The Clinical journal of pain
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Postherpetic neuralgia (PHN) is a neuropathic sequelae in 8% to 27% of individuals with prior varicella zoster virus infection and herpes zoster resulting in retrograde demyelination, neurotoxic reactive oxygen species levels, and proinflammatory cytokine activation of microglia. Pain management strategies are well documented, but not always effective. Laser therapy has shown utility in nerve injury-related pain disorders and was considered a potentially efficacious intervention. ⋯ Theoretically, laser therapy induced tissue changes in this case occurring at and below the skin surface altering inflammatory and excitatory peripheral mechanisms noted to take place in the PHN patient. Peripheral nociceptor firing must be brought back to normal thresholds to resolve such chronic neuropathic pain and inhibit the possible central sensitization component. Anti-inflammatory cytokines, growth factors, nitric oxide, adenosine triphosphate (ATP), and other mechanisms stimulated by laser therapy as noted in medical literature may be central to the favorable response seen in this patient. Controlled clinical trials of class 4 laser therapy in the PHN patient population with similar doses would be beneficial to determine if this is an effective treatment option in PHN.
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Controlled Clinical Trial
Suppression of Emotion Expression Mediates the Effects of Negative Affect on Pain Catastrophizing: A Cross-Sectional Analysis.
Negative affect is associated with individual differences in pain catastrophizing (PC). Research suggests that variations in emotion regulation may modify negative affect on PC. Using the process model of emotion regulation, this study examined the relationships of 2 emotion regulatory strategies, cognitive reappraisal and expressive suppression, with negative affect and PC. ⋯ These preliminary findings suggest that expressive suppression of emotion plays a mediating role in PC and subsequent pain adjustment outcomes. More research is needed to further examine other types of negative emotions and different emotion regulatory strategies used in chronic pain adjustment.
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Case Reports
An Alternative to Traditional Mirror Therapy: Illusory Touch Can Reduce Phantom Pain When Illusory Movement Does Not.
There is evidence that amputation leads to cortical reorganization, and it has been suggested that phantom pain might be related to a consequently emerging incongruence of motor intention, somatosensation and visual feedback. One therapeutic approach that has the potential to temporarily resolve this visuo-proprioceptive dissociation is mirror therapy, during which amputees typically move their intact limb while observing its reflection in a mirror, which in turn evokes the illusory perception of movement of their phantom limb. However, while the action of moving the phantom relieves pain for some patients, it can actually increase cramping sensations in others. In the current study we therefore implemented an alternative version of the mirror therapy involving a visuotactile illusion, to explore whether it might be effective with amputees for whom the action of moving the phantom increases phantom pain. ⋯ Albeit preliminary, our results represent an encouraging finding of possible future clinical relevance, and indicate that the type of multisensory stimulation that most efficiently reduces phantom pain can vary in different sub-populations of amputees.
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Comparative Study
Hypogonadism in Men With Chronic Pain Linked to the Use of Long-acting Rather Than Short-acting Opioids.
There is a need to elucidate the variables associated with testosterone suppression among men on daily opioid therapy for chronic pain. ⋯ Among a contemporary sample of men receiving chronic daily opioids, we found a high prevalence of hypogonadism associated with duration of action, but not with total daily dose of the opioid.
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Pain is a symptom reported in 50% to 70% of primary care visits and negatively impacts both physical and psychological functioning. People at risk of receiving inadequate management of pain include the indigent and people of color. The purpose of this exploratory, descriptive, cross-sectional study was to describe the prevalence of pain and its relation to functional status, depressive symptoms, perception of control over pain and coping in an urban, primary care clinic for indigent adults. ⋯ Pain levels were reported as high and affected psychological and physical functioning. This study was unique in the high percentage of African American participants and being conducted in a primary care clinic for indigent adults. Greater understanding of this population's pain will assist clinicians to assess pain comprehensively, provide education, and make treatment decisions for these patients.