The traditional method should be retained for estimation of pain intensity preprocedure and the duration of pain relief postprocedure.